Kim Jong Wook, Moon Sung-Hoon, Park Do Hyun, Lee Sang Soo, Seo Dong Wan, Kim Myung-Hwan, Lee Sung Koo
Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Scand J Gastroenterol. 2010 Jun;45(6):739-45. doi: 10.3109/00365521003675054.
To compare natural course and treatment results of various types of choledochal cysts.
Complication rate in treated (T) and natural course in not treated (NT) patients with choledochal cysts were compared. The level of bilioenteric anastomosis after cyst resection was categorized and their post-procedure courses were analyzed.
A total of 204 patients (T, 174; NT, 30) were included. Patients with initial malignancies were excluded from the outcome analysis (n = 13). Of the remaining 191 patients, the mean follow-up time was 35.9 months (range 6-310.7 months). Biliary stricture was the most troublesome post-operative complication, and occurred in 10 patients (6.1%). It occurred significantly more frequently in the above hilar anastomosis group than in at or below (p-trend = 0.017), and also with older age (p-trend = 0.019). Common bile duct stone was the most frequent adverse event among NT (42.9%). Overall, there were fewer complications among treated patients (T, 17.2%; NT, 67.9%; p < 0.001). Anomalous pancreaticobiliary union (APBU) was present in 69 patients (37.5%), which was associated with higher prevalence of carcinoma (APBU-present, 13%; APBU-absent, 3.5%; p = 0.019). No malignancy developed in both T and NT groups during follow-up.
This study suggests, that even asymptomatic choledochal cysts should be treated, not only for prevention of malignancies, but also to lower the future adverse events. Bilioenteric anastomosis at larger caliber duct is recommended for prevention of post-operative biliary strictures.
比较不同类型胆总管囊肿的自然病程及治疗效果。
比较接受治疗（T）的胆总管囊肿患者和未接受治疗（NT）的患者的并发症发生率。对囊肿切除术后胆肠吻合的水平进行分类，并分析其术后病程。
共纳入204例患者（T组174例，NT组30例）。初始患有恶性肿瘤的患者被排除在结局分析之外（n = 13）。在其余191例患者中，平均随访时间为35.9个月（范围6 - 310.7个月）。胆管狭窄是最麻烦的术后并发症，发生在10例患者中（6.1%）。其在肝门以上吻合组的发生率明显高于肝门及以下组（p趋势 = 0.017），且与年龄较大有关（p趋势 = 0.019）。胆总管结石是NT组中最常见的不良事件（42.9%）。总体而言，接受治疗的患者并发症较少（T组17.2%，NT组67.9%；p < 0.001）。69例患者（37.5%）存在胰胆管合流异常（APBU），其与较高的癌症患病率相关（存在APBU，13%；不存在APBU，3.5%；p = 0.019）。随访期间T组和NT组均未发生恶性肿瘤。
本研究表明，即使是无症状的胆总管囊肿也应接受治疗，不仅是为了预防恶性肿瘤，也是为了降低未来的不良事件。建议在较大口径的胆管进行胆肠吻合以预防术后胆管狭窄。
