胆总管囊肿切除不同胆道重建术的远期疗效评价

目的分析和评价先天性胆总管囊肿切除后采用不同胆道重建手术方式的远期治疗效果。方法对1985-2000年所行121例胆总管囊肿切除、胆道重建手术治疗的患儿资料进行总结和长期随访观察，胆道重建手术包括单纯肝管空肠Roux-Y吻合27例、肝管十二指肠吻合黏膜乳头成形24例、回盲部肠段间置14例和肝管空肠Roux-Y吻合加曾氏防反流瓣56例四种术式。结果91例获得远期随访，平均时间11．7g。2例发生恶变，出现反复发作胆管炎13例(单纯吻合组7例、黏膜乳头成形组5例和加防反流瓣组1例)、吻合口狭窄8例和肝门胆管结石5例，11例再手术后症状消失。结论根治切除囊肿是治疗本病的基础，肝门大口肝管空肠Roux-Y吻合加抗反流瓣术是胆道重建手术可选择的最佳术式。

Long-term follow-up of biliary reconstruction after choledochal cyst excision

Objective To evaluate the long-term outcome of different procedures of biliary tract reconstruction after resection of congenital choledochal cyst(CCC). Methods From 1985 to 2000,121 patients with CCC underwent cystectomy with biliary reconstruction and were followed up. Four procedures adopted included single Roux-Y hepaticojejunostomy in 27 patients, hepaticoduodenostomy plus mucosal papilloplasty in 24, ileocecal segment replacement in 14 and Roux-Y hepaticojejunostomy plus Zeng's anti-reflux valve in 56. Results Ninety-one cases were followed up for 11.73 years. Two patients developed biliary malignancy. There were 13 cases of recurrent post-operative ascending cholangitis (of these, 7 cases after single Roux-Y hepaticojejunostomy, 5 after hepaticoduodenostomy plus mucosal papilloplasty and 1 after Roux-Y hepaticojejunostomy plus Zeng's anti-reflux valve), 9 anastomasis stricture and 7 cases of stone formation. The symptom subsided in 11 cases after reoperation. Conclusions The standard excision of choledochal cyst is a basic procedure for treatment of CCC. The end-to-side hepaticojejunostomy with a wide stoma at the hilum and Roux-Y jejunostomy with anti-reflux valve is our method of choice for biliary reconstruction.