妊娠期胆总管囊肿的诊治分析_临床医学论文.docVIP

妊娠期胆总管囊肿的诊治分析_临床医学论文 妊娠期胆总管囊肿的诊治分析_临床医学论文 【摘要】 目的 探讨妊娠期胆总管囊肿的临床特征、诊断和治疗方案。方法 收集自2003年以来收治的3例妊娠期胆总管囊肿的临床资料，进行随访与回顾性分析。结果 3例患者均为Ⅰ型胆总管囊肿，术前均有急性胆管炎发作史，1例患者孕22周因严重的胆管炎经非手术治疗无效而急诊行胆总管T管外引流术，术后出现先兆流产而行引产，于术后3月行囊肿切除胆管空肠Roux-Y吻合术。另2例均发生于妊娠晚期（孕34周,孕36周），经非手术治疗控制胆管炎症状后，继续妊娠，于足月剖腹产后第6天及2周行囊肿切除胆管空肠Roux-Y吻合术。3例患者随访至今均情况良好。结论 妊娠期胆总管囊肿以B超作为首选检查手段，对于B超无法确诊的患者，可选用MRCP，妊娠期无症状者以随访为主，待分娩后再行胆总管囊肿切除术；对于有症状而经非手术治疗无效者，行胆总管T管外引流术，分娩后再行囊肿切除术。 【关键词】 胆总管囊肿 妊娠 外科手术 Analysis of diagnosis and treatment of congenital choledochal cyst in pregnancy Abstract Objective To discuss the clinical feature, diagnosis and treatment method for congenital choledochal cyst in pregnancies. Methods The clinical data of three patients, diagnosed of congenital choledochal cyst in pregnancy were collected since 2003. Follow-up and retrospective analysis wｅｒｅ carried out. Results Three patients were all diagnosed as typeⅠcholedochal cysts with acute cholangitis. The first patient was given a T-tube biliary drainage emergently because of the serious cholangeitis in her 22 weeks’ pregnancy after conservative treatment. Postoperatively， she was diagnosed of threatened abortion and then was given induced labor. Three months later, the patient accepted cyst resection and Roux-Y cholangio-jejunostomy. The other two patients both diagnosed of the same disease in late pregnant stage (34 weeks and 36 weeks， respectively)， accepted conservative therapy to control the cholangitis and kept pregnancy until full term. Then they respectively underwent cyst resection and Roux-Y cholangio-jejunostomy on the 6th and 14th day after cesarean section. Follow-up results showed that three patients were all very well up to now. Conclusion B ultrasound should be considered as the recommended test in diagnosing choledochal cysts. If the result of ultrasound test can’t confirm the disease, MRCP should be chosen. For the patients without any symptoms， follow-up should be given and the operation of cyst resection and Roux-Y cystojejunostomy sh