Caudle S O, Dimler M
Am Surg. 1986 Feb;52(2):76-80.
The diagnosis and treatment of choledochal cysts have changed dramatically in the past decade. Although history and physical exam remain paramount in arousing clinical suspicions, the classic triad of abdominal pain, jaundice, and a palpable mass is present infrequently. Ultrasonography can readily identify and precisely locate upper abdominal masses and distinguish between intrahepatic, extrahepatic, renal, and gastrointestinal cystic and solid masses. Use of the new iminodiacetic acid tracers then allows visualization of these cysts even in the presence of significant jaundice or abnormal liver function tests. For many years choledochal cystenterostomy was considered the treatment of choice because of the high morbidity and mortality originally associated with attempts at total excision. Over the years, evaluation of cystenterostomy has revealed an unacceptable rate of recurrent jaundice, ascending cholangitis, stone formation, and anastamotic stricture. In addition, a disturbing incidence of highly malignant biliary duct carcinoma that increases with the passage of time has been reported. Total excision of choledochal cysts has been reported in the English and Japanese literature with minimal morbidity and mortality and has become the treatment of choice. The authors' recent experience of two patients with this relatively rare condition confirms these changing trends and will be reported here.
在过去十年中，胆总管囊肿的诊断和治疗发生了巨大变化。尽管病史和体格检查在引发临床怀疑方面仍然至关重要，但腹痛、黄疸和可触及肿块这一经典三联征并不常见。超声检查能够轻易识别并精确定位上腹部肿块，区分肝内、肝外、肾以及胃肠道的囊性和实性肿块。使用新型亚氨基二乙酸示踪剂，即使在存在明显黄疸或肝功能检查异常的情况下，也能使这些囊肿显影。多年来，由于最初尝试完全切除时伴随的高发病率和死亡率，胆总管囊肿肠吻合术一直被视为首选治疗方法。多年来，对囊肿肠吻合术的评估显示，复发性黄疸、上行性胆管炎、结石形成和吻合口狭窄的发生率令人难以接受。此外，还报告了随着时间推移高度恶性胆管癌的发生率令人不安地增加。英文和日文文献中均有关于胆总管囊肿完全切除的报道，其发病率和死亡率极低，已成为首选治疗方法。作者近期对两名患有这种相对罕见病症患者的经验证实了这些变化趋势，并将在此报告。
