CAJ | 학술논문

目的总结国人成人胆总管囊肿的发病趋势,探讨降低胆肠吻合术后吻合口狭窄的合理术式.方法回顾性分析1977年7月至2008年10月诊治的169例成人胆总管囊肿患者临床资料.依据影像学检查及手术记录的描述,按改良Todani分型,分为Ⅰ型110例(65.1％),Ⅱ型1例(0.6％),Ⅳ型56例(33.1％),2例因临床资料缺乏无法分型.在所有病例中,手术治疗163例,其中行囊肿切除术119例,内引流术33例,胆道探查并T管引流术5例,手术探查活检5例,内镜下括约肌切开取石术1例.结果随着诊断方法的进步与普及,成人胆总管囊肿在80年代表现为发病率显著增加,90年代后期至今则趋于稳定.由于对该病认识的深入和治疗方法的改进,既往因误诊而行多次胆道手术的患者近年来逐渐降至25％左右.癌变率由1977年至1995年间的l6.5％降为1996年至2008年间的9.7％.胆总管囊肿行囊肿切除治疗的主要远期并发症为吻合口狭窄引起的肝内胆管结石及反复发作胆管炎.结论近年,成人胆总管囊肿的发病率趋于稳定.囊肿切除并胆肠吻合术是治疗成人胆总管囊肿的主要方法,可降低癌变率.为防止吻合口狭窄,应该根据肝门部胆管的不同情况术中采取不同的手术方式.
목적 총결국인성인담총관낭종적발병추세,탐토강저담장문합술후문합구협착적합리술식.방법 회고성분석1977년7월지2008년10월진치적169례성인담총관낭종환자림상자료.의거영상학검사급수술기록적묘술,안개량Todani분형,분위Ⅰ형110례(65.1％),Ⅱ형1례(0.6％),Ⅳ형56례(33.1％),2례인림상자료결핍무법분형.재소유병례중,수술치료163례,기중행낭종절제술119례,내인류술33례,담도탐사병T관인류술5례,수술탐사활검5례,내경하괄약기절개취석술1례.결과 수착진단방법적진보여보급,성인담총관낭종재80년대표현위발병솔현저증가,90년대후기지금칙추우은정.유우대해병인식적심입화치료방법적개진,기왕인오진이행다차담도수술적환자근년래축점강지25％좌우.암변솔유1977년지1995년간적l6.5％강위1996년지2008년간적9.7％.담총관낭종행낭종절제치료적주요원기병발증위문합구협착인기적간내담관결석급반복발작담관염.결론 근년,성인담총관낭종적발병솔추우은정.낭종절제병담장문합술시치료성인담총관낭종적주요방법,가강저암변솔.위방지문합구협착,응해근거간문부담관적불동정황술중채취불동적수술방식.
Objective To characterize the spectrum of adult choledochal cyst and to determine suitable surgical procedures for this disorder.Methods The medical records of 169 patients who were treated for choledochal cyst from July 1977 to October 2008 in our Department were retrospectively reviewed.The cysts were classified using Todani's classification as type Ⅰ in 110 patients (65.1％),type Ⅱ in one patient (0.6％),and type Ⅳ in 56 patients (33.1％).The choledochal cysts in two patients could not be classified because of the lack of clinical data.163 patients received surgical treatment,which included cystectomy (n=119),cystenterosotmy (n=33),T-tube drainage following bile duct exploration (n=5),surgical exploration/biopsy (n =5),and endoscopic sphincterotomy (n =1).Results There was an increase in the number of patients in the 1980s which became stable at round 30 patients per every four years since the late 1990s.The proportion of patients presenting with a history of biliary surgery decreased and accounted for about 25％ of patients in the past decades.The rate of cyst malignancy dropped from 16.5％ in 1977=1995 to 9.7％ in 1996=2008.Of the 163 patients who received surgical treatment,long-term complications included anastomotic strictures and intrahepatic bile ductal stones presenting with repeated cholangitis.Conclusions The incidence of adult congenital choledochal cysts had become stable following years of rapid increase.The rate of cancer progression had gradually decreased.The use of different surgical treatments based on the condition of the proximal bile duct helped to prevent postoperative stenosis of biliary anastomosis.