Nagorney D M, McIlrath D C, Adson M A
Surgery. 1984 Oct;96(4):656-63.
The surgical management of 29 adults with choledochal cysts is reviewed with emphasis on clinicopathologic features, long-term postoperative results (mean 9.1 years), and factors affecting outcome. Clinical symptoms were characterized by abdominal pain, jaundice, and cholangitis. Coexistent hepatobiliary pathologic findings were more complex and frequent than those that occur in children and included cystolithiasis or cholelithiasis, pancreatitis, malignancy, cirrhosis with portal hypertension, and intrahepatic abscess. Associated pathologic findings and cyst type (type I-22, II-1, III-2, IVA-4) determined the operative approach. In patients with type I or IVA cysts, results of cyst excision were excellent in five of seven patients but results of cystenterostomy were excellent in only seven of 19 patients. The high prevalence of pancreatitis (33%) and cyst-associated malignancy (28%) were major causes of treatment failure. Cyst excision with Roux-en-Y hepaticojejunostomy is recommended as the treatment of choice for adults to eliminate pancreatitis by pancreaticobiliary disconnection and possibly to reduce the risk of malignancy.
回顾了29例成人胆总管囊肿的手术治疗情况，重点关注临床病理特征、术后长期结果（平均9.1年）以及影响预后的因素。临床症状以腹痛、黄疸和胆管炎为特征。与儿童相比，并存的肝胆病理表现更为复杂和常见，包括囊肿结石或胆结石、胰腺炎、恶性肿瘤、伴有门静脉高压的肝硬化以及肝内脓肿。相关病理表现和囊肿类型（I型-22例、II型-1例、III型-2例、IVA 型-4例）决定了手术方式。对于I型或IVA 型囊肿患者，7例患者中有5例囊肿切除效果极佳，但19例患者中只有7例囊肿肠吻合术效果极佳。胰腺炎的高发病率（33%）和囊肿相关恶性肿瘤的高发病率（28%）是治疗失败的主要原因。建议采用囊肿切除加 Roux-en-Y 肝空肠吻合术作为成人的首选治疗方法，通过胰胆管离断消除胰腺炎，并可能降低恶性肿瘤风险。
