Todani T, Watanabe Y, Toki A, Ogura K, Wang Z Q
Department of Paediatric Surgery, Kagawa Medical University, Kitagun, Japan.
Br J Surg. 1998 Jun;85(6):760-3. doi: 10.1046/j.1365-2168.1998.00697.x.
Excision is the treatment of choice for choledochal cyst, and free bile drainage is essential to avoid ascending cholangitis. However, anastomosis between the relatively narrow common hepatic duct and bowel (conventional anastomosis) in case of type IV-A cyst, co-existing biliary anomalies and anatomical variations may cause ascending cholangitis resulting from insufficient biliary decompression.
One hundred and four patients with choledochal cyst were treated by cyst excision. Conventional anastomosis was performed in 22 patients and hilar anastomosis in 82.
An anastomotic stricture developed in nine of the 22 conventional anastomosis cases and all required reoperation. Of the 82 hilar anastomosis cases, only one required reoperation for a primary stricture. Co-existing biliary anomalies and anatomical variants were seen in 26 patients: (1) primary stricture in 18; (2) aberrant posterior duct in two; (3) low confluence of the hepatic ducts in two; (4) aberrant hepatic artery in two; and (5) very small bile duct in two. All 26 patients underwent widening of the ductal lumen (ductoplasty) or additional procedures.
Complete removal of the extrahepatic bile duct and a wide hilar anastomosis is essential to prevent ascending cholangitis. Ductoplasty or additional procedure can be performed only at the hilum.
胆总管囊肿的治疗首选手术切除，充分的胆汁引流对于避免胆管炎至关重要。然而，IV-A型囊肿患者相对狭窄的肝总管与肠道之间的吻合术（传统吻合术）、并存的胆管异常及解剖变异可能导致胆汁减压不充分，从而引发胆管炎。
104例胆总管囊肿患者接受了囊肿切除术。其中22例行传统吻合术，82例行肝门部吻合术。
22例传统吻合术患者中有9例出现吻合口狭窄，均需再次手术。82例肝门部吻合术患者中，仅1例因原发性狭窄需再次手术。26例患者存在并存的胆管异常及解剖变异：（1）原发性狭窄18例；（2）后支胆管异常2例；（3）肝管低位汇合2例；（4）肝动脉异常2例；（5）胆管细小2例。所有26例患者均接受了胆管腔扩张术（胆管成形术）或其他附加手术。
完整切除肝外胆管并进行广泛的肝门部吻合对于预防胆管炎至关重要。胆管成形术或附加手术仅能在肝门部进行。
