Ⅲ型胆总管囊肿的诊断与微创治疗。
Diagnosis and minimally invasive treatment of type III choledochal cysts.
机构信息
Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, 71 Xinmin Street, Changchun City, Jilin Province, China.
出版信息
BMC Surg. 2022 Jul 14;22(1):272. doi: 10.1186/s12893-022-01713-w.
BACKGROUND
Type III choledochal cysts (CCs) are the rarest and least well-characterized of the five variants of biliary cysts. Only a few relevant studies have been conducted and a gold standard treatment for type III CCs is still lacking because of their scarcity. An unusual case of type III CC with choledochocele at the end of the distal common bile duct (CBD) with no bulging of the duodenum is presented here.
CASE PRESENTATION
A 61-year-old woman presented to our department with repeated upper abdominal pain for one year. Laboratory examination revealed abnormal liver function and a slight increase in the white blood cell (WBC) count and proportion of neutrophils. In an MRCP of the patient, the distal CBD was found to have a cystic structure indicative of a type III CC. Endoscopic retrograde cholangiopancreatograpy (ERCP) revealed cystic findings compatible with Todani type III CCs. However, duodenoscopy did not show a bulge in the duodenum so laparoscopic cholecystectomy and Roux-en-Y hepaticojejunostomy were performed. In her 6-month follow-up, the patient reported that recovery from the operation was uneventful.
CONCLUSIONS
ERCP has become the gold standard for diagnosing type III CCs. Type III CCs can be treated minimally invasively with laparoscopic cholecystectomy and Roux-en-Y hepaticojejunostomy.
背景
III 型胆总管囊肿（CC）是五种胆管囊肿中最罕见且特征最少的一种。由于其罕见性，仅有少数相关研究，III 型 CC 的金标准治疗方法仍然缺乏。本文报告了一例不伴有十二指肠隆起的胆总管末端憩室型 III 型 CC 的罕见病例。
病例介绍
一名 61 岁女性因反复上腹痛一年就诊于我院。实验室检查显示肝功能异常，白细胞（WBC）计数和中性粒细胞比例略有增加。患者的 MRCP 显示远端 CBD 有囊性结构，提示为 III 型 CC。内镜逆行胰胆管造影（ERCP）显示与 Todani 分型 III 型 CC 相符的囊性表现。然而，十二指肠镜检查未发现十二指肠隆起，因此行腹腔镜胆囊切除术和 Roux-en-Y 肝肠吻合术。在 6 个月的随访中，患者报告手术恢复顺利。
结论
ERCP 已成为诊断 III 型 CC 的金标准。III 型 CC 可通过腹腔镜胆囊切除术和 Roux-en-Y 肝肠吻合术进行微创治疗。
Zotero 插件