先天性胆总管囊肿术后远期并发症及处理.pdfVIP

·86 · 中国实用外科杂志 2011年1月 第31 卷 第 1期 论 著 文章编号：1005-2208（2011）01-0086-03 先天性胆总管囊肿术后远期并发症及处理 刘 源 ，刘冰阳 ，周 勇 ，王 勇 ，余 云 ，刘金钢1 2 1 1 1 1 【摘要】 目的 探讨先天性胆总管囊肿术后远期并发症的治疗。方法 回顾分析1999年1月至2008年12月中 国医科大学附属盛京医院普外科收治的48例先天性胆总管囊肿术后出现远期并发症的临床资料。结果 先天 性胆总管囊肿术后远期并发症主要有胆管结石形成31例，反流性胆管炎25例，吻合口狭窄16例，囊肿癌变3 例。手术治疗方式包括囊肿彻底切除、肝总管空肠Roux-en-Y吻合术28例，胆肠吻合口切除、再吻合术7例，胆 道探查取石术3例，胆道探查取石术并肝段切除术3例，囊肿切除加胰十二指肠切除术1例。经皮经肝胆道镜治 疗吻合口狭窄和（或）胆管结石6例。结论 先天性胆总管囊肿术后远期并发症的发生常与首次手术方式选择 不当有关。治疗上以囊肿切除、去除病灶、解除梗阻、胆胰分流、通畅引流为目标，减少再手术后并发症。 【关键词】 先天性胆总管囊肿；并发症 中图分类号：R6 文献标志码：A Thetreatmentsoflong-termpostoperativecomplicationsofcongenitalcholedochalcyst LIUYuan*,LIU Bing-yang, ZHOU Yong, et al. *Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang110004,China Correspondingauthor：LIUJin-gang，E-mail：liujg@sj-hospital.org Abstract Objective To investigate the experience of treatments of long-term postoperative complications in congenitalcholedochalcyst(CCC). Methods Retrospectiveanalysisoftheclinicaldataofpostoperativepatientswith long-termcomplicationsin 48 casesofCCCpatientsfromJanuary 1999toDecember 2008 inShengjinghospitalof ChinaMedicalUniversity. Results Thelong-termpostoperativecomplicationsofCCCmainlyincluded 31 casesof biliary lithiasis, 25 cases of repeated cholangitis, 16 cases of stoma stenosis, 3 cases of cyst cancerization. The reoperative methods included complete cyst excision and Roux-en-Y hepatojejunostomy in 28 cases, excision of hepatojejunostomyandreanastomosisin 7 cases,biliaryductexplorationandcalculusremovedin 3cases,biliaryduct explorationandhepaticsegmentexcisionin 3 cases,cystexcisionandpancreatoduodenectomyin 1case. 6 casesof stoma stenosis and/or intrahepatic calculus were managed by percutaneous transhepatic cholangioscopy (PTCS). Conclusions The long-