Takiff H, Stone M, Fonkalsrud E W
Am J Surg. 1985 Jul;150(1):141-6. doi: 10.1016/0002-9610(85)90023-6.
The UCLA Medical Center experience in the surgical treatment of 23 young patients with choledochal cysts over a 28 year period has been reviewed. All patients had saccular or fusiform extrahepatic cysts, and one patient also had a diverticular cyst. Eleven patients had no intrahepatic dilatation, whereas 9 had cylindrical and 3 cystic intrahepatic dilatation. There were 39 operations for biliary drainage performed: 17 Roux-Y choledochojejunostomies, 7 choledochoduodenostomies, 7 excisions, and 8 miscellaneous procedures. The morbidity for initial operations was 17 percent and for reoperations, 31 percent. Biliary calculi were found after 2 of 23 primary operations (9 percent) and 6 of 16 reoperations (37.5 percent). All developed while enteric drainage was present and were primary bile duct stones. No reoperation was necessary after cyst excision. An intrahepatic cholangiocarcinoma developed in one patient treated with enteric drainage. Three of 10 patients who did not undergo cholecystectomy at their initial operation later required laparotomy for cholecystectomy alone. We recommend cholecystectomy and cyst excision when technically feasible for primary operative treatment of choledochal cysts.
回顾了加州大学洛杉矶分校医学中心在28年期间对23例胆总管囊肿年轻患者进行手术治疗的经验。所有患者均有囊状或梭形肝外囊肿，1例患者还患有憩室样囊肿。11例患者无肝内扩张，9例有柱状肝内扩张，3例有囊性肝内扩张。共进行了39次胆道引流手术：17例 Roux-Y 胆总管空肠吻合术、7例胆总管十二指肠吻合术、7例切除术和8例其他手术。初次手术的发病率为17%，再次手术的发病率为31%。23例初次手术中有2例（9%）发现胆石，16例再次手术中有6例（37.5%）发现胆石。所有胆石均在有肠道引流时出现，且均为原发性胆管结石。囊肿切除术后无需再次手术。1例接受肠道引流治疗的患者发生了肝内胆管癌。10例初次手术时未行胆囊切除术的患者中有3例后来仅因胆囊切除术而行剖腹手术。我们建议，在技术可行时，对胆总管囊肿进行初次手术治疗时应行胆囊切除术和囊肿切除术。
