胆总管囊肿：它们是胆总管囊肿吗？

Choledochoceles: are they choledochal cysts?

机构信息

Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.

出版信息

Ann Surg. 2010 Oct;252(4):683-90. doi: 10.1097/SLA.0b013e3181f6931f.

DOI:10.1097/SLA.0b013e3181f6931f

PMID:20881775

Abstract

OBJECTIVE

The aim of this analysis was to report a multidisciplinary series comparing choledochoceles to Todani Types I, II, IV, and V choledochal cysts.

SUMMARY BACKGROUND DATA

Choledochoceles have been classified as Todani Type III choledochal cysts. However, most surgical series of choledochal cysts have reported few choledochoceles because they are managed primarily by endoscopists.

METHODS

Surgical, endoscopic, and radiologic records were reviewed at the Riley Children's Hospital and the Indiana University Hospitals to identify patients with choledochal cysts. Patient demographics, presenting symptoms, radiologic studies, associated abnormalities, surgical and endoscopic procedures as well as outcomes were reviewed.

RESULTS

A total of 146 patients with "choledochal cysts" including 45 children (31%) and 28 with choledochoceles (18%) were identified, which represents the largest Western series. Patients with choledochoceles were older (50.7 vs. 29.0 years, P < 0.05) and more likely to be male (43% vs. 19%, P < 0.05), to present with pancreatitis (48% vs. 24%, P < 0.05) rather than jaundice (11% vs. 30%, P < 0.05) or cholangitis (0% vs. 21%, P < 0.05), to have pancreas divisum (38% vs. 10%, P < 0.01), and to be managed with endoscopic therapy (79% vs. 17%, P < 0.01). Two patients with choledochoceles (7%) had pancreatic neoplasms.

CONCLUSIONS

Patients with choledochoceles differ from patients with choledochal cysts with respect to age, gender, presentation, pancreatic ductal anatomy, and their management. The association between choledochoceles and pancreas divisum is a new observation. Therefore, we conclude that classifications of choledochal cysts should not include choledochoceles.

摘要

目的

本分析旨在报告一项多学科系列研究，比较胆总管囊肿与 Todani Ⅰ型、Ⅱ型、Ⅳ型和Ⅴ型胆总管囊肿。

摘要背景数据

胆总管囊肿曾被归类为 Todani Ⅲ型胆总管囊肿。然而，由于大多数胆总管囊肿的手术系列报告中胆总管囊肿较少，因为它们主要由内镜医生管理。

方法

在 Riley 儿童医院和印第安纳大学医院回顾手术、内镜和放射学记录，以确定患有胆总管囊肿的患者。回顾患者的人口统计学、临床表现、放射学研究、相关异常、手术和内镜程序以及结果。

结果

共确定了 146 名患有“胆总管囊肿”的患者，其中 45 名儿童（31%）和 28 名患有胆总管囊肿（18%），这是西方最大的系列。胆总管囊肿患者年龄较大（50.7 岁比 29.0 岁，P < 0.05），更可能为男性（43%比 19%，P < 0.05），表现为胰腺炎（48%比 24%，P < 0.05）而不是黄疸（11%比 30%，P < 0.05）或胆管炎（0%比 21%，P < 0.05），胰腺分裂（38%比 10%，P < 0.01）更多，内镜治疗（79%比 17%，P < 0.01）。2 名胆总管囊肿患者（7%）患有胰腺肿瘤。