Chijiiwa K
Department of Surgery 1, Kyushu University Faculty of Medicine, Fukuoka, Japan.
Int Surg. 1993 Jul-Sep;78(3):204-7.
Thirty-nine patients initially treated for choledochal cyst (25: cyst-enterostomy for 15 type I and 10 type IV A, 13: cyst excision for 8 type I and 5 type IV A, 1: sphincterotomy for type III) have been completely followed up for a mean period of 17 years to examine the effect of surgical management on their lives. Eighteen of 25 cases with cyst-enterostomy (72%) needed retreatment due to the complications but one could not be retreated because of the presence of advanced bile duct carcinoma. Fourteen of 17 cases were retreated with cyst excision, of whom 12 showed an excellent outcome but other two were suffering from cholangitis and hepatolithiasis. The remaining 3 patients retreated with PTCS or cyst-enterostomy showed a poor outcome. Of 13 patients who had undergone cyst excision with hepatico-jejunostomy as the first choice, 12 showed a good outcome but one needed retreatment due to the anastomotic stenosis and hepatolithiasis. Thus, excision of cyst should be the surgical management for choledochal cyst. However, it should be noted that three of 27 patients treated initially or secondarily with cyst excision showed unsatisfactory results mainly due to the anastomotic stenosis. The results demonstrate that hepaticojejunostomy with a wide opening stoma is necessary to prevent postoperative morbidity.
39例最初接受胆总管囊肿治疗的患者（25例：15例Ⅰ型和10例ⅣA 型行囊肿肠吻合术，13例：8例Ⅰ型和5例ⅣA 型行囊肿切除术，1例：Ⅲ型行括约肌切开术）已被完整随访，平均随访期为17年，以检查手术治疗对其生活的影响。25例行囊肿肠吻合术的患者中有18例（72%）因并发症需要再次治疗，但1例因存在进展期胆管癌无法再次治疗。17例再次治疗的患者中有14例行囊肿切除术，其中12例效果良好，但另外2例患有胆管炎和肝内胆管结石。其余3例行经皮经肝胆道镜下球囊扩张术（PTCS）或囊肿肠吻合术再次治疗的患者效果不佳。13例最初以肝空肠吻合术为首选行囊肿切除术的患者中，12例效果良好，但1例因吻合口狭窄和肝内胆管结石需要再次治疗。因此，囊肿切除术应作为胆总管囊肿的手术治疗方法。然而，应注意的是，27例最初或二次接受囊肿切除术的患者中有3例结果不理想，主要原因是吻合口狭窄。结果表明，为防止术后发病，需要进行宽开口吻合的肝空肠吻合术。
