Long-term outcomes after excision of choledochal cysts in a single institution: Operative procedures and late complications
Long-term outcomes after excision of choledochal cysts in a single institution: Operative procedures and late complications
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DOI：
10.1016/j.jpedsurg.2012.09.001
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发表时间：
2012-12-01
影响因子：
2.4
通讯作者：
Miyake, Hiromu
中科院分区：
文献类型：
--
作者：
Urushihara, Naoto;Fukumoto, Koji;Miyake, Hiromu
目的：本研究旨在评估儿童胆总管囊肿摘除术后至少3年的远期疗效，重点探讨手术方式与预后的关系。对120例患者进行了随访。年龄4~49岁，平均20.9岁。手术和进行分析之间的平均间隔为16.6年(范围3-34年)。根据手术方式分为A组(1977~2000年)和B组(2001~2008年)，A组(1977~2000年)行囊肿切除肝门以下肝管空肠吻合术，B组(2001~2008)行肝管汇合处至胰胆管汇合处附近肝门部胆管宽阔吻合术44例。当肝门附近发现肝狭窄时，行胆管成形术。结果：共有18例(15.0%)患者出现晚期并发症。A组晚期并发症16例(21.1%)，包括胆管炎和(或)肝内结石9例，胰内残留结石4例，肠梗阻2例，胰腺炎1例。其中12例(15.8%)行手术治疗，其中肝内胆管结石7例(IV-A型6例，IC型1例)，胰内残留囊肿4例，肠梗阻3例。B组无一例发生胆管炎、胰腺炎或结石形成。结论：虽然需要较长的随访期，但A组的晚期并发症比B组和IV-A型囊肿者更常见。我们认为肝外胆管切除、肝门部胆管空肠宽阔吻合术是预防术后并发症的关键。(C)2012 Elsevier Inc.保留所有权利。
Purpose: The purpose of this study was to evaluate long-term outcomes for a minimum of 3 years after cyst excision in children with choledochal cysts, focusing on the relationship between operative procedures and outcomes.Methods: Between 1977 and 2008, 138 children underwent cyst excision. Follow-up results were obtained from 120 patients. Their mean age was 20.9 years (range 4-49). The mean interval between surgery and conducting the analysis was 16.6 years (range 3-34). These patients were divided into two groups based on their operative procedures: group A (1977-2000) comprising 76 patients who underwent cyst excision with hepaticojejunostomy below the hilum, and group B (2001-2008) comprising 44 patients who underwent excision of the extrahepatic bile duct from the confluence of the hepatic duct to near the level of the pancreatobiliary junction with wide hilar hepaticojejunostomy. When hepatic strictures were seen near the hilum, duct plasty was made. We evaluated the long-term outcomes in the two groups.Results: Late complications were seen in a total of 18 patients (15.0%). In group A, 16 patients (21.1%) had late complications, which included cholangitis and/or hepatic stones in 9, stones in residual intrapancreatic cysts in 4, intestinal obstruction in 2, and pancreatitis in 1. Of these 16 patients, 12 patients (15.8%), including 7 with hepatic stones (6 IV-A and 1 Ic cysts), 4 with remnant intrapancreatic cysts, and 3 with intestinal obstruction underwent surgical intervention. In group B, none of the patients developed cholangitis, pancreatitis, or stone formation. However, 2 patients (4.5%) developed intestinal obstruction that required surgery.Conclusions: Although a longer follow-up period is necessary, late complications were more frequent in group A than in group B patients and with type IV-A cysts. We believe that excision of the extrahepatic bile duct with wide hilar hepaticojejunostomy is essential for the prevention of postoperative complications. (C) 2012 Elsevier Inc. All rights reserved.