Jesudason S R, Govil S, Mathai V, Kuruvilla R, Muthusami J C
Department of General Surgery II, Christian Medical College Hospital, Vellore, India.
Ann R Coll Surg Engl. 1997 Nov;79(6):410-3.
The clinical features and management of 14 adults with choledochal cysts who presented to our hospital are discussed. There were 10 Todani type I, and four type IV cysts. The cysts were fusiform in all but three cases. The pancreatobiliary junction was abnormal in only two patients. Ten patients had cystolithiasis. Six patients had undergone previous biliary surgery, three of whom presented with biliary strictures. We recommend that choledochal cyst be considered as a differential diagnosis in all patients with dilated bile ducts, especially when symptoms persist after biliary surgery. In two patients who had undergone endoscopic sphincterotomy and stone clearance, and in whom the diagnosis was still in doubt after cholangiography, hepatic iminodiacetic acid (HIDA) scan confirmed the diagnosis of choledochal cyst by showing persistent biliary stagnation despite free flow of bile across the sphincter of Oddi. Complete resection of the cyst was achieved in all cases with one postoperative death. A modification of the standard surgical technique is described which makes mobilisation of the cyst easier. The need to demonstrate the pancreatobiliary ductal confluence as an aid to complete excision of the cyst is emphasised.
本文讨论了我院收治的14例胆总管囊肿成年患者的临床特征及治疗情况。其中，Todani I型囊肿10例，IV型囊肿4例。除3例囊肿外，其余均呈梭形。仅2例患者胰胆管交界处异常。10例患者有胆囊结石。6例患者曾接受过胆道手术，其中3例出现胆管狭窄。我们建议，对于所有胆管扩张的患者，尤其是胆道手术后症状持续存在的患者，应将胆总管囊肿作为鉴别诊断之一。2例接受内镜括约肌切开取石术的患者，胆管造影后诊断仍存疑问，而肝亚氨基二乙酸（HIDA）扫描显示，尽管胆汁可自由通过Oddi括约肌，但仍存在持续性胆汁淤积，从而确诊为胆总管囊肿。所有病例均成功完成囊肿完全切除，术后1例死亡。本文描述了一种改良的标准手术技术，该技术使囊肿的游离更加容易。强调了显示胰胆管汇合处对于完全切除囊肿的辅助作用。
