先天性胆管囊性扩张症的外科治疗(附114例报告)

目的：提高先天性胆管囊性扩张症(CBD)的诊治水平。方法与结果：研究分析114例CBD患者的临床资料，计I型80例、Ⅱ型7例、Ⅲ型2例、Ⅳ型21例、V型4例。107例行手术治疗。囊肿外引流术8例，均二次行囊肿切除术，效果满意：囊肿内引流术20例，死亡3例，11例常有胆道感染；囊肿切除肝总管空肠Roux-Y吻合术70例，疗效优良率达94.3％：肝叶切除2例，活体肝部分移植术1例，效果满意。结论：囊肿外引流术只能作为急救措施，单纯内引流术应废用，囊肿切除胆道重建是治疗胆管囊肿的最有效方法，肝内胆管囊性扩张的治疗应根据病变的部位和范围来选择术式。

The Treatment of Congenital Biliary Tract Dilatation

Objective:To improve the diagnosis and treatment of congenial biliary tract dilatation(CBD).Methods and Results:One hundred and fourteen patients with CBD were admitted between1980and1998and107of them were operated upon.Clinical presentation,preoperative radiologic evaluation and surgical procedures were analyzed.Eight patients were treated by external biliary duct drainage,secondarily all of them underwent cystectomy plus internal biliary drainage with good results.Twenty patients were subjected to internal biliary drainage,3of them died after operation,11of the patients presented repeated biliary infections.Seventy patients underwent cystectomy with Roux-en-Y hepaticojejunostmy with a successful rate of94.3%.Two patients underwent partial hepatectomy and one patient was subjected to liver transplanta-tion with good results.Conclusions:External drainage is to be used in emergency,and internal biliary drainage should be abandoned.Cyst excision with Roux-en-Y hepaticojejunostomy remains the method of choice.For intrahepatic cysts,the surgical approach is to be chosen according to different conditions.