Ishii Junya, Miyano Go, Takahashi Toshiaki, Ochi Takanori, Miyake Yuichiro, Koga Hiroyuki, Seo Shogo, Lane Geoffrey J, Fukumoto Koji, Arakawa Atsushi, Yamataka Atsuyuki
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
Pediatr Surg Int. 2022 Dec 27;39(1):65. doi: 10.1007/s00383-022-05339-0.
During choledochal cyst (CC) excision, the hepaticojejunostomy anastomosis (HJA) can be performed conventionally (CHJA) or with a Carrel patch (CPA). CPA can increase CHD diameter to 10-13 mm, preventing anastomotic stenosis and intrahepatic bile duct (IHBD) stones but may be at risk for malignant transformation.
The medical records of 83 cystic-type CC with CHD ≤ 9 mm followed up for at least 20 years were reviewed retrospectively. Available excised CC specimens (70/83) were re-examined blindly for pre-malignant changes. A questionnaire about suturing narrow lumens was conducted.
All 83 had pancreaticobiliary maljunction. Group data were similar. Anastomoses were CPA (n = 43) and CHJA (n = 40). Mean diameter for CPA was 11.4 mm (range: 10-13 mm); for CHJA was 7.4 mm (range: 5-9 mm). Mean follow-up was 27.7 years (range: 20-42). Postoperative anastomotic stenoses were less after CPA: 1/43 (2.3%) versus 5/40 (12.5%) (p = 0.10), but CHJA had significantly more postoperative IHBD stones: 0% versus 4/40 (10.0%) (p < 0.05). All IHBD stone patients had anastomotic stenosis. Excised specimens showed no pre-malignant cytology. Lumen diameter ≤ 9 mm was considered challenging by 10/10 surgical trainees and ≤ 7 mm by 16/22 pediatric surgeons.
CPA appears to be oncologically safe because of the absence of malignant transformation for at least 20 years.
在胆总管囊肿（CC）切除术中，肝空肠吻合术（HJA）可采用传统方式（CHJA）或使用卡雷尔补片（CPA）进行。CPA可将胆总管直径增加至10 - 13毫米，预防吻合口狭窄和肝内胆管（IHBD）结石形成，但可能存在恶变风险。
回顾性分析83例胆总管直径≤9毫米的囊性CC患者的病历，这些患者至少随访20年。对可用的切除CC标本（70/83）进行盲法复查，以检查癌前病变。针对缝合狭窄管腔进行问卷调查。
83例患者均存在胰胆管合流异常。两组数据相似。吻合方式为CPA（n = 43）和CHJA（n = 40）。CPA的平均直径为11.4毫米（范围：10 - 13毫米）；CHJA的平均直径为7.4毫米（范围：5 - 9毫米）。平均随访时间为27.7年（范围：20 - 42年）。CPA术后吻合口狭窄较少：1/43（2.3%）对比5/40（12.5%）（p = 0.10），但CHJA术后IHBD结石明显更多：0%对比4/40（10.0%）（p < 0.05）。所有IHBD结石患者均有吻合口狭窄。切除标本未显示癌前细胞学改变。1 / 10外科住院医师认为管腔直径≤9毫米具有挑战性，16 / 22儿科外科医生认为≤7毫米具有挑战性。
由于至少20年未发生恶变，CPA在肿瘤学上似乎是安全的。
