先天性胆总管囊肿再次手术的原因分析及治疗.doc

先天性胆总管囊肿再次手术的原因分析及治疗 张成武 赵大建 吴伟顶 胡智明 张宇华 刘杰 【摘要】 目的 探讨先天性胆总管囊肿再次手术的原因分析及治疗。方法 对41例先天性胆总管囊肿再次手术患者的临床资料进行总结分析。结果 按先天性胆总管囊肿Todani分析，41例中I型32例，II型1例，IV型3例，V型5例（其中1例呈弥漫性左右肝分布）。既往有1次胆道手术史者30例，2次者8例，3次者3例。41例中合并有胆管结石40例，胆道感染33例，肝门部胆管狭窄7例，原肝肠吻合口狭窄6例，囊肿癌变5例。本次行切肝外胆管囊肿、肝管空肠Roux-en-Y吻合者32例，其中2例囊肿癌病变着同时行肝十二指肠韧带骨骼化和区域淋巴结清扫术；行肝叶切除联合胆总管囊肿切除、肝管空肠Roux-en-Y吻合者8例；行胆肠吻合口狭窄切开成形、肝肠内引流重建术1例。41例术后均获随访，随访时间3个月至10年，平均53.7+32.1个月，随访期内发生肝道感染4例，无吻合口狭窄或结石复发等并发症发生。结论 胆总管囊肿术式选择不当及诊断失误导致的多种并发症是导致再手术的主要原因，肝内外胆管囊肿切除、肝管空肠Roux-en-Y吻合术可取得较为满意的疗效。 【关键词】 胆总管囊肿；再手术；手术后并发症 Reoperative surgery for congenital cyst ZHANG Cheng-wu,ZHAO Da-jian,WU Wei-ding,HU Zhi-ming,ZHANG Yu-hua,LIU Jie.Department of Hepatobiliary Surgery,Zhejiang Provincial People’s Hospital.Hangzhou 310014,China Corresponding author:ZHANG Cheng-wu,E-mail:zcw1989@ [Abstract] Objective To study the causes of and management for reoperative surgery in patients of congenital choledochal cyst. Methods The clinical data of 41 patients of congenital choledochal cysts undergoing peoperative surgeries were reviewed. Results There were 32 cases of type I,1 of type II,3 of type IV, and 5of type V according to Todani classification of congenital choledochal cyst. Thirty patients experienced one previous biliary tract surgery, 8 had a history of 2 surgeries and 3 experienced three times of operations previously. Among the 41 patients ,40 presented bile duct stones, 33 suffered from biliary infections, 7 had hilar hepatic duct strictures, 6 had strictures of previous hepatoenteric anastomosis, 5 had carcinomas arising in cysts. The reoperative surgeries of the 41 patients consisted of excisions of extre-hepatic bile cyst and hepato-jejunal anastomosis by Roux-Y fashion(combining with hepatoduodenal ligament dissection and regional lymphadenectomy for two patients with cholangiocarcinoma) in 32 cases, hepatectomies combined with excisions of choldeochal cyst and hepato-jejunal anastomosis in 8cases, reconstruction of hepatoenteric anastomosis by ex