Long-term outcomes after hepaticojejunostomy for choledochal cyst: a 10-to 27-year follow-up
Long-term outcomes after hepaticojejunostomy for choledochal cyst: a 10-to 27-year follow-up
复制标题
DOI：
10.1016/j.jpedsurg.2009.10.078
复制
发表时间：
2010-02-01
影响因子：
2.4
通讯作者：
Iwai, Naomi
中科院分区：
文献类型：
--
作者：
Ono, Shigeru;Fumino, Shigehisa;Iwai, Naomi
前言：胆总管囊肿与胰胆管排列异常密切相关，被认为是胆道恶性肿瘤的高危因素。CC的早期诊断和早期治疗可获得良好的预后。本研究调查了56例CC患者术后远期并发症和远期疗效，并对其进行了10年以上的随访。所有患者均行肝外胆管全切除、肝管空肠吻合术。结果：6例患者在术后10年内出现肝功能障碍，但术后均恢复正常。术后6例肝内胆管持续扩张，3例术后10年以上仍明显扩张。复发腹痛3例，胰腺分裂伴胰腺结石1例，粘连性小肠梗阻1例。2例患者发展为胆道恶性肿瘤。1例14岁女孩在胆管癌伴腺癌初次切除2年后死于胆道癌复发。一位26岁男性，因多发性肝内胆管结石导致反复胆管炎，在初次肝细胞癌切除26年后发展为胆管癌。无事件生存率和总生存率分别为%(50/56)和96%(54/56)。结论：胆总管囊肿早期全切除重建预后良好。对恶性肿瘤的发展进行长期监测仍然是必要的，特别是如果肝内胆管或胆管结石持续扩张。(C)2010 Elsevier Inc.保留所有权利。
Introduction: Choledochal cyst (CC) is closely associated with anomalous arrangement of the pancreaticobiliary duct, which is considered a high-risk factor for biliary tract malignancy. Early diagnosis and early treatment for CC could lead to a good prognosis. This study investigated late complications and long-term outcomes after surgery for CC.Patients and Methods: Fifty-six patients with CC and over 10 years of postoperative follow-up were analyzed retrospectively. All patients had undergone total resection of the extrahepatic bile duct and hepaticojejunostomy.Results: Six patients showed liver dysfunction manifested in the first 10 years after surgery, but all returned to normal thereafter. Dilatation of intrahepatic bile ducts persisted in 6 postoperatively, and in 3, this was still apparent more than 10 years after. Recurrent abdominal pain was encountered in 3, 1 had pancreas divisum with a pancreatic stone, and 1 had adhesive small bowel obstruction. Two patients developed biliary tract malignancy. A 14-year-old girl died of recurrent common bile duct cancer 2 years after the initial resection of CC with adenocarcinoma. A 26-year-old man with repeated cholangitis owing to multiple intrahepatic bile stones developed cholangiocarcinoma 26 years after the initial resection of CC. Event-free survival rate and overall survival rate were 89% (50/56) and 96% (54/56), respectively.Conclusions: Choledochal cyst generally has an excellent prognosis with early total resection and reconstruction. Long-term surveillance for the development of malignancy is still essential, especially if there is ongoing dilatation of the intrahepatic bile duct or biliary stones. (C) 2010 Elsevier Inc. All rights reserved.