Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan.
Department of Pediatric Surgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1 Yasashicho, Asahi, Yokohama, Kanagawa, 241-0811, Japan.
Pediatr Surg Int. 2021 Feb;37(2):241-245. doi: 10.1007/s00383-020-04790-1. Epub 2021 Jan 22.
The standard surgical procedure for congenital biliary dilatation (CBD) consists of excision of extrahepatic bile duct and Roux-en-Y hepaticojejunostomy (HJ). However, alternative reconstructive operations for CBD includes hepaticoduodenostomy (HD). We compared postoperative complications and therapeutic outcomes of these two operations at our institution.
From 1981 to 2009, there were 23 traceable patients who underwent operation for CBD, They were divided into an HJ Group (n = 15) and an HD Group (n = 8). Demographic and outcome data were compared.
There were no significant differences in postoperative complications (cholangitis, pancreatitis, and anastomotic stenosis) and current blood test data (AST, ALT, Total Bilirubin, Direct Bilirubin, Amylase) between the two groups. Current abdominal pain and carcinogenesis were not observed in either group. Intrahepatic stones occurred in one patient in each group, both > 25 years post-operation.
HD is considered to be an acceptable reconstruction method compared to HJ, based on our results. There has been a suggestion that inadequate diversion in HD might increase the risk of cholangiocarcinoma. To date, in this series, that has not happened.
先天性胆管扩张症（CBD）的标准手术方法包括肝外胆管切除术和 Roux-en-Y 肝肠吻合术（HJ）。然而，CBD 的其他重建手术还包括胆肠吻合术（HD）。我们比较了我院这两种手术的术后并发症和治疗效果。
1981 年至 2009 年，共有 23 例可追踪的 CBD 手术患者，分为 HJ 组（n=15）和 HD 组（n=8）。比较两组患者的人口统计学和结果数据。
两组患者术后并发症（胆管炎、胰腺炎和吻合口狭窄）和目前的血液检查数据（AST、ALT、总胆红素、直接胆红素、淀粉酶）均无显著差异。两组均未出现目前的腹痛和癌变。两组各有 1 例患者在术后 25 年以上出现肝内结石。
根据我们的结果，HD 被认为是一种可接受的与 HJ 相比的重建方法。有研究表明，HD 分流不足可能增加胆管癌的风险。到目前为止，在本系列中尚未发生这种情况。
