Lopez-Fernandez Sergio, Hernandez-Martin Sara, Ramírez María, Ortiz Rubén, Martinez Leopoldo, Tovar J A
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
Eur J Pediatr Surg. 2013 Aug;23(4):312-6. doi: 10.1055/s-0033-1333640. Epub 2013 Feb 26.
Abdominal enteric duplications are found in 1 out of 4,500 autopsies, and only 4 to 5% of them are located in the duodenum, where they may be connected with the biliary or pancreatic ducts. The aim of this study was to describe the clinical features, management, and outcome of a large series of duodenal duplication cysts.
The charts of all patients treated at our institution between 1985 and 2011 were reviewed retrospectively with particular attention to imaging, surgical technique, pathology, and outcome.
During that period, 11 cases (81.8% females) were treated. Out of the 11 patients, 8 were symptomatic (vomiting in 3, recurrent acute pancreatitis in 2, and abdominal pain in 3) and 3 were tentatively diagnosed prenatally as choledochal cysts. Median age at surgery was 2.3 years (0 to 13.7) and preoperative diagnosis was correct in five cases. Five cysts were developed intraluminally and three communicated with the biliary duct (one), pancreatic duct (one), or both (one). Surgical treatment consisted of complete resection (four cases, including one pancreaticoduodenectomy), partial removal including all mucosa (four cases), and internal marsupialization (three cases). In all cases, the ductal communications were divided and opened into the duodenal lumen. In six cases, ectopic gastric mucosa was found. All patients recovered uneventfully.
Duodenal duplication cysts are rare and may have bizarre anatomical patterns due to biliopancreatic involvement. Optimal treatment is complete surgical removal, and, if this is not possible, partial removal including the mucosa or marsupialization are also good alternatives. In cases with biliary and pancreatic tract connections, these have to be taken down carefully and drained into the duodenum.
腹部肠道重复畸形在4500例尸检中出现1例，其中仅4%至5%位于十二指肠，十二指肠重复畸形可能与胆管或胰管相连。本研究旨在描述一系列十二指肠重复囊肿的临床特征、治疗方法及预后。
回顾性分析1985年至2011年在我院接受治疗的所有患者的病历，特别关注影像学、手术技术、病理学及预后情况。
在此期间，共治疗11例患者（女性占81.8%）。11例患者中，8例有症状（3例呕吐，2例复发性急性胰腺炎，3例腹痛），3例在产前被初步诊断为胆总管囊肿。手术时的中位年龄为2.3岁（0至13.7岁），5例术前诊断正确。5个囊肿呈腔内生长，3个与胆管（1例）、胰管（1例）或两者（1例）相通。手术治疗包括完整切除（4例，包括1例胰十二指肠切除术）、部分切除包括所有黏膜（4例）和内袋形缝合术（3例）。所有病例中，导管连接处均被切断并开口于十二指肠腔。6例发现异位胃黏膜。所有患者均顺利康复。
十二指肠重复囊肿罕见，由于胆胰受累可能具有奇特的解剖结构。最佳治疗方法是完整手术切除，如果无法做到，部分切除包括黏膜或袋形缝合术也是不错的选择。对于有胆道和胰管连接的病例，必须小心处理并引流至十二指肠。
