CAJ | 학술논문

目的探讨成人型胆管囊肿的临床特点和手术方式,总结胆管囊肿的诊治经验.方法回顾性分析1984-2007年北京协和医院收治的109例成人型胆管囊肿的病例,总结病例特点.109例中男女之比为1:3.8.平均年龄32.8岁.Ⅰ型78例,Ⅳa型26例,Ⅴ型5例,没有Ⅱ、Ⅲ型病例.结果成人型胆管囊肿临床表现以右上腹不适或疼痛占大多数,共100例(91.7%),其次为寒战、发热等发作性胆管炎症状.30例(27.5%)有过胆道系统手术史,26例初次手术在2000年前施行.B超结合MRCP是确诊的主要手段.94例行囊肿切除、肝管空肠Roux-Y吻合重建术,4例因肝内病变局限于左肝加做左肝外侧段切除术.4例囊肿恶变.无手术死亡病例.手术近期并发症有胰瘘、膈下脓肿.后期并发症主要是发作性胆管炎、吻合口狭窄和肝内胆管结石.结论成人型胆管囊肿的临床表现不典型,以右上腹痛或不适最为多见.B超是初查的主要手段,为明确诊断、了解胆管囊肿分型和累及范围可首选MRCP.胆管囊肿理想的手术方式是囊肿切除、肝管空肠Roux-Y吻合重建术.
목적 탐토성인형담관낭종적림상특점화수술방식,총결담관낭종적진치경험.방법 회고성분석1984-2007년북경협화의원수치적109례성인형담관낭종적병례,총결병례특점.109례중남녀지비위1:3.8.평균년령32.8세.Ⅰ형78례,Ⅳa형26례,Ⅴ형5례,몰유Ⅱ、Ⅲ형병례.결과 성인형담관낭종림상표현이우상복불괄혹동통점대다수,공100례(91.7%),기차위한전、발열등발작성담관염증상.30례(27.5%)유과담도계통수술사,26례초차수술재2000년전시행.B초결합MRCP시학진적주요수단.94례행낭종절제、간관공장Roux-Y문합중건술,4례인간내병변국한우좌간가주좌간외측단절제술.4례낭종악변.무수술사망병례.수술근기병발증유이루、격하농종.후기병발증주요시발작성담관염、문합구협착화간내담관결석.결론 성인형담관낭종적림상표현불전형,이우상복통혹불괄최위다견.B초시초사적주요수단,위명학진단、료해담관낭종분형화루급범위가수선MRCP.담관낭종이상적수술방식시낭종절제、간관공장Roux-Y문합중건술.
Objective To discuss the diagnosis and treatment of congenital choledochal cyst (CCC).Methods The clinical data of 109 adult patients with congenital choledochal cyst admitted in Peking Union Medical College Hospita between 1984 and 2007 were retrospectively analyzed.The male: female ratio was 1 : 3.8.The mean age was 32.8 years.Seventy-eight of the patients belonged to Todani type Ⅰ, while twenty-six to type Ⅳ and five to type Ⅴ.There was no case of type Ⅱ or Ⅲ.Results Right upper abdominal pain or discomfort and recurrent cholangitis were the predominant presentations.Thirty patients had undergone previous surgical procedures while 26 procedures were done before 2000.B-US and MRCP were the primary methods for diagnosis after 2000.Ninety-four patients underwent complete excision of the extrahepatic cyst and hepaticojejunostomy.Four patients required the left lateral hepateetomy in addition.Four patients were testified malignant change by pathological examination.There were four pancreatic fistulas and two Subphrenic abscesses.There was no postoperative death.Forty-six patients were available for follow-up.The late complications in-eluded recurrent cholangitis, hepaticojejunostomy anastomosis stricture and intrahepatic biliary calcu-la.Conclusions Right upper abdominal pain or discomfort and recurrent cholangitis were the most common presentations in adult congenital choledochal cyst patients.B-US and MRCP should be the prefered imaging methods for diagnosis.Complete excision of the extrahepatic cyst and hepaticojeju-nostomy were ideal treatment.