摘要
目的 探讨在先天性胆管扩张症 (congenitalbiliarydilatation ,CBD)标准术式即囊肿切除胆道重建的基础上 ,对远近端胆管处理的要点及临床意义 ,以提高手术的远期疗效。方法 第一组13例 ,均单纯行扩张胆总管、胆囊切除 ,肝总管空肠Roux Y吻合。第二组共 2 4例 ,在第一组手术术式的基础上 ,了解肝内胆管及胰胆管共同通道的病理变化 ,所有病例行胰胆管共同通道冲洗 ,有肝内胆管狭窄者行胆管成形术。再比较两组的疗效结果。结果 第一组有 6例合并肝内胆管扩张 ,4例为囊样扩张。第二组 8例有肝内胆管扩张 ,其中 5例为囊样扩张。囊样扩张的病例均可见左右肝管汇入肝总管的开口处呈瓣膜状或短的细管状狭窄。部分胰胆管共同通道内存在泥沙样胰石。术后随访 ,第二组胆道感染的发生率明显低于第一组。结论 在标准根治术 ,即囊肿切除胆道重建的基础上对远端胰胆管共同通道冲洗和近端肝内胆管狭窄矫治可有效降低术后胆道胰管并发症的发生。
Objective Postoperative complications such as cholangitis and calculi may develop even after the complete excision of a choledochal cyst. Since congenital stenosis of the intrahepatic bile ducts are more likely to be the cause of postoperative complications, operative procedures for intrahepatic stenosis and pancreatic calculi in pancreaticobiliary common duct are reported. Methods The operative outcome of two groups were studied. Group Ⅰ (n= 13): simple hepaticojejunostomy with complete excision of a choledochal cyst was performed. Group Ⅱ (n = 24 ) in addition to the operative procedures of group one, surgery for stenosis of intrahepatic bile ducts was performed and all of the pancreaticobiliary common ducts were lavaged with normal saline.Results In group one, there were six cases of intrahepatic dilatation, four of them showing cystic type. In group two, 11 had intrahepatic dilatation, 5 of them showing cystic. Stenosis that involved an intraluminal membrane or septum were seen in the cases with intrahepatic cystic dilatation and the stenosis were excised from the divided end of the common hepatic duct at the hepatic hilum. The pancreatic calculi were found in the pancreaticobiliary common duct in some cases. According to the long-term follow-up, the incidence of postoperative complications in group two was much less than that in group one.Conclusions On the base of hepaticojejunostomy with radical excision of a choledochal cyst, operative management of intrahepatic stenosis and pancreaticobiliary common duct calculi can reduce the postoperative complications significantly.
出处
《中华小儿外科杂志》
CSCD
北大核心
2001年第5期293-295,共3页
Chinese Journal of Pediatric Surgery
关键词
胆道疾病
外科手术
先天性胆管扩张症
儿童
Bile duct diseases
Surgical procedures,operative
Bile ducts,intrahepatic
