Ando H, Ito T, Watanabe Y, Seo T, Kaneko K, Nagaya M
Department of Surgery, Branch Hospital, University of Nagoya School of Medicine, Japan.
J Am Coll Surg. 1995 Aug;181(2):125-8.
Spontaneous perforation of the common bile duct in children is very rare and its etiology is unknown. We describe herein five patients treated for the spontaneous perforation of choledochal cyst and suggest the important factors leading to perforation.
All patients were initially treated with T-tube drainage through the perforated site. Cholangiography through the T tube was performed intraoperatively and the important factors leading to perforation were examined. Furthermore, histological examination of the perforated wall of the common bile duct was performed.
Cholangiography through a T tube revealed the presence of a pancreaticobiliary junction malformation and filling defects (protein plugs) in the common channel in all patients. Postoperatively, the T tube was gently irrigated with a physiological salt solution until the free flow of bile into the duodenum was established. Histological examination showed that the wall near the perforation was covered with a granulation tissue that was present only at the limited area.
Perforation of the common bile duct was related to the abrupt increase in intraluminal pressure due to obstruction by protein plugs at the common channel.
儿童胆总管自发性穿孔非常罕见，其病因尚不清楚。我们在此描述5例胆总管囊肿自发性穿孔的治疗病例，并指出导致穿孔的重要因素。
所有患者最初均通过穿孔部位进行T管引流治疗。术中通过T管进行胆管造影，并检查导致穿孔的重要因素。此外，还对胆总管穿孔壁进行了组织学检查。
通过T管进行的胆管造影显示，所有患者均存在胰胆管连接部畸形以及共同通道内的充盈缺损（蛋白栓）。术后，用生理盐水轻轻冲洗T管，直至胆汁自由流入十二指肠。组织学检查显示，穿孔附近的管壁覆盖有仅存在于有限区域的肉芽组织。
胆总管穿孔与共同通道内蛋白栓阻塞导致管腔内压力突然升高有关。
