CAJ | 학술논문

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查。胆道重建包括单纯Roux-Y吻合48例、Roux-Y吻合套叠瓣成形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。
목적평개선천성담총관낭종절제담도중건적술식。방법대1984년7월～1999년12월행낭종절제담도중건적106례선천성담총관낭종진행수방복사。담도중건포괄단순Roux-Y문합48례、Roux-Y문합투첩판성형37례화Roux-Y문합구형판성형21례。결과획수방59례，수방시간평균4.68년。술중가작항반류조시자무일례발생반류성담관염，미작항반류판자술후발생역행성담도감염3례，2례재차행투첩판성형후증상소실。결론규범성적철저절제병변낭벽조직、유효적공장번간총관Roux-Y문합가투첩판성형，가유효적방지술후역행감염。재환인능내수적정황하응진조선택해술식。
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.