成人先天性胆总管囊肿根治术15例临床研究

目的探讨成人先天性胆总管囊肿根治性切除手术要点及临床意义，提高手术安全性和远期疗效。方法回顾性分析自1997年4月-2004年11月，本院实施胆总管囊肿根治性切除、左右肝管成形、肝管空肠Roux—Y吻合术手术疗效。结果全组患者无手术死亡，近期无出血、感染、肠瘘、胰瘘，2例分别于术后第2天和第3天从引流管引出30ml、50ml胆汁，持续引流1周后，观察3天无胆汁引出，拔管后无并发症。随访6个月-8年，无复发、结石、癌变、黄疸等并发症；1例反复发作右上腹痛，低热，经补液、抗感染治疗可控制。B超检查31例次未示肝内胆管扩张。患者营养状况良好，达到临床治愈。结论囊肿外引流术应作为急诊手术的首选术式，囊肿内引流术应当废弃，肝管空肠Roux—Y吻合术应作为根治性切除的首选术式。

Radical surgery for congenital choledochal cyst in 15 adult patients

Objective To review the essentials and clinical significances of radical operation on adult patients with congenital choledochal cyst.Methods Radical removal of congenital choledochal cyst,plastic operation of the right and left bile ducts,and Roux-Y cholangio-jejunostomy were performed in our hospital from April,1997 to November,2004.Results All of the operations were successful,with no mortality,postoperative bleeding,infection,or intestinal and pancreatic fistula.30 ml and 50 ml of bile was drained on the second and the third postoperative day in two patients respectively.Follow-up for 6 months to 8 years showed the postoperative course was very smooth,except for one case of abdominal pain in upper right belly and low fever,which was controlled with anti-infection treatment.The B-ultrasonic examination(31 times) showed no bile duct dilatation in the liver.All of the patients looked healthy and well nourished after the treatment.Conclusion Cystic external drainage as an emergency operation can be adopted in complicated cases before proceeding to the radical treatment,but the cystic internal drainage should be abandoned.Roux-Y cholangio-jejunostomy as a radical operation is the ideal way to treat the congenital abnormality.