Schmid C, Meyer H J, Ringe B, Scheumann G F, Pichlmayr R
Division of Abdominal and Transplantation Surgery, Hannover Medical School, Germany.
Surgery. 1993 Jul;114(1):65-70.
Cystic enlargement of the extrahepatic bile duct system is a rare abnormal finding. A congenital origin is usually supposed; however, the pathogenesis is unknown. We report on our experience with extrahepatic bile duct cysts with special regard to cause, treatment, and recurrent disease.
From 1976 to 1991, 13 patients, 35 to 74 years of age, were treated for extrahepatic bile duct cysts. Seven patients had previously undergone cholecystectomy. Two patients were admitted because of recurrent disease; neither had undergone curative resection.
In 11 patients a biliojejunal anastomosis with a Roux-en-Y was created after cyst resection; one patient underwent a diverticular stalk resection with end-to-end anastomosis of the choledochal duct. After a mean follow-up of 68 months eight of 10 patients were alive, two of whom complained about cholangitis. Recurrent diffuse dilatation of the remaining choledochus developed in one patient; one other patient died of cholangiocellular carcinoma 2 years after operation.
In patients who had undergone previous cholecystectomy or with recurrent disease an acquired malformation cannot be excluded. Surgical treatment is always indicated because of imminent complications and should aim at complete resection of cystic tissue. Periodic postoperative evaluation is necessary to detect recurrent disease and malignant transformation.
肝外胆管系统的囊性扩张是一种罕见的异常表现。通常认为其起源于先天性；然而，发病机制尚不清楚。我们报告我们在肝外胆管囊肿方面的经验，特别关注病因、治疗和复发性疾病。
1976年至1991年，13例年龄在35至74岁之间的患者接受了肝外胆管囊肿治疗。7例患者此前接受过胆囊切除术。2例患者因复发性疾病入院；均未接受根治性切除术。
11例患者在囊肿切除术后进行了Roux-en-Y式胆肠吻合术；1例患者接受了憩室蒂切除术及胆总管端端吻合术。平均随访68个月后，10例患者中有8例存活，其中2例抱怨有胆管炎。1例患者剩余胆总管出现复发性弥漫性扩张；另1例患者术后2年死于胆管细胞癌。
对于既往接受过胆囊切除术或患有复发性疾病的患者，不能排除后天性畸形。由于存在迫在眉睫的并发症，手术治疗总是必要的，且应旨在完全切除囊性组织。术后定期评估对于检测复发性疾病和恶性转化是必要的。
