Flanigan P D
Ann Surg. 1975 Nov;182(5):635-43. doi: 10.1097/00000658-197511000-00017.
This review brings the total number of biliary cysts reported in the world literature to 955. Eighty-one per cent of patients are females and 61% were discovered before age ten. The classical triad of right upper quadrant pain, right upper quandrant mass, and juandice is present in 38% of cases. The duration of symptoms prior to diagnosis ranged from less than one week to more than 40 years. The etiology is multifaceted and evidence of the existence of both acquired and congenital cysts is presented. The most useful diagnostic tool is fiberoptic endoscopy with retrograde contrast injection of the common bile duct and pancreatic duct. The incidence of biliary carcinoma in patients with biliary cysts is found to be 2.5%; 24 cases have been reported. Considerable controversy has existed concerning the best operative procedure for biliary cysts; no treatment or medical treatment yielding a 97% mortality rate. In an analysis of 235 patients presented since 1968 with an average followup of 5.2 years, the best procedure appears to be excision with either choledochocholedocostomy or Roux-en-Y hepaticojejunostomy. The operative mortality for all procedures is now 3 to 4%.
这篇综述使世界文献中报道的胆管囊肿总数达到955例。81%的患者为女性，61%在10岁前被发现。38%的病例出现右上腹疼痛、右上腹肿块和黄疸这一经典三联征。诊断前症状持续时间从不到一周到超过40年不等。病因是多方面的，文中呈现了后天性和先天性囊肿存在的证据。最有用的诊断工具是纤维内镜逆行胆管和胰管造影。胆管囊肿患者的胆管癌发病率为2.5%；已报道24例。关于胆管囊肿的最佳手术方法一直存在相当大的争议；不治疗或药物治疗的死亡率为97%。在对1968年以来出现的235例患者进行的分析中，平均随访5.2年，最佳手术方法似乎是行胆管囊肿切除并进行胆总管对端吻合术或Roux-en-Y肝空肠吻合术。目前所有手术的死亡率为3%至4%。
