先天性胆总管囊肿与胆管癌

先天性胆总管囊肿(choledochal cyst)又名先天性胆管扩张症,表现为肝外胆管或肝内胆管的囊性扩张或两者并存.女性与男性比例大约为3～4 : 1.Vater和Ezler于1973年最早发现解剖学上的异常,1852年Douglas首次报道临床病例,Alonso-Lej在1959年作了系统的临床和解剖学上的详细报道.     

细胞凋亡与增殖在先天性胆总管囊肿发病中的作用

目的　研究不同类型 (囊状、梭状型 )先天性胆总管囊肿壁细胞凋亡与增殖的关系 ,了解细胞凋亡 /增殖在胆总管囊肿中的作用。方法　以胆总管囊状扩张组 32例、梭状扩张组 35例及胆总管结石致胆管扩张组 (对照组 ) 2 5例为研究对象。术中取部分胆总管壁送检 ,观察胆总管壁损伤情况。用免疫组织化学法检测细胞凋亡的相关指标bcl 2、bax及细胞增殖指标PCNA的表达 ;用TUNEL法检测细胞凋亡情况。结果　囊状扩张组胆总管壁粘膜上皮细胞破坏严重 ,梭状扩张组镜下所见与囊状扩张组相似 ,但程度较轻。对照组胆总管粘膜上皮细胞破坏最轻 ,其凋亡细胞呈散在分布 ,上皮细胞和成纤维细胞凋亡阳性率较低 ,分别为 (2 .74± 1 .0 0 ) %和 (2 .95± 0 .87) % ;bcl 2、bax表达率较低 ,水平相似 (P>0 .0 5) ;PCNA表达率较高 ,分别为 (3 .74± 1 .0 0 ) %和 (3 .71± 1 .77) %。囊状扩张组与梭状扩张组囊壁残留上皮中的bcl 2和PCNA表达率低 ,分别为 (0 .99± 0 .51 ) %和 (0 .90± 0 .38) % ;bax呈高表达 ,bcl 2呈低表达 ,凋亡细胞阳性率较高 ,分别为 (1 3 .94± 4 .77) %和 (7.51± 3 .46) % ;成纤维细胞中的PCNA表达率较高 ,分别为 (9.91± 2 .91 ) %和(9.70± 3 .1 8) % ,bax呈低表达 ,bcl 2呈高表达 ,凋亡细胞阳性率较低     

上皮钙粘附蛋白和CD44v6在肝外胆管癌和胆总管囊肿组织中的表达及临床意义

细胞粘附分子在肿瘤细胞侵袭和转移中的作用已越来越为人们重视，研究表明，上皮钙粘附蛋白(epithelial cadherin，E-CD)和白细胞分化抗原CD44分子拼接变异体(CD44v6)的表达与肿瘤的浸润、转移有密切关系。我们采用免疫组织化学方法研究E-CD和CD44v6的表达在肝外胆管癌发生、发展及转移中的作用。     

先天性胆总管囊肿的治疗

目的:研究囊肿切除肝总管空肠Roux-Y吻合术治疗先天性胆总管囊肿的随访结果和疗效评价。方法:本组18例,男5例,女13例,均采用囊肿切除肝总管空肠吻合术,部分加矩形瓣及其他抗返流手术。结果:18例均痊愈出院,随访6月～2年,全部患儿均未出现胆管炎及腹痛症状,肝功能正常。2例术后1年有钡剂返流,均属于未行抗返流手术者。结论:囊肿切除,肝总管空肠吻合加抗返流术是治疗先天性胆总管囊肿的一种较完善的手术。     

bax蛋白在胆管癌组织中的表达及意义

近年来有关细胞凋亡及凋亡因素在恶性肿瘤发生及发展中的研究越来越受到重视，ｂａｘ是一种凋亡基因促进基因，有关它在胆管癌组织中表达的研究很少，作者探讨其在胆管癌发生和发展中所起的作用。材料和方法２０例胆管癌组织标本为我院肝胆外科１９９４年～１９９８年间手术的胆管肿瘤患者，男１４例，女６例，年龄４６～６９岁，平均５９岁。７例先天性胆总管囊肿组织标本为同上期年间手术的先天性胆总管囊肿患者，男３例，女４例，年龄１６～４１岁，平均３２岁。所有标本均经病理组织学证实，质量分数为１０％中性甲醛固定，石蜡包埋，切…     

先天性胆总管囊肿的外科治疗

先天性胆总管囊肿的外科治疗第三军医大学西南医院肝胆外科中心（重庆，６３００３８）蔡景修先天性胆总管囊肿（简称胆总管囊肿）比较常见。在我院收治的先天性胆管囊肿病例中，胆总管囊肿占６７．９％。对胆总管囊肿理想的治疗是切除囊肿，行肝总管空肠吻合术，从而消除...     

先天性胆总管囊肿外科治疗

目的 探讨先天性胆总管囊肿最佳术式及术后并发症的预防。方法 分析50例先天性胆总管囊肿手术时机、手术方法、治疗效果。结果 15例行胆总管囊肿切除、肝总管空肠Roux-en-Y吻合,术后症状复发1例;35例行胆总管囊肿十二指肠或空肠吻合术,术后症状复发20例。结论 先天性胆总管囊肿的手术治疗以囊肿切除、胆管空肠吻合最佳;术中应尽可能作大口吻合;避免行单纯囊肿内引流,急症情况下可先行囊肿外引流。     

P^75NGFR在先天性胆总管囊肿的表达意义初探

目的 探讨神经生长因子受体（P^75NGFR）在先天性胆总管囊肿（CCC）的分布情况及其意义。方法 应用免疫组化方法对18例先天性胆总管囊肿患儿及9例对照组的胆总管进行检测。结果 丰富的P^75NGFR染色阳性神经纤维分布于正常胆总管外膜下,神经节细胞表现为P^75NGFR染色强阳性;先天性胆总管囊肿的P^75NGFR染色阳性纤维明显减少。结论 P^75NGFR在先天性胆总管囊肿的异常分布可能与CCC的发病机理有关。     

腹腔镜先天性胆总管囊肿切除术

目的 比较开腹和腹腔镜手术治疗先天性胆总管囊肿的效果.方法 回顾性分析1999年5月至2007年3月140例先天性胆总管囊肿患儿的临床资料.按不同手术方法分为开腹组和腹腔镜组,均采用胆总管囊肿切除+肝管空肠Roux-en-Y吻合术,比较两组疗效.结果 1999年5月至2001年2月开腹组收治患儿38例,2001年4月至2007年3月腹腔镜组收治患儿102例.平均手术时间:开腹组190 min,腹腔镜组224 min.开腹组术中、术后输血3例.腹腔镜组无术中、术后输血.开腹组术后并发症发生率为16%(6/38),明显高于腹腔镜组的5%(5/102),两组比较差异有统计学意义(χ2=4.33,P<0.05).结论 对于先天性胆总管囊肿患儿采用腹腔镜行胆总管囊肿切除+肝管空肠Roux-en-Y吻合术治疗,手术打击小,术后恢复快.     

腹腔镜技术在治疗成人先天性胆总管囊肿中的应用

目的 探讨完全腹腔镜下成人先天性胆总管囊肿切除、肝总管空肠Roux-en-Y吻合术的可行性、安全性及其临床应用价值.方法 回顾性分析2008年5月至2011年2月期间收治的采用完全腹腔镜囊肿切除、肝总管空肠Roux-en-Y吻合手术治疗的7例成人先天性胆总管囊肿患者的临床资料.结果 所有手术顺利,无中转开腹.平均手术时间210 min,出血量80 ml.术后第1日患者离床活动,平均2.4d排气或排便.除1例术后有少量胆汁漏外,无严重术后并发症发生,均恢复顺利,平均住院时间8.1d.术后随访3～30个月,无腹痛、发热或黄疸等症状.结论 完全腹腔镜成人先天性胆总管囊肿切除、肝总管空肠Roux-en-Y术安全可行,具有创伤小、恢复快的优点,值得推广.     

109例成人型胆管囊肿的诊治经验

目的 探讨成人型胆管囊肿的临床特点和手术方式,总结胆管囊肿的诊治经验.方法 回顾性分析1984-2007年北京协和医院收治的109例成人型胆管囊肿的病例,总结病例特点.109例中男女之比为1:3.8.平均年龄32.8岁.Ⅰ型78例,Ⅳa型26例,Ⅴ型5例,没有Ⅱ、Ⅲ型病例.结果 成人型胆管囊肿临床表现以右上腹不适或疼痛占大多数,共100例(91.7%),其次为寒战、发热等发作性胆管炎症状.30例(27.5%)有过胆道系统手术史,26例初次手术在2000年前施行.B超结合MRCP是确诊的主要手段.94例行囊肿切除、肝管空肠Roux-Y吻合重建术,4例因肝内病变局限于左肝加做左肝外侧段切除术.4例囊肿恶变.无手术死亡病例.手术近期并发症有胰瘘、膈下脓肿.后期并发症主要是发作性胆管炎、吻合口狭窄和肝内胆管结石.结论 成人型胆管囊肿的临床表现不典型,以右上腹痛或不适最为多见.B超是初查的主要手段,为明确诊断、了解胆管囊肿分型和累及范围可首选MRCP.胆管囊肿理想的手术方式是囊肿切除、肝管空肠Roux-Y吻合重建术.     

先天性胆总管囊肿多次手术原因分析

目的分析先天性胆总管囊肿(CCC)多次手术的原因。方法回顾性分析我院1995年1月至2004年12月因各种原因行再次及多次手术的CCC15例患者的临床资料。15例中,小儿7例,成人8例。首次手术行囊肿空肠吻合3例、囊肿十二指肠吻合3例(其中1例为妊娠期合并胆总管囊肿)。成人胆总管囊肿被误诊手术4例。囊肿自发破裂行外引流2例。胆漏2例。吻合口狭窄1例。结果13例行2次手术,2例行3次手术。本组1例术后发生胆漏患儿死亡,余均治愈。结论对CCC应尽可能地行囊肿切除,胆道重建,但在某些情况下可考虑先行外引流术以缓解症状,待病情稳定后再行囊肿切除,胆道重建。     

Laparoscopic treatment of congenital choledochal cyst

We describe the laparoscopic treatment of a patient presenting with congenital choledochal cyst. Our patient was a 19-year-old man with a complaint of recurrent abdominal pain due to pancreatitis. The choledochal cyst was type I and had a common channel of pancreatobiliary duct, as revealed by endoscopic retrograde cholangiopancreatography. Under laparoscopic guidance, the dilated bile duct and the gallbladder were excised, and a Roux-en-Y anastomosis was constructed with an endo-EEA. Finally, end-to-side anastomosis was carried out by the continuous suture method, aided by an Endostitch between the stump of the hepatic duct and the Roux-en-Y limb. After the operation, slight hyperamylasemia was observed for several days but further treatment was not necessary. Postoperative symptoms were minimal, and the patient was discharged on the 11th day after the procedure. Although it is difficult and time-consuming, laparoscopic operation is highly beneficial for the patient. The use of such instruments as the endostapler and Endostitch may help to simplify this complex intracorporeal procedure involving division and anastomosis of the digestive tract. Received: 7 March 1997/Accepted: 11 April 1997     

109例成人型胆管囊肿的诊治经验

Objective To discuss the diagnosis and treatment of congenital choledochal cyst (CCC).Methods The clinical data of 109 adult patients with congenital choledochal cyst admitted in Peking Union Medical College Hospita between 1984 and 2007 were retrospectively analyzed.The male: female ratio was 1 : 3.8.The mean age was 32.8 years.Seventy-eight of the patients belonged to Todani type Ⅰ, while twenty-six to type Ⅳ and five to type Ⅴ.There was no case of type Ⅱ or Ⅲ.Results Right upper abdominal pain or discomfort and recurrent cholangitis were the predominant presentations.Thirty patients had undergone previous surgical procedures while 26 procedures were done before 2000.B-US and MRCP were the primary methods for diagnosis after 2000.Ninety-four patients underwent complete excision of the extrahepatic cyst and hepaticojejunostomy.Four patients required the left lateral hepateetomy in addition.Four patients were testified malignant change by pathological examination.There were four pancreatic fistulas and two Subphrenic abscesses.There was no postoperative death.Forty-six patients were available for follow-up.The late complications in-eluded recurrent cholangitis, hepaticojejunostomy anastomosis stricture and intrahepatic biliary calcu-la.Conclusions Right upper abdominal pain or discomfort and recurrent cholangitis were the most common presentations in adult congenital choledochal cyst patients.B-US and MRCP should be the prefered imaging methods for diagnosis.Complete excision of the extrahepatic cyst and hepaticojeju-nostomy were ideal treatment.     

109例成人型胆管囊肿的诊治经验

Objective To discuss the diagnosis and treatment of congenital choledochal cyst (CCC).Methods The clinical data of 109 adult patients with congenital choledochal cyst admitted in Peking Union Medical College Hospita between 1984 and 2007 were retrospectively analyzed.The male: female ratio was 1 : 3.8.The mean age was 32.8 years.Seventy-eight of the patients belonged to Todani type Ⅰ, while twenty-six to type Ⅳ and five to type Ⅴ.There was no case of type Ⅱ or Ⅲ.Results Right upper abdominal pain or discomfort and recurrent cholangitis were the predominant presentations.Thirty patients had undergone previous surgical procedures while 26 procedures were done before 2000.B-US and MRCP were the primary methods for diagnosis after 2000.Ninety-four patients underwent complete excision of the extrahepatic cyst and hepaticojejunostomy.Four patients required the left lateral hepateetomy in addition.Four patients were testified malignant change by pathological examination.There were four pancreatic fistulas and two Subphrenic abscesses.There was no postoperative death.Forty-six patients were available for follow-up.The late complications in-eluded recurrent cholangitis, hepaticojejunostomy anastomosis stricture and intrahepatic biliary calcu-la.Conclusions Right upper abdominal pain or discomfort and recurrent cholangitis were the most common presentations in adult congenital choledochal cyst patients.B-US and MRCP should be the prefered imaging methods for diagnosis.Complete excision of the extrahepatic cyst and hepaticojeju-nostomy were ideal treatment.     

109例成人型胆管囊肿的诊治经验

Objective To discuss the diagnosis and treatment of congenital choledochal cyst (CCC).Methods The clinical data of 109 adult patients with congenital choledochal cyst admitted in Peking Union Medical College Hospita between 1984 and 2007 were retrospectively analyzed.The male: female ratio was 1 : 3.8.The mean age was 32.8 years.Seventy-eight of the patients belonged to Todani type Ⅰ, while twenty-six to type Ⅳ and five to type Ⅴ.There was no case of type Ⅱ or Ⅲ.Results Right upper abdominal pain or discomfort and recurrent cholangitis were the predominant presentations.Thirty patients had undergone previous surgical procedures while 26 procedures were done before 2000.B-US and MRCP were the primary methods for diagnosis after 2000.Ninety-four patients underwent complete excision of the extrahepatic cyst and hepaticojejunostomy.Four patients required the left lateral hepateetomy in addition.Four patients were testified malignant change by pathological examination.There were four pancreatic fistulas and two Subphrenic abscesses.There was no postoperative death.Forty-six patients were available for follow-up.The late complications in-eluded recurrent cholangitis, hepaticojejunostomy anastomosis stricture and intrahepatic biliary calcu-la.Conclusions Right upper abdominal pain or discomfort and recurrent cholangitis were the most common presentations in adult congenital choledochal cyst patients.B-US and MRCP should be the prefered imaging methods for diagnosis.Complete excision of the extrahepatic cyst and hepaticojeju-nostomy were ideal treatment.     

109例成人型胆管囊肿的诊治经验

Objective To discuss the diagnosis and treatment of congenital choledochal cyst (CCC).Methods The clinical data of 109 adult patients with congenital choledochal cyst admitted in Peking Union Medical College Hospita between 1984 and 2007 were retrospectively analyzed.The male: female ratio was 1 : 3.8.The mean age was 32.8 years.Seventy-eight of the patients belonged to Todani type Ⅰ, while twenty-six to type Ⅳ and five to type Ⅴ.There was no case of type Ⅱ or Ⅲ.Results Right upper abdominal pain or discomfort and recurrent cholangitis were the predominant presentations.Thirty patients had undergone previous surgical procedures while 26 procedures were done before 2000.B-US and MRCP were the primary methods for diagnosis after 2000.Ninety-four patients underwent complete excision of the extrahepatic cyst and hepaticojejunostomy.Four patients required the left lateral hepateetomy in addition.Four patients were testified malignant change by pathological examination.There were four pancreatic fistulas and two Subphrenic abscesses.There was no postoperative death.Forty-six patients were available for follow-up.The late complications in-eluded recurrent cholangitis, hepaticojejunostomy anastomosis stricture and intrahepatic biliary calcu-la.Conclusions Right upper abdominal pain or discomfort and recurrent cholangitis were the most common presentations in adult congenital choledochal cyst patients.B-US and MRCP should be the prefered imaging methods for diagnosis.Complete excision of the extrahepatic cyst and hepaticojeju-nostomy were ideal treatment.     

109例成人型胆管囊肿的诊治经验

Objective To discuss the diagnosis and treatment of congenital choledochal cyst (CCC).Methods The clinical data of 109 adult patients with congenital choledochal cyst admitted in Peking Union Medical College Hospita between 1984 and 2007 were retrospectively analyzed.The male: female ratio was 1 : 3.8.The mean age was 32.8 years.Seventy-eight of the patients belonged to Todani type Ⅰ, while twenty-six to type Ⅳ and five to type Ⅴ.There was no case of type Ⅱ or Ⅲ.Results Right upper abdominal pain or discomfort and recurrent cholangitis were the predominant presentations.Thirty patients had undergone previous surgical procedures while 26 procedures were done before 2000.B-US and MRCP were the primary methods for diagnosis after 2000.Ninety-four patients underwent complete excision of the extrahepatic cyst and hepaticojejunostomy.Four patients required the left lateral hepateetomy in addition.Four patients were testified malignant change by pathological examination.There were four pancreatic fistulas and two Subphrenic abscesses.There was no postoperative death.Forty-six patients were available for follow-up.The late complications in-eluded recurrent cholangitis, hepaticojejunostomy anastomosis stricture and intrahepatic biliary calcu-la.Conclusions Right upper abdominal pain or discomfort and recurrent cholangitis were the most common presentations in adult congenital choledochal cyst patients.B-US and MRCP should be the prefered imaging methods for diagnosis.Complete excision of the extrahepatic cyst and hepaticojeju-nostomy were ideal treatment.