Surgical Management of Choledochal Cyst

總膽管囊腫之外科治療

吳鴻昇(Hurng-Sheng Wu) ； 沈國樑(Kuo-Liang Shen) ； 陳之凱(Tze-Kai Chen) ； 張子明(Tzu-Ming Chang) ； 徐冬民(Tom-Ming Hsu)

《Journal of Medical Sciences》 10卷5期 (1990/10) Pp. 321-328

摘要

先天性膽管擴大通稱為總膽管囊腫，仍被認為是一種相當罕見的先天疾患，東方人之發生率較歐美國家高，尤其好發於日本人，女性占大多數。自從1986年6月至1989年5月三軍總醫院共有34例總膽管囊腫接受外科治療，男性10例占29.4％，女性24例占70.6％，年齡由7個月至66歲，平均年齡22.8歲。追溯時間由6個月至216個月，平均88.1個月。腹痛及黃疸是最常見的臨床症狀，而典型的三症候（還包括腹部腫塊）約占1/3。第I型最多見有22例占64.7％，第IVa型其次有11例占32.4％，第V型僅1例占2.9％。惡性變化有兩例占5.9％。1979年以前本院主要採取容易完成而死亡率低的引流術。而後改以囊腫切除、膽囊切除及肝管空腸Roux-en-Y式吻合為確定的手術（n=25, op=28）。第一族有兩例因為吻合處狹窄而屢犯膽管炎再接受囊腫切除之確定手術；有一例雖然做了外部引流，仍死於敗血症。比較兩族都沒有手術死亡率；然而於僅做引流者，手術後之併發症如膽管炎或胰臟炎較高，而且再手術率增加，長期追踪更有發現惡性變化之病例。囊腫切除之確定性手術不僅可以解除膽汁滯留及膽道阻塞，減少上行感染造成膽管炎及形成結石，還有減少惡性腫瘤發生之危險。本篇報告，主旨在分析本院近21年來之病例，比較引流術與總膽管囊腫切除之手術結果，並肯定總膽管囊腫切除及膽道重建術為確定性手術。

關鍵字

總膽管囊腫

並列摘要

In a 21-year period from 1968 to 1989, there were 34 patients with choledochal cyst treated by drainage or excision operations at Tri-Service General Hospital. Of these 10 were men (29.4%) and 24 women (70.6%), with ages ranging from 7 months to 66 years old, and the mean age being 22.8 years. The follow-up duration was from 6 months to 216 months with a mean of 88.1 months. Abdominal pain and jaundice were the most common presenting symptoms. The classic triad of pain, jaundice and abdominal mass occurring about one-third of our cases. There were 22 cases of type I (64.7%), 11 of type IVa (32.4%), and 1 case of type V (2.9%). Malignant changes into adenocarcinoma were noted in 2 cases (5.9%). Drainage was the major treatment modality before 1979 in our patients (n=9). After 1979, cyst excision, cholecystectomy with biliary reconstruction (here after refer to as ”definite operation”) was the method of choice (n=25, op=28). Two patients in the first group received further surgical treatment, namely, excision and reconstruction, due to inadequate drainage and repeated cholangitis. There was no operation-related mortality in either group. However, one patient in the first group died of sepsis, although external drainage was done. A high incidence of complications, such as cholangitis or pancreatitis, was noted in patients receiving drainage only, and further definite operations for these patients were necessary. Operation-related morbidities were rare in patients receiving excision operations. In conclusion, the definite operation is assured to be a better method than the drainage operation for treating the choledochal cyst from the analysis of this series of patients.

並列關鍵字

Choledochal cyst ； Bile duct cyst ； Internal drainage