Miyano T, Yamataka A, Kato Y, Kohno S, Fujiwara T
Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
J Pediatr Surg. 1995 Mar;30(3):482-4. doi: 10.1016/0022-3468(95)90061-6.
Long-term complications after excisional surgery for choledochal cyst include stone formation within the intrahepatic bile duct (IHBD) and within the intrapancreatic portion of the bile duct (IPBD). The authors reviewed 180 patients with choledochal cysts (137 women) seen during a 30-year period and report their recent experience with intraoperative cyst endoscopy. Primary cyst excision with hepaticoenterostomy was performed in 150 cases, and a secondary cyst excision, after various lesser drainage procedures, in 24. Six children were treated early in the series with a cyst enterostomy. The mean age and follow-up period were 4.3 and 9.4 years, respectively. At surgery, dilatation of the IHBD was identified in 96 patients, and protein plugs or stones were observed in 31 common pancreaticobiliary channels. Fifty-five common channels were noted to be dilated. Hepaticojejunostomy was performed in 123 patients without intraoperative endoscopy. Late stone formation occurred within the IHBD in 4 of these cases and within residual segments of intrapancreatic cyst in 2 (mean age and follow-up period were 4.9 and 13.0 years, respectively). Intraoperative endoscopy was performed in 51 patients (mean age and follow-up period 3.6 and 4.3 years), and stone formation has not been observed in any patients in this group. Intraoperative cyst endoscopy is recommended as a valuable adjunct to choledochal cyst excision.
胆总管囊肿切除术后的长期并发症包括肝内胆管（IHBD）和胆管胰内段（IPBD）内结石形成。作者回顾了30年间诊治的180例胆总管囊肿患者（137例女性），并报告了他们近期术中囊肿内镜检查的经验。150例行一期囊肿切除加肝肠吻合术，24例行各种较小引流手术后二期囊肿切除术。该系列早期有6例儿童行囊肿肠造口术。平均年龄和随访时间分别为4.3岁和9.4年。手术时，96例患者发现肝内胆管扩张，31例胰胆管共同通道观察到蛋白栓或结石。55条共同通道发现扩张。123例患者未行术中内镜检查而行肝空肠吻合术。其中4例肝内胆管发生晚期结石形成，2例胰内囊肿残余段发生结石形成（平均年龄和随访时间分别为4.9岁和13.0岁）。51例患者行术中内镜检查（平均年龄和随访时间分别为3.6岁和4.3岁），该组患者均未观察到结石形成。建议术中囊肿内镜检查作为胆总管囊肿切除的一项有价值的辅助手段。
