先天性胆总管囊肿切除及胆道重建

目的 评价先天性胆总管囊肿切除胆道重建的术式。方法 对1984年7月－1999年12月行囊肿切除胆道重建的106例先天性胆总管囊肿进行随访复晒，胆道重建包括单纯Roux-Y吻合48例、Roux-Y吻合套瓣成形37例和Roux-Y吻合矩形瓣成形21例。结果 获随访59例，随访时间平均4.68年，术中加作抗返流措施者无一例发生返流性胆管炎，未作抗返流瓣者术后发生逆行性胆道感染3例，2例再次行套叠瓣成形后症状消失。结论 规范性的彻底切除病变囊壁组织、有效的空肠袢肝总管Roux-Y吻合加套叠瓣成形，可有效的防止术后逆行感染，在患儿能耐受的情况下应尽早选择该术式。

BILIARY TRACT RECONSTRUCTION AFTER CYSTECTOMY OF CONGENITAL CHOLEDOCHAL CYST

Objective To evaluate the operative methods of biliary tract reconstruction after cystectomy of congenital choledochal cyst(CCC). Methods One hundred and six cases with CCC underwent cystectomy and biliary tract reconstruction in our hospital from July 1984 to December 1999 were followed up. Among them, there were three kinds of procedures in biliary tract reconstruction: with single Roux Y hepaticojejunostomy in 48 cases, with intussusceptive valve to the line of Roux Y hepaticojejunostomy in 37 cases, with rectangular valve to the line of Roux Y hepaticojejunostomy in 21 cases. Results Fifty nine cases were followed up for 4.68 years in average. There were 3 cases with ascending cholangitis after single Roux Y hepaticojejunostomy. And the symptom disappeared in 2 cases underwent reoperation with an intussueceptive valve plasty to the line of Roux Y hepaticojejunostomy. No patients suffered from ascending cholangitis in the precautionary valve plasty group. Conclusion It suggests that the postoperative ascending cholangitis can be prevented effectively if standard cystectomy and prophylactic intussusceptive valve added to the line of Roux Y hepaticojejunostomy are carried out. The procedure should be performed as soon as possible providing the child is tolerable.