先天性胆管扩张症诊治过程中应该注意的几个问题

目的复习文献及结合本中心的诊治经验,探讨先天性胆管扩张症诊治过程中应该注意的问题。方法总结分析我院2000年3月至2012年5月共收治的147例先天性胆管扩张症患者的临床资料。结果 147例患者中,接受手术治疗126例,其中术式包括:①囊肿完整切除、肝总管空肠端侧吻合98例;②囊肿大部分切除、肝总管空肠端侧吻合14例;③胰十二指肠切除术3例(其中1例为胆总管下端囊肿癌变);④11例癌变患者1例行胰十二指肠切除术,7例行胆管癌根治术,3例行姑息性外引流术;⑤1例患者因合并胆总管囊肿破裂出血并胆汁性腹膜炎而行单纯外引流术。126例手术患者中获随访89例,随访率为70.6%,随访2个月-8年,平均37个月。结论先天性胆管扩张症的手术方式已较为规范,但是关于囊肿切除范围、胆道重建中抗反流袢的长度以及成人先天性胆管扩张症等治疗方面应该引起外科医师的重视。

Several issues about the process of diagnosis and treatment of congenital biliary dilatation

Objective According to the literature and the experience of our center,to discuss several issues about the process of diagnosis and treatment of congenital biliary dilatation.Methods A retrospective analysis was made in 147 cases from Mar,2000 to May,2012.Results Among all the cases 126 patients accepted operation: ① 98 cases accepted cyst excision with the excision of the entire extra-hepatic duct with a Roux-on-Y hepatojejunostomy;② 14 cases accepted cyst partial excision with a Roux-on-Y hepatojejunostomy;③ 3 cases accepted duodenopancreatectomy;④ Among 11 cases with cancer,1 casee accepted duodenopancreatectomy,7 cases accepted radical correction of cholangiocarcinoma,3 cases accepted external drainage of palliation;⑤ 1 case accepted external drainage for bleeding and accepted external drainage due to rupture of choledochal cyst.Among all the cases 89 patients were on visit,the rate of visit was 70.6%.Follow-up 2 months-8 years,mean 37 months.Conclusion Operation methods for congenital biliary dilatation has been relatively standardized.But surgeon should pay attention to the cyst excision range,the anti-reflux loop length in biliary reconstruction and adult congenital biliary dilatation.