Objective To present the surgical treatment experiences of congenital choledochal cyst (CCC). MethodsOne hundred and fortyfive patients in 152 CCC were analyzed retrospectively and followed in west China hospital of Sichuan university from 1964 to 1999. ResultsOne hundred and fortyfive cases underwent operation and 6 of them died after operation. The incidence of hepatocirrhosis within first year after birth is higher than those over one year old （P＜0.05）. Thirtynine cases underwent cystoduodenostomy or cystojejunostomy. One hundred and six children underwent cyst resection and biliary tract reconstruction (with single RouxY hepaticojejunostomy 48 cases, intussusceptive valve and rectangular valve to the line of RouxY hepaticojejunostomy 37 and 21 cases respectively). Seventyseven patients were followedup (means 4.68 years). Two of 3 cases with ascending cholangitis after single RouxY hepaticojejunostomy underwent reoperations with an intussusceptive valve added to the line of RouxY hepaticojejunostomy and the symptoms disappeared. All of them have a good outcome. Conclusion The younger the patients, the less severe the liver damaged, and its prognosis are better. The procedure that cyst resection totally and an intussusceptive valve added to the line of RouxY hepaticojejunostomy should be carried out early as soon as possible.
目的为提高胆总管囊肿切除、胆肠RouxY吻合术的疗效，对其影响疗效的相关因素进行经验总结。方法对我院收治的34例小儿先天性胆总管囊肿进行回顾性分析。结果31例施行了手术，术后随访通过B超、X线胃肠钡餐检查表明30例治愈，疗效满意，1例新生儿术后并发吻合口漏死亡。手术治愈率96.8%，手术死亡率3.2%。结论为提高本术式的疗效，术前的B超、CT扫描以及术中的胆道造影，ERCP检查对判定本病类型，有无胰胆管合流异常，对选择手术方法和疗效有帮助，此外注意囊肿的病理改变及手术技术对提高疗效，减少并发症的发生也是十分重要的。
【Abstract】Objective To evaluate the distribution of nerve growth factor receptor( P75 NGFR) in congenital choledochal cyst(CCC) and its clinical implication. Methods Specimens from 18 children with CCC and normal choledochal specimens from 9 controls were immuno-stained with P75 NGFR antibody. Results Extensive P75 NGFR staining was found in the nerve fibres of normal comnon bile duct，bly staining of ganglion cells were observed on the normal specimens. There was very little immunoreactive fibre in the CCC. Conclusion The abnormal distribution of P75 NGFR in the aganglionic choledochal suggests that abnormal P75 NGFR is related to the occurrance of the CCC.
OBJECTIVE: To evaluate the operative methods of biliary tract reconstruction after cystectomy of congenital choledochal cyst(CCC). METHODS: One hundred and six cases with CCC underwent cystectomy and biliary tract reconstruction in our hospital from July 1984 to December 1999 were followed up. Among them, there were three kinds of procedures in biliary tract reconstruction: with single Roux-Y hepaticojejunostomy in 48 cases, with intussusceptive valve to the line of Roux-Y hepaticojejunostomy in 37 cases, with rectangular valve to the line of Roux-Y hepaticojejunostomy in 21 cases. RESULTS: Fifty nine cases were followed up for 4.68 years in average. There were 3 cases with ascending cholangitis after single Roux-Y hepaticojejunostomy. And the symptom disappeared in 2 cases underwent reoperation with an intussueceptive valve plasty to the line of Roux-Y hepaticojejunostomy. No patients suffered from ascending cholangitis in the precautionary valve plasty group. CONCLUSION: It suggests that the postoperative ascending cholangitis can be prevented effectively if standard cystectomy and prophylactic intussusceptive valve added to the line of Roux-Y hepaticojejunostomy are carried out. The procedure should be performed as soon as possible providing the child is tolerable.
目的 探讨Ⅰ型先天性胆总管囊肿的手术治疗。方法 回顾性分析笔者所在医院1987年3月至2011年6月期间收治的42例Ⅰ型先天性胆总管囊肿患者手术治疗后的效果。结果 本组中2例因并发腹膜炎先行囊肿外引流术后4周再行囊肿空肠吻合术；3例直接行囊肿空肠吻合术；35例行囊肿切除肝总管空肠Roux-en-Y吻合术；2例行囊肿切除间置空肠肝总管十二指肠吻合术。手术成功率为100%。5例内引流术（囊肿空肠吻合术）后均有不同程度的胆道感染症状。37例行囊肿根治术（即囊肿切除肝总管空肠Roux-en-Y吻合或间置空肠肝总管十二指肠吻合术）中有2例囊肿切除肝总管空肠Roux-en-Y吻合术后患者偶有右上腹隐痛不适，经X线钡餐检查，诊断为胆管逆行性感染，抗炎治疗有效；其余病例无腹痛、黄疸、发热、再生结石、吻合口狭窄、癌变及其他手术并发症。结论 囊肿外引流术仅作为急诊手术，待患者一般情况改善后再行第二次手术；囊肿根治术是治疗Ⅰ型先天性胆总管囊肿理想的手术方式。
【摘要】目的 探讨成人先天性胆总管囊肿的诊断和治疗。方法 对我科收治的7例成人先天性胆总管囊肿患者的资料进行回顾性分析。术前B超诊断正确率为91.9%(34／37)。6例行囊肿切除和肝总管空肠Roux-Y吻合术，1例因癌变行胰十二指肠切除术。结果 共随访29例，随访率为78.4%，平均随访43个月，未发现恶变者。结论 B超应作为先天性胆总管囊肿的首选检查，囊肿切除和肝总管空肠Roux-Y吻合术应作为首选术式，早期诊断，早期根治性治疗，是先天性胆总管囊肿诊治的关键。
目的 总结Lilly氏法切除先天性胆总管囊肿的经验。方法 对1980年以来我院收治的20例采用Lilly氏法保留胆总管囊肿后壁外层切除先天性胆总管囊肿的技术要点及手术疗效进行了回顾性分析。结果 该术式操作方便，术后随访表明，它可有效地解除胆管囊肿的主要症状，无严重手术并发症及不良后果。结论 该术式安全简便，疗效满意，在Ⅰ型先天性胆总管囊肿炎性粘连较重时可适当选用。
Objective To explore surgery strategy of reoperation for type Ⅳa congenital choledochal cyst. Methods The patient was a 20-year-old female with repeated right upper abdominal pain and fever for more than 1 year and aggravation for more than 1 month, and the choledochal cyst excison was performed 15 years ago. The MRI revealed that a huge cyst located in the left lobe of liver, with multiple intrahepatic calculus. The patient was diagnosed with a type Ⅳa congenital choledochal cyst and choledochojejunostomy later and the intrahepatic dilated bile duct was untreated. Results The cystic dilatation of the intrahepatic bile duct was confirmed during the reoperation, and the multiple stones with pus formation were seen, the color of the right liver was normal and the anatomical left hemihepatectomy was performed. The original anastomosis had no stenosis then was preserved. An about 1.5 cm length of extrahepatic bile duct was dissociated from the upper of anastomosis, and the extrahepatic bile duct was cut open and explored with a choledochoscope. The T-tube drainage was performed following removing the stone. The patient recovered well and was discharged smoothly following the surgery. The cholangiography 6 weeks later revealed that the biliary tract was patency and there was no residual stone. There was no jaundice or fever afterwards. Conclusion Complete excision of choledochal cyst and hepaticoduodenostomy is widely accepted as a standard surgery for type Ⅳa congenital choledochal cyst.