Ullah A O, Amin M R
Dr Abu Saleh Md Oli Ullah, Assistant Professor, Department of Paediatric Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; E-mail:
Mymensingh Med J. 2020 Apr;29(2):337-340.
Excision of type I choledochal cyst mandates restoration of continuity of extrahepatic biliary drainage system through anastomotic options having their advantages and disadvantages. Roux en-Y Hepaticojejunostomy (RYHJ) has been very popular and long studied standard surgical treatment for type I choledochal cyst. But now Hepaticoduodenostomy (HD) is also being practiced and studied in different centers all over the world for the treatment of the same disease. We have been practicing Hepaticoduodenostomy for treating type I choledochal cyst, at Bangabandhu Sheik Mujib Medical University (BSMMU), for last five years. Here, we are presenting our experience at BSMMU Hospital, regarding immediate post-operative outcome of Hepaticoduodenostomy for the treatment of type I Choledochal cyst, to show whether this procedure can be safely practiced, producing acceptable results. It is a retrospective document review of forty two MRCP confirmed type I Choledochal cyst children, admitted and operated at BSMMU Hospital, from January 2013 to December 2017. Patient's particulars, history, physical examination, investigations (including MRCP confirmation), assessment, surgical plan were collected from relevant medical records under standard privacy protocol. Information regarding early post-operative outcome of Hepaticoduodenostomy in treating uncomplicated type I choledochal cyst were searched for review and evaluation, specifically with respect to- a) mortality (if any); b) morbidities like- i) prolonged post-operative abdominal pain, ii) anastomotic bile leak, iii) features of early Cholangitis, iv) wound dehiscence and c) prolonged Hospital stay. There was no immediate post-operative mortality. But 9(21.42%) patients had prolonged post-operative pain requiring parenteral Pethidine 'on demand' beyond second post-operative day, 2(4.76%) had anastomotic bile leak, 7(16.67%) had early cholangitis and 1(2.38%) had abdominal wound dehiscence; they (21.42%) also stayed in hospital for more than fourteen days. The outcome was acceptably safe when compared with other studies abroad. Through this study, at BSMMU Hospital, immediate post-operative outcome of Hepaticoduodenostomy for treating type I choledochal cyst- in terms of morbidity, mortality and hospital stay- was found to be yielding acceptable results, for safe practice.
I 型胆总管囊肿切除术需要通过具有各自优缺点的吻合方式来恢复肝外胆管引流系统的连续性。Roux-en-Y 肝空肠吻合术（RYHJ）一直是治疗 I 型胆总管囊肿非常流行且经过长期研究的标准手术方式。但如今，肝十二指肠吻合术（HD）也在世界各地的不同中心用于治疗同一种疾病并得到研究。在过去五年里，我们一直在孟加拉国谢赫·穆吉布医学大学（BSMMU）采用肝十二指肠吻合术治疗 I 型胆总管囊肿。在此，我们介绍在 BSMMU 医院关于肝十二指肠吻合术治疗 I 型胆总管囊肿术后即刻结果的经验，以表明该手术是否能够安全实施并产生可接受的效果。这是一项对 2013 年 1 月至 2017 年 12 月期间在 BSMMU 医院收治并接受手术的 42 例经磁共振胰胆管造影（MRCP）确诊的 I 型胆总管囊肿患儿的回顾性文献研究。根据标准隐私协议，从相关病历中收集患者的详细信息、病史、体格检查、检查结果（包括 MRCP 确诊）、评估情况及手术方案。搜索并回顾评估了肝十二指肠吻合术治疗单纯性 I 型胆总管囊肿术后早期结果的相关信息，具体涉及：a）死亡率（如有）；b）并发症，如 i）术后持续性腹痛、ii）吻合口胆漏、iii）早期胆管炎特征、iv）伤口裂开；以及 c）住院时间延长。术后无即刻死亡病例。但有 9 例（21.42%）患者术后持续性疼痛，术后第二天后需要按需注射哌替啶；2 例（4.76%）发生吻合口胆漏；7 例（16.67%）出现早期胆管炎；1 例（2.38%）发生腹部伤口裂开；这些患者（21.42%）住院时间也超过了 14 天。与国外其他研究相比，该结果的安全性是可接受的。通过本研究发现，在 BSMMU 医院，肝十二指肠吻合术治疗 I 型胆总管囊肿在术后并发症、死亡率及住院时间方面的即刻结果是可接受的，能够安全实施。
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