Miyano T, Yamataka A, Kato Y, Segawa O, Lane G, Takamizawa S, Kohno S, Fujiwara T
Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
J Pediatr Surg. 1996 Oct;31(10):1417-21. doi: 10.1016/s0022-3468(96)90843-x.
In the long-term follow-up of patients with choledochal cyst, postoperative ascending cholangitis and/or stone formation in the intrahepatic bile ducts (IHBD) owing to anastomotic stricture present serious problems. To prevent the formation of anastomotic strictures, some surgeons recently have performed hepaticoenterostomy at the hepatic hilum, with a wide stoma, in all patients with choledochal cyst. The authors of the present study review the surgical procedures performed on a total of 180 children with choledochal cyst and discuss the treatment of choice, with special reference to the types of hepaticoenterostomy. The medical records and radiographs of all patients treated for choledochal cyst between January 1964 and December 1993 at the authors' institutions were reviewed. A total of 180 patients (mean age at time of surgery, 4.3 years) had follow-up for a mean of 11.1 years; 174 of them had cyst excision and hepaticoenterostomy, and six had cystoenterostomy. Of the 174 patients who underwent cyst excision, 171 had a conventional hepaticoenterostomy; two had an intrahepatic cystoenterostomy, and one had a hepaticoenterostomy at the hepatic hilum. IHBD stones with or without cholangitis developed postoperatively in four (2.3%) of the 171 patients who had conventional hepaticoenterostomy. The age at time hepaticoenterostomy of these four patients was 12, 7, 16, and 6 years. Postoperative IHBD stone formation and cholangitis were not found in 121 patients under 5 years of age. The authors recommend conventional hepaticoenterostomy as the treatment of choice for children with choledochal cyst. Hepaticoenterostomy at the hepatic hilum is indicated in only selected cases.
在胆总管囊肿患者的长期随访中，由于吻合口狭窄导致的术后上行性胆管炎和/或肝内胆管（IHBD）结石形成是严重问题。为防止吻合口狭窄形成，一些外科医生最近对所有胆总管囊肿患者在肝门处进行了宽吻合口的肝肠吻合术。本研究的作者回顾了总共180例胆总管囊肿患儿接受的手术操作，并讨论了治疗选择，特别提及肝肠吻合术的类型。回顾了1964年1月至1993年12月在作者所在机构接受胆总管囊肿治疗的所有患者的病历和影像学资料。共有180例患者（手术时平均年龄4.3岁）接受了平均11.1年的随访；其中174例行囊肿切除和肝肠吻合术，6例行囊肿肠吻合术。在174例行囊肿切除的患者中，171例行传统肝肠吻合术；2例行肝内囊肿肠吻合术，1例行肝门处肝肠吻合术。171例行传统肝肠吻合术的患者中有4例（2.3%）术后发生了有或无胆管炎的IHBD结石。这4例患者肝肠吻合术时的年龄分别为12岁、7岁、16岁和6岁。121例5岁以下患者术后未发现IHBD结石形成和胆管炎。作者推荐传统肝肠吻合术作为胆总管囊肿患儿的首选治疗方法。仅在特定病例中才考虑肝门处肝肠吻合术。
