先天性胆管扩张症合并肝内胆管扩张的手术治疗对策

目的探讨先天性胆管扩张症合并肝内胆管扩张的手术治疗对策，以提高手术的远期疗效。方法第1组不管是否提示合并肝内胆管扩张，均单纯行扩张胆总管、胆囊切除，肝总管空肠Roux—en—Y吻合。第2组在第1组手术术式基础上，对胆管狭窄者行胆管成形术和冲洗处理胰胆管共同通道。采用时序分组进行对比分析研究。结果第1组13例，6例合并肝内胆管扩张，4例为囊样扩张。第2组共46例，18例有肝内胆管扩张，其中11例为囊样扩张，同时存在胆管狭窄。第2组术后腹痛、胆道感染的发生率明显低于第1组。讨论在标准根治术(囊肿切除胆道重建)的基础上对近端肝内胆管狭窄矫治、可能存在的复杂胆道畸形的处理及远端胰胆管共同通道冲洗，可有效降低术后胆道胰管并发症的发生，提高手术远期疗效。

The operative management of congenital biliary dilatation with intrahepafic bile duct dilatation

Objective To explore the operative management of congenital biliary dilatation with intrahepatic bile duct dilatation are reported.Methods The treatment results between two groups were studied.Group one had 13 cases,simple hepaticojejunostomy with complete excision of a choledochal cyst was done in this group.Group two had 46 cases,on the base of operative procedures of group one,surgical procedures for stenoses of intrahepatic bile ducts in 11 cases were performed and all of the pancreaticobiliary common ducts were lavaged by normal saline in group two.Results In group one,there were 6 cases with intrahepatic bile duct dilatation,four of them showing cystic type.In group two,18 cases were accompanied with intrahepatic bile duct dilatation,11 of them showing cystic.Stenoses involved an intraluminal membrane or septum were seen in the cases with intrahepatic cystic dilatation and the stenoses were excised from the divided end of the common hepatic duct at the hepatic hilum.The pancreatic calculi were found in the pancreaticobiliary common duct in some cases.According to the long term follow up,the incidence of postoperative complications in group two was much less than that in group one.Conclusion On the base of hepaticojejunostomy with radical excision of a choledochal cyst,operative procedures for intrahepatic stenoses and pancreaticobiliary common duct calculi can reduce the postoperative complications significantly.