Mukai Motoi, Kaji Tatsuru, Masuya Ryuta, Yamada Koji, Sugita Koshiro, Moriguchi Tomoe, Onishi Shun, Yamada Waka, Kawano Takafumi, Machigashira Seiro, Nakame Kazuhiko, Takamatsu Hideo, Ieiri Satoshi
Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
Surg Today. 2018 Sep;48(9):835-840. doi: 10.1007/s00595-018-1660-9. Epub 2018 Apr 20.
The late postoperative complications of choledochal cyst (CC) surgery are serious and include intrahepatic stones and biliary carcinoma; therefore, long-term follow-up is crucial.
The subjects of this retrospective study were patients who underwent surgery for CC at Kagoshima University Hospital between April, 1984 and December, 2016. We analyzed the operative results, early and late postoperative complications, and postoperative follow-up rate.
The study population comprised 110 CC patients (male/female: 33/77) with a median age at surgery of 4 years, 3 months (range 12 days-17 years). The patients underwent hepaticoduodenostomy (n = 1; 0.9%) or hepaticojejunostomy (n = 109; 99.1%). Late complications included intrahepatic bile duct (IHBD) dilatation (n = 1; 0.9%), IHBD stones (n = 3; 2.7%), and adhesive ileus (n = 4; 3.6%). There was no incidence of biliary carcinoma in this series. The rates of follow-up at our institute within 10 years of surgery and more than 20 years after surgery were 69.2% (18 of 26) and 14.5% (8 of 55), respectively.
The follow-up rate after definitive surgery declined with time. Late complications were observed within 20 years, but biliary carcinoma was not observed. The follow-up rate should be increased to detect late complications. Moreover, patient education on long-term follow up is essential to prevent life-threatening events after definitive surgery for CC.
胆总管囊肿（CC）手术的术后晚期并发症较为严重，包括肝内结石和胆管癌；因此，长期随访至关重要。
本回顾性研究的对象为1984年4月至2016年12月在鹿儿岛大学医院接受CC手术的患者。我们分析了手术结果、术后早期和晚期并发症以及术后随访率。
研究人群包括110例CC患者（男/女：33/77），手术时的中位年龄为4岁3个月（范围12天至17岁）。患者接受了肝十二指肠吻合术（n = 1；0.9%）或肝空肠吻合术（n = 109；99.1%）。晚期并发症包括肝内胆管（IHBD）扩张（n = 1；0.9%）、IHBD结石（n = 3；2.7%）和粘连性肠梗阻（n = 4；3.6%）。本系列中未发生胆管癌。我院在术后10年内和术后20年以上的随访率分别为69.2%（26例中的18例）和14.5%（55例中的8例）。
根治性手术后的随访率随时间下降。在20年内观察到了晚期并发症，但未观察到胆管癌。应提高随访率以发现晚期并发症。此外，对患者进行长期随访教育对于预防CC根治性手术后的危及生命事件至关重要。
