摘要
目的 探讨董家鸿等提出的新分型（以下简称“新分型”）对胆管囊状扩张症治疗方式选择的指导价值.方法 回顾性分析1968年9月至2013年7月北京协和医院收治的213例参照Todani 2003分型原则选择治疗方式的胆管囊状扩张症患者的临床资料,采用2013年董家鸿等提出的新分型对213例患者重新分析,评价其对术式选择的指导作用.通过门诊、电话等方式随访,随访时间截至2013年8月.结果 213例患者中,Todani Ⅰ型139例（新分型为C型）;Todani Ⅱ型3例（新分型为C1型）;Todani Ⅲ型1例（新分型为E型）;TodaniⅣa型52例（新分型为D1型35例、D2型17例）;TodaniⅣb型1例（新分型为C型）;Todani Ⅴ-Ⅰ型8例（新分型为B1型5例、B2型3例）;Todani Ⅴ-Ⅱ型9例（新分型为A1型5例、2型4例）.18例患者未行手术治疗.195例手术患者中,C型和D型患者占多数.型患者主要采用胆囊切除、胆管囊肿切除、胆肠吻合术、内引流术.D型患者采用肝外胆管切除、胆肠吻合术,对于肝内病变严重的D1型患者同时行左半肝切除或胰十二指肠切除术.A1型行右半肝切除,A2型外院行劈离式肝移植后保守治疗,B1型行左半肝切除、胆肠吻合,B2型行胆管取石.E型施行胆管囊肿部分切除,胆管成型术.74患者术后出现胰瘘、胆瘘、反流性胆管炎、胆管炎以及吻合口狭窄等并发症,经保守治疗或取石后恢复良好.187例患者获得随访,中位随访时间85个月（1～432个月）.175例患者恢复良好,发生胆管系统癌变的患者中12例于随访1～282个月后因肿瘤全身播散死亡.结论 新分型方法简化了肝外胆管囊状扩张的分型,细化了肝内胆管囊状扩张的分型,对治疗方式的选择具有重要指导价值.
Objective To investigate the guidance of a new classification on the treatment methods selection for cystic dilation of bile duct （CDBD）.Methods The clinical data of 213 patients with CDBD who received treatment according to the Todani 2003 classification at the Peking Union medical College Hospital from September 1968 to July 2013 were retrospectively analyzed.The CDBD was reclassified with a new classification proposed by Dong Jiahong et al,and the guidance of the new classification on the treatment methods selection for CDBD was analyzed.Patients were followed up via out-patient examination and telephone interview till August 2013.Results Of the 213 patients,139 were with Todani type Ⅰ CDBD （type C CDBD of the new classification） ; 3 were with Todani type Ⅱ CDBD （type C1 CDBD of the new classification） ; 1 was with Todani type Ⅲ CDBD （type E CDBD of the new classification）; 52 were with Todani type Ⅳa CDBD （35 with type D1 and 17 with type D2 CDBD of the new classification） ; 1 was with Todani type Ⅳb CDBD （type C CDBD of the new classification） ; 8 were with Todani typeⅤ-Ⅰ CDBD （type B CDBD of the new classification） ; 9 were with Todani type Ⅴ-Ⅱ CDBD （type A CDBD of the new classification）.Eighteen patients did not receive the surgical treatment.Of the 195 patients who received surgical treatment,patients with type C and D CDBD of the new classification took a large proportion.Patients with type C CDBD of the new classification received cystectomy,biliary cyst resection,Rouxen-Y cholangiojejunostomy or internal drainage.Patients with type D CDBD of the new classification received extrahepatic biliary cyst resection,Roux-en-Y cholangiojejunostomy.Patients with severe intrahepatic disease and with type D1 CDBD of the new classification received concomitant left hemihepatectomy or pancreaticoduodenectomy.Patients with type A1 CDBD of the new classification received right hemihepatectomy.Patients with type A2 CDBD of the new classification were cured by conservat
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2014年第11期880-885,共6页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金面上项目（81372578）
关键词
胆管囊状扩张症
分型
外科手术
胆肠吻合
Cystic dilation of the bile duct
Classification
Surgical procedures, operative
Cholangiojejunostomy
