Samuel M, Spitz L
Department of Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK.
Eur J Pediatr Surg. 1996 Apr;6(2):78-81. doi: 10.1055/s-2008-1066476.
The clinical features and long-term outcome of 21 children with choledochal cyst treated over a 31-year-period is reviewed. All 7 infants ( < 1-year-old) presented with jaundice. Only 3 older children (14%) presented with the classical triad of pain, jaundice and an abdominal mass. Other forms of presentation included pancreatitis (n = 8), cholangitis (n = 3), biliary peritonitis (n = 2) and biliary cirrhosis (n = 2). An incidental diagnosis of a choledochal cyst was made in 3 patients one each with bilateral ureteroceles, renal hypoplasia and meningitis with hepatitis A infection. An elevated serum amylase (SA: mean = 1005 U/L) and intraoperative bile amylase (BA: mean = 16,902 U/L) was observed in all 8 children with pancreatitis. Complete excision of the choledochal cyst with Roux-en-Y hepaticojejunostomy was the primary operative procedure in 18 patients. The remaining patients underwent cystoduodenostomy (n = 2) and cystojejunostomy (n = 1). Recurrent cholangitis and stricture formation complicated cyst enterostomies. In comparison cyst excision with Roux-en-Y hepaticojejunostomy gave excellent long-term results with minimal complication.
回顾了31年间接受治疗的21例胆总管囊肿患儿的临床特征和长期预后。所有7例婴儿（＜1岁）均表现为黄疸。只有3例大龄儿童（14%）表现出腹痛、黄疸和腹部肿块的典型三联征。其他表现形式包括胰腺炎（n = 8）、胆管炎（n = 3）、胆汁性腹膜炎（n = 2）和胆汁性肝硬化（n = 2）。3例患者为胆总管囊肿的偶然诊断，分别合并双侧输尿管囊肿、肾发育不全和甲型肝炎感染伴脑膜炎。所有8例胰腺炎患儿均观察到血清淀粉酶升高（SA：平均 = 1005 U/L）和术中胆汁淀粉酶升高（BA：平均 = 16,902 U/L）。18例患者的主要手术方式为胆总管囊肿完整切除并 Roux-en-Y 肝空肠吻合术。其余患者接受了囊肿十二指肠吻合术（n = 2）和囊肿空肠吻合术（n = 1）。复发性胆管炎和狭窄形成使囊肿肠吻合术复杂化。相比之下，囊肿切除并 Roux-en-Y 肝空肠吻合术取得了优异的长期效果，并发症最少。
