Todani T, Watanabe Y, Urushihara N, Noda T, Morotomi Y
Department of Pediatric Surgery, Kagawa Medical School, Japan.
J Pediatr Surg. 1995 Mar;30(3):478-81. doi: 10.1016/0022-3468(95)90060-8.
During the last 25 years, from 1969 to 1994, the authors treated 97 choledochal cysts by surgical excision. Biliary reconstruction consisted of 67 hepaticoduodenostomies and 30 hepaticojejunostomies. The common hepatic duct was the site of anastomosis in 9 of the duodenostomies and 13 of the jejunostomies and of the bifurcation of the hepatic ducts in 58 duodenostomies and 17 jejunostomies. Reoperation was required in 10 cases because of recurrent cholangitis with intrahepatic gallstones. Biliary strictures were responsible for the cholangitis in 9 children with anastomoses at the level of the common hepatic duct and in 1 with an anastomosis at the level of the bifurcation. These results suggest that biliary complications develop because of anastomotic stricture or primary ductal stricture, and may be minimised by the creation of a wide anastomosis, which is best accomplished at the hepatic hilum.
在1969年至1994年的过去25年中，作者通过手术切除治疗了97例胆总管囊肿。胆道重建包括67例肝十二指肠吻合术和30例肝空肠吻合术。在9例十二指肠吻合术和13例空肠吻合术中，肝总管是吻合部位；在58例十二指肠吻合术和17例空肠吻合术中，肝管分叉处是吻合部位。10例患者因复发性胆管炎合并肝内胆结石需要再次手术。9例肝总管水平吻合的儿童和1例肝管分叉处吻合的儿童，胆管狭窄是胆管炎的原因。这些结果表明，胆道并发症是由于吻合口狭窄或原发性胆管狭窄所致，通过建立宽吻合口可将其降至最低，这最好在肝门处完成。
