Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
J Pediatr Surg. 2010 Feb;45(2):379-82. doi: 10.1016/j.jpedsurg.2009.10.083.
We routinely perform intraoperative endoscopy (IOE) of the intrahepatic bile duct (IHBD) and intrapancreatic bile duct (IPBD) with a pediatric cystoscope during excision of choledochal cyst (CC). Here we compare extended long-term follow-up patients with a series of recent cases.
We compared 25 CC patients treated over the past 5 years (group 1) with 69 CC patients treated between 1986 and 1998 and followed up for more than 10 years (group 2), focusing on stone formation.
In group 1 (mean follow-up, 2.6 years) IOE identified IHBD debris in 7 (28%) of 25 and IPBD protein plugs in 9 (36%) of 25. In group 2 (mean follow-up, 14.6 years) IOE identified IHBD debris in 11 (16%) of 69 and IPBD protein plugs in 17 (25%) of 69. There was no relation between type of CC and incidence of IHBD debris or IPBD protein plugs. The incidence of postoperative stones to date is 0% in group 1 and 2.9% in group 2, rates far lower than those reported in the literature.
We attribute our lower incidence of stones directly to IOE and recommend that it be performed routinely during cyst excision. It is simple, is effective, and improves outcome.
我们在切除胆总管囊肿（CC）时，常规使用小儿膀胱镜进行肝内胆管（IHBD）和胰内胆管（IPBD）的术中内镜检查（IOE）。在此，我们将比较长期随访的患者与一系列近期病例。
我们比较了过去 5 年（第 1 组）的 25 例 CC 患者和 1986 年至 1998 年治疗且随访时间超过 10 年的 69 例 CC 患者（第 2 组），重点关注结石形成。
第 1 组（平均随访 2.6 年）中，7 例（28%）的 IHBD 中有胆管碎片，9 例（36%）的 IPBD 中有蛋白栓。第 2 组（平均随访 14.6 年）中，11 例（16%）的 IHBD 中有胆管碎片，17 例（25%）的 IPBD 中有蛋白栓。CC 类型与 IHBD 碎片或 IPBD 蛋白栓的发生率之间无关系。迄今为止，第 1 组和第 2 组的术后结石发生率分别为 0%和 2.9%，远低于文献报道的发生率。
我们将结石发生率的降低归因于 IOE，并建议在囊肿切除时常规进行。它简单、有效，改善了治疗结果。
