345例成人先天性胆总管囊肿诊治经验

摘要

Objective To evaluate the diagnosis and surgical treatment of adult congenital choledochal cyst(ACCC). Methods Clinical data of 345 ACCC cases from 1974 to 2007 were analyzed retrospectively. Results There were only 110 patients (31.9%) with typical triad (abdominal pain, palpable mass and jaundice). B-ultrasound, CT, ERCP, PTC and MRCP were methods for diagnosis. Cancer arising from choledochal cysts was found in 19 cases who had undergone internal drainage and its incidence of cholangiocarcinoma is much higher than in the general population. All cases underwent surgical treatment, in which total excision of choledochal cyst and Roux-en-Y hepaticojejunostomy was main operation, 337 cases recovered well and 8 (2. 3%) died. C..ondusions Accurate diagnosis of ACCC was difficult depending on clinical symptoms only. B-ultrasound was the choice of atraumatic diagnosis. All patients with an established diagnosis of ACCC should undergo exploratory laparotomy. Total excision of eholedochal cyst and Roux-en-Y hepaticojejunostomy is most effective treatment for ACCC.%目的 总结成人先天性胆总管囊肿的诊治经验.方法 回顾性分析1974-2007年收治的345例成人先天性胆总管囊肿患者的临床资料.结果 345例中具有典型临床表现(腹痛、黄疸、腹部肿块三联征)者仅110例.345例检查辅以BUS、CT、ERCP、PTC、MRCP获得确诊,其中BUS检查321例,有311例确诊,确诊率为96.9%.19例囊肿内引流术后发生癌变,癌变率为31%,明显高于未手术者(未住院且拒绝手术的72例中有3例癌变,癌变率为4.2%).345例均行手术治疗,其中284例次行囊肿切除、肝管空肠Roux-en-Y形吻合胆道重建术.337例手术后早期恢复,近期(术后2～3周)死亡8例(2.3%).结论 成人先天性胆总管囊肿仅靠临床表现不易确诊,还应辅以BUS、CT、ERCP、PTC及MRCP等检查,其中BUS是较好的早期诊断方法.手术以采用囊肿切除、肝管空肠Roux-en-Y形吻合胆道重建术为优.