CAJ | 학술논문

目的探讨采用双Y型吻合方式治疗先天性胆管扩张症(congenital biliary dilatation, CBD)合并迷走胆管畸形的可行性.方法回顾性分析2012年1月至2013年7月手术治疗先天性胆管扩张症合并迷走胆管畸形3例的临床资料.这3例均为女孩,年龄分别为2岁、5岁和6岁,术中发现均为右侧肝管畸形,均行双Y型吻合.病例1术中行胆囊切除、囊肿切除肝总管-空肠Roux-Y型吻合,术后出现胆瘘,再次手术中发现原吻合口愈合好,肝支右侧有一迷走胆管畸形,行迷走胆管-空肠肝支端侧吻合.病例2术中见胆总管扩张成囊状,囊内可见较多蛋白栓.肝总管外侧可见一直径约0.4cm的异常分支,上通肝脏,下连于扩张的胆总管.切除胆囊及扩张的胆总管,行肝总管空肠Roux-Y吻合后,肝总管吻合口下方2.0 cm处做0.4cm切口,行迷走肝管-空肠肝支端侧吻合.病例3术中见肝总管外侧有一迷走肝管,远端与胆囊管汇合后与胆总管相连,胆总管扩张呈囊状.手术过程与病例2相同.结果本组3例行双Y型吻合术后7d均痊愈出院.随访3个月～2年,恢复良好,无胆瘘、胆道梗阻和逆行性感染发生.结论采用双Y吻合方式治疗先天性胆管扩张症合并迷走胆管畸形效果可靠.
목적 탐토채용쌍Y형문합방식치료선천성담관확장증(congenital biliary dilatation, CBD)합병미주담관기형적가행성.방법 회고성분석2012년1월지2013년7월수술치료선천성담관확장증합병미주담관기형3례적림상자료.저3례균위녀해,년령분별위2세、5세화6세,술중발현균위우측간관기형,균행쌍Y형문합.병례1술중행담낭절제、낭종절제간총관-공장Roux-Y형문합,술후출현담루,재차수술중발현원문합구유합호,간지우측유일미주담관기형,행미주담관-공장간지단측문합.병례2술중견담총관확장성낭상,낭내가견교다단백전.간총관외측가견일직경약0.4cm적이상분지,상통간장,하련우확장적담총관.절제담낭급확장적담총관,행간총관공장Roux-Y문합후,간총관문합구하방2.0 cm처주0.4cm절구,행미주간관-공장간지단측문합.병례3술중견간총관외측유일미주간관,원단여담낭관회합후여담총관상련,담총관확장정낭상.수술과정여병례2상동.결과 본조3례행쌍Y형문합술후7d균전유출원.수방3개월～2년,회복량호,무담루、담도경조화역행성감염발생.결론 채용쌍Y문합방식치료선천성담관확장증합병미주담관기형효과가고.
Objective To explore the feasibility of treating congenital biliary dilatation with aberration bile duct by double-Y anastomosis.Methods The clinical data were retrospectively analyzed for 3 female cases of congenital biliary dilatation with aberration bile duct undergoing double-Y anastomosis from January 2012 to July 2013.Their ages were 2, 5 and 6 years respectively.One case underwent the excision of gallbladder and cyst and bile duct reconstruction of hepaticojejunostomy.Bile leak occurred postoperatively.Primary anastomosis remained intact during a second laparotomy.However, an aberration bile duct lied at the right side of common hepatic duct stump.It was corrected by end-to-side anastomosis of aberration bile duct and jejunum.In another case, the cyst was dilated as a saccule with abundant protein plugs.An abnormal branch with a diameter of 0.4 cm was found outside of common hepatic duct, up to liver and down to cyst.Beside the excision of gallbladder and cyst and bile duct reconstruction of hepaticojejunostomy, the aberration bile duct was end-to-side anastomosed to 0.4 cm incision at 2 cm inferior to hepaticojejunum anastomosis.In a third case, an aberration bile duct outside common hepatic duct was confluent into the duct of gallbladder and lied downstream to dilated common bile duct.The operative procedure was the same as that for Case 2.Results All cases were discharged at the 7 days postoperatively.No bile leak, bilary tract obstruction or ascending cholangitis occurred during a follow-up period of 3 months to 2 years.Conclusions The procedure of double-Y anastomosis is both reliable and safe in the treatment of congenital biliary dilatation with aberration bile duct.