摘要
目的探讨成人先天性胆总管囊肿的诊断及手术疗效。方法回顾性分析1997年1月至2010年12月南京医科大学第一附属医院手术治疗的58例成人先天性胆管囊肿患者的临床资料。术前采用B超、CT、MRCP和ERCP检查，确诊后根据Todani分型决定手术方式。计量资料采用t检验；计数或等级资料采用X^2检验。结果58例患者中，术前腹部B超、CT、MRCP和ERCP检查确诊率分别为78％（45／58）、92％（23／25）、9／9和5／5。手术治疗方式为开腹胆总管囊肿切除＋肝管空肠Roux-en-Y吻合术41例（其中2例为腹腔镜中转开腹手术）；腹腔镜胆总管囊肿切除＋肝管空肠Roux-en-Y吻合术8例；胰十二指肠切除术3例（其中1例联合肝部分切除术）；胆总管囊肿并部分肝叶切除＋肝管空肠Roux-en-Y吻合术2例；胆囊切除＋胆总管探查术2例；左半肝切除术1例；因肿瘤晚期行囊肿外引流术1例。胆总管囊肿切除＋肝管空肠Roux-en-Y术中，开腹手术与腹腔镜手术平均手术时间分别为（235±70）min和（320±50）min，两者比较，差异有统计学意义（t=3．157，P〈0．05）；术后并发症发生率分别为18％（7／39）和3／8，两者比较，差异无统计学意义（X^2=1．515，P〉0．05）；术后平均住院时间分别为（10．0±2．3）d和（12．6±6．6）d，两者比较，差异有统计学意义（t=2．162，P〈0．05）。术后病理检查发现患者癌变率为10％（6／58）。全组患者无围手术期死亡，手术并发症发生率为24％（14／58）。随访1-15年，良性病变患者无严重远期并发症；6例癌变患者中4例于术后1年内死亡，另2例已分别生存3年和5年。结论成人先天性胆总管囊肿影像学诊断首选腹部B超检查，MRCP检查是诊断金标准。患者确诊后应尽早手术治疗，首选术式为完整胆总管囊肿切除＋肝管空肠Roux-en-Y吻合术。
Objective To investigate the diagnosis and surgical management of adult choledochal cyst.Methods The clinical data of 58 adult patients with congenital choledochal cyst who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 1997 to December 2010 were retrospectively analyzed. All patients were diangosed by the B ultrasonography, computed tomography （CT） , Magnetic resonance cholangiopancreatography （MRCP） and endoscopic retrograde cholangiopancreatography （ERCP）. Surgical procedures were selected according to the diagnosis and Todani classification. All data were analyzed using the t test or chi-square test. Results The accurate rates of B sonography, CT, MRCP and ERCP were 78% （45/58） , 92% （23/25） , 9/9 and 5/5, respectively. Forty-one patients underwent complete excision of the cyst ＋ hepaticojejunostomy （2 patients were converted from laparotomy due to abdominal adhesions）, 2 underwent resection of the cyst and involed hepatic segments ＋ hepaticojejunostomy, 8 underwent laparoscopic excision of the cyst ＋ hepaticojejunostomy, 1 underwent left hemihepatectomy, 3 underwent pancreaticoduodenectomy （ including partial hepatectomy in 1 patient）, 2 underwent common bile duct exploration ＋ cholecystectomy due to acute obstructive suppurative cholangitis, 1 underwent external drainage of choledochal cyst due to advanced malignance. The mean operation time and postoperative duration of hospital stay of patients who received open and laparoscopic excision of the cyst and hepaticojejunostomy were （235 ± 70） minutes, （ 320 ±50） minutes, and （ 10.0 ± 2.3 ） days, （ 12.6±6.6） days, respectively, with significant differences between the 2 groups （ t = 3. 157, 2. 162, P 〈 0.05 ）. The postoperative morbidities of patients who received open and laparoscopic excision of the cyst and hepaticojejunostomy were 18% （7/39） and 3/8, respectively, with no significant difference （X^2 = 1. 515, P 〉 0. 05 ）. Canceration of the ch
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2012年第5期440-443,共4页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金（81170336）
关键词
胆总管囊肿
诊断
外科手术
Choledochal cyst
Diagnosis
Surgical procedcures, operative
