Surgical treatment of type IV choledochal cysts
Surgical treatment of type IV choledochal cysts
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DOI：
10.1007/s00534-009-0052-3
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发表时间：
2009-09-01
期刊：
影响因子：
--
通讯作者：
Isaji, Shuji
中科院分区：
文献类型：
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作者：
Kawarada, Yoshifumi;Das, Bidhan C.;Isaji, Shuji
扩张胆管全切除术的益处尚不清楚。我们在这里描述我们的手术治疗13例IV型胆总管囊肿。六个年轻的病人（25-35岁）行肝外胆管切除术（EHBD）和肝管空肠吻合术（HJ），而7例老年患者中有3例（50-68岁）接受EHBD切除和HJ切除，其余4名老年患者接受扩张胆管全切除术和S4 a+形式的胰胆管连接异常（PBMJ）切除术，S5肝切除术（所谓的Taj Mahal）和/或胰头切除术伴第二部分胰头切除术。在年轻患者中，切除术后未在扩张的胆管中检测到恶性肿瘤，但在2例（27.5%）老年患者中发现胆囊癌和/或扩张的胆管。在长期随访期间（1974-2008年），在接受EHBD切除加部分肝切除术的患者中未检测到癌症，但在仅接受EHBD切除术的老年患者中，残留导管中发生了癌症。根据我们的研究结果，我们建议IV型胆总管囊肿应通过全切除扩张的胆管（包括PBMJ）进行治疗，因为它经常与恶性肿瘤相关，并防止残留胆管中的癌症发展，提高长期生存率。
The benefit of total resection of the dilated bile duct has remained unclear. We describe here our surgical management of 13 patients with type IV choledochal cysts. All six younger patients (25-35 years old) underwent resection of the extrahepatic bile duct (EHBD) and hepaticojejunostomy (HJ), whereas three of the seven older patients (50-68 years old) underwent resection of the EHBD resection and HJ, with the remaining four older patients undergoing total resection of the dilated bile duct and removal of a pancreatobiliary maljunction (PBMJ) in the form of a S4a+S5 hepatectomy (so-called Taj Mahal) and/or pancreas head resection with second portion pancreaticoduodenectomy. No malignancies were detected in the dilated bile duct after resection in the younger patients, but cancer of the gallbladder and/or the dilated bile duct was found in two (27.5%) of the older patients. No cancers were detected during the long-term follow up (1974-2008) in those patients who underwent EHBD resection plus partial hepatectomy, but cancer developed in the remnant duct in one of the older patients who underwent EHBD resection alone. Based on our findings, we recommend that type IV choledochal cysts should be treated by total excision of the dilated bile duct, including the PBMJ, due to its frequent association with malignancy, and to prevent the development of cancer in the remnant duct and improve the long-term survival rate.