先天性胆管囊肿再手术原因分析及防治

目的分析先天性胆管囊肿患者再手术原因，降低再手术率，提高首次手术疗效。方法统计分析我院自1997年4月-2008年4月收治的168名先天性胆管囊肿患者的临床资料，比较不同年龄、性别、首次手术时机、首次手术方式的患者的再手术率。结果不同年龄、性别的患者再手术率并无明显差异；首次手术为急诊手术的患者再次手术率为63．79％，择期手术患者再手术率仅为31．82％，两组比较差异有显著性（P〈0．05）；在各种术式中，囊肿切除并肝管空肠Roux—en—Y吻合术再手术率最低，仅为31．43％，与其他各组比较差异有显著性（P〈0．05）。结论患者在初诊为该病时应尽可能行手术根治，避免后期急性发作被迫行急诊手术；囊肿切除并肝管空肠Roux—en—Y吻合术是首选术式，内引流术应淘汰，外引流术仅在不能耐受复杂手术的急诊患者中应用，为二期手术做准备。

The causes and prevention of repeat surgery for congenital choledochal cyst

Objective To lower the rate of repeat surgery and enhance the efficacy of initial surgery by analyzing the causes of repeat surgery for congenital choledochal cyst. Methods The clinical data on 168 patients with congenital choledochal cyst who had been hospitalzed during the period of April 1997 to April 2008 were analyzed retrospectively. The differences in age, gender, timing and procedures of initial, and rates of repeat surgery were compared. Results There was no significant difference in the rate of repeat surgery among different groups of age or gender. The rate of repeat surgery differed significantly between the patients undergoing emergent surgery as the initial treatment and those undergoing selective surgery （ 63.79% vs. 31.82%, P〈 0.05 ）. In all of the surgical procedures, cyst removal plus Roux-en-Y cholangiojejunostomy had a lowest rate of repeat surgery （ 31.43% ）. Conclusions In order to avoid emergent surgery, surgical treatment should be administered as early as possible once the diagnosis of congenital choledochal cyst is established. Cyst removal plus Roux-en-Y cholangiojejunostomy is the first choice. Internal drainage should be abandoned and external drainage can only be used in those who are not tolerated to complicated procedures.