囊肿切除间置空肠术治疗Ⅰ型先天性胆总管囊肿21例临床研究.doc

囊肿切除间置空肠术治疗Ⅰ型先天性胆总管囊肿21例临床研究［摘要］目的：探讨Ⅰ型先天性胆总管囊肿的手术方式及疗效。方法：对切除囊肿行空肠间置胆肠吻合手术治疗的Ⅰ型先天性胆总管囊肿21例临床资料进行分析。结果：手术后早期发生2例吻合口胆汁漏，均经保守治疗漏口愈合；1年内2例发生吻合口狭窄，并发肝内胆管结石，再次手术取石并扩大吻合口治愈。一次手术治愈率90.5%(19/21)。本组无反流性胆管炎及胆管癌发生。结论：应用胆总管囊肿切除后行空肠间置的胆肠吻合术治疗Ⅰ型胆总管囊肿，并尽量扩大吻合口，为可行有效的术式。 ［关键词］胆总管囊肿；空肠间置；反流性胆管炎；胆管癌 [中图分类号] R657.4 [文献标识码]B [文章编号]1673-7210（2008）09（b）-173-02 Clinical analysis of 21 cases of treating Ⅰtype congenital choledoch cyst by the operation of interpositional jejunum after excising cyst WANG Rui （Department of surgery, Lanshan district People’s Hospital of Linyi, Linyi276002, China） [Abstract] Objective：To explore the operation selection and the therapeutic effect inⅠtype congenital choledochal cyst. Methods：To analyse the date of 21 cases of treatingⅠtype congenital choledoch cyst using cholangiojejunostomy with the operation of interpositional jejunum after excising cyst. Results：2 patients anastomosis leaked bile which were cured by the conservative treatments after the operation in early time. 2 patients? anastomosis occurred narrow and concurred stone inside the bile ducts of the liver which were cured by expanding the anastomotic stoma and taking out the stone in 1 year. The cure rate was 90.5% (19/21) at once operation. There didn?t occur regurgitation cholangitis and bile duct cancers in this group. Conclusion: It?s practical and effective operation selection to treatⅠtype congenital choledoch cyst using cholangiojejunostomy with the operation of interpositional jejunum after excising cyst, and with expanding the anastomotic stoma of cholangiojejunostomy as far as possible. [Key words]Choledoch; Interpositional jejunu; Regurgitation cholangitis; Bile duct cancer 先天性胆总管囊肿的手术方式较多，目前主要采取胆总管囊肿切除及胆道重建术。我院自1994年3月～2006年6月对21例Ⅰ型先天性胆总管囊肿行囊肿切除并间置空肠胆管空肠吻合术，疗效较满意，现对本组临床资料进行回顾性分析。 1资料与方法 1.1一般资料 本组21例，男6例，女15例。年龄11～63岁，平均年龄28.6岁。本组均为I型先天性胆总管囊肿。临床表现为黄疸15例，右上腹疼痛14例，上腹触及包块9例，三者均存在7例；合并急性化脓性胆管炎2例；合并肝内外胆管结石4例，胆汁性肝炎和(或)肝硬化3例，局部肝萎缩3例；肝功能均有不同程度受损；本组均经B超或CT检查