中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2013年
8期
582-585
,共4页
罗喜荣%詹江华%胡晓丽%宫济春
囉喜榮%詹江華%鬍曉麗%宮濟春
라희영%첨강화%호효려%궁제춘
胆总管囊肿%外科手术%胆道发育不良%胆道扩张症
膽總管囊腫%外科手術%膽道髮育不良%膽道擴張癥
담총관낭종%외과수술%담도발육불량%담도확장증
Choledochal cyst%Surgical procedures,operative%Biliary hypoplasia%Choledochal cyst
目的 探讨巨大胆总管囊肿伴胆道发育不良症患儿的诊断和手术难点.方法 回顾性分析胆道扩张症患儿278例,其中3例伴有肝外巨大囊肿的胆道发育不良症患儿.本组患儿术中都进行胆道造影检查,了解肝内、外胆管通畅情况以及肝内胆管扩张情况;术中行肝脏活检,行囊肿切除术,术中放置肝总管支架管,并行肝总管-空肠Roux-en-Y吻合手术. 结果 3例患儿手术年龄在1~2个月之间,术中造影显示囊肿较巨大,左、右肝管发育较细且与肝内相通,有黄色胆汁流出.切开囊肿时有1例损伤肝总管,行肝总管修补手术,并行肝总管部位囊肿成型术,再行肝门-空肠吻合术.3例患儿术后无吻合口狭窄和结石形成;肝活检病理证实有通畅胆管,但胆管数量减少,未见类似胆道闭锁的胆管增生以及胆栓形成.术后随访1~5年,未见黄疸发生,超声显示无肝内胆管扩张.结论 术中胆道造影检查非常必要,如遇囊肿巨大,左、右肝管较细,切开囊肿时应小心,切口位置选择在胆囊管水平以下,勿损伤肝管,造成吻合困难,吻合时放置支架管对于早期胆汁引流意义重大.
目的 探討巨大膽總管囊腫伴膽道髮育不良癥患兒的診斷和手術難點.方法 迴顧性分析膽道擴張癥患兒278例,其中3例伴有肝外巨大囊腫的膽道髮育不良癥患兒.本組患兒術中都進行膽道造影檢查,瞭解肝內、外膽管通暢情況以及肝內膽管擴張情況;術中行肝髒活檢,行囊腫切除術,術中放置肝總管支架管,併行肝總管-空腸Roux-en-Y吻閤手術. 結果 3例患兒手術年齡在1~2箇月之間,術中造影顯示囊腫較巨大,左、右肝管髮育較細且與肝內相通,有黃色膽汁流齣.切開囊腫時有1例損傷肝總管,行肝總管脩補手術,併行肝總管部位囊腫成型術,再行肝門-空腸吻閤術.3例患兒術後無吻閤口狹窄和結石形成;肝活檢病理證實有通暢膽管,但膽管數量減少,未見類似膽道閉鎖的膽管增生以及膽栓形成.術後隨訪1~5年,未見黃疸髮生,超聲顯示無肝內膽管擴張.結論 術中膽道造影檢查非常必要,如遇囊腫巨大,左、右肝管較細,切開囊腫時應小心,切口位置選擇在膽囊管水平以下,勿損傷肝管,造成吻閤睏難,吻閤時放置支架管對于早期膽汁引流意義重大.
목적 탐토거대담총관낭종반담도발육불량증환인적진단화수술난점.방법 회고성분석담도확장증환인278례,기중3례반유간외거대낭종적담도발육불량증환인.본조환인술중도진행담도조영검사,료해간내、외담관통창정황이급간내담관확장정황;술중행간장활검,행낭종절제술,술중방치간총관지가관,병행간총관-공장Roux-en-Y문합수술. 결과 3례환인수술년령재1~2개월지간,술중조영현시낭종교거대,좌、우간관발육교세차여간내상통,유황색담즙류출.절개낭종시유1례손상간총관,행간총관수보수술,병행간총관부위낭종성형술,재행간문-공장문합술.3례환인술후무문합구협착화결석형성;간활검병리증실유통창담관,단담관수량감소,미견유사담도폐쇄적담관증생이급담전형성.술후수방1~5년,미견황달발생,초성현시무간내담관확장.결론 술중담도조영검사비상필요,여우낭종거대,좌、우간관교세,절개낭종시응소심,절구위치선택재담낭관수평이하,물손상간관,조성문합곤난,문합시방치지가관대우조기담즙인류의의중대.
Objective To explore diagnosis and treatment of biliary hypoplasia with huge choledochal cyst in infants.Methods From Feb 2003 to Dec 2011,278 choledochal cyst cases were treated in our hospital.There were 3 infant cases of biliary hypoplasia with huge extrahepatic choledochal cyst diagnosed and treated during this period.All patients underwent cholangiogram demonstrating patent,but markedly diminutive extrahepatic biliary structures.After excision of the cyst,hepatic duct was injured in 1 case.The cyst wall was removed,a stent was put inside of hepatic duct,and Roux-en-Y hepaticojejunostomy was porformed.Results All three patients (ages from 1 month to two months) received the Roux-en-Y hepaticojejunostomy,none of our patients has developed stenosis and fistula of the Roux-en-Y hepaticojejunostomy.Intraoperative cholangiogram showed the huge choledochal cyst and diminutive intrahepatic ducts.All three cases were followed-up for 1-5 years,there was no jaundice and nor stones formation.Conclusions In cases of huge choledochal cyst when intraoperative cholangiogram demonstrates a diminutive biliary tree with huge choledochal cyst,great care is required during cyst excision in order not to injury the hepatic duct.Stent placement into hepatic duct helps bile flow at early stage after surgery.