Forty-Year Experience With Flow-Diversion Surgery for Patients With Congenital Choledochal Cysts With Pancreaticobiliary Maljunction at a Single Institution
Forty-Year Experience With Flow-Diversion Surgery for Patients With Congenital Choledochal Cysts With Pancreaticobiliary Maljunction at a Single Institution
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DOI：
10.1097/sla.0b013e3182243550
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发表时间：
2011-12-01
影响因子：
9
通讯作者：
Yamamoto, Masakazu
中科院分区：
文献类型：
--
作者：
Takeshita, Nobuhiro;Ota, Takehiro;Yamamoto, Masakazu
背景资料：先天性胆总管囊肿合并胰胆管合流异常（PBM）是引起胆管炎、胰腺炎、胆汁和胰液相互回流引起的胆道系统癌变等多种并发症的高危因素。此外，如果选择错误的手术程序，术后并发症并不罕见。因此，我们试图回顾I型和IV-A型手术方式之间的关系（Todani分类）先天性胆总管囊肿PBM和长期治疗结果。回顾性分析了40年来在我们机构接受血流导向手术的144例患者，结果：144例患者中，137例行囊肿完全切除术，7例行胰头切除引流术。I型和IV-A型囊肿患者的随访时间分别为1至345个月和1至271个月（平均100.2和94.1）。关于手术治疗结局，144例患者中有130例（90.3%）术后进展良好。14例患者因术后长期并发症（如胆管炎、胰腺炎、肝内结石、胰腺结石和术后随访期间的癌变）而需要住院治疗。其中2例IV-A型囊肿手术患者分别死于继发性胆汁性肝硬化伴肝功能衰竭和晚期肝内胆管细胞癌。目前的研究表明，先天性胆总管囊肿伴PBM的分流手术可显著降低胆道恶性肿瘤的后续发展风险，选择合适的手术方式是预防术后并发症发生的关键。
Background: Congenital choledochal cyst with pancreaticobiliary maljunction (PBM) is known as a high-risk factor for various complications such as cholangitis, pancreatitis, and carcinogenesis of the biliary system by mutual refluxes of bile and pancreatic juice. Furthermore, it is not rare to suffer from postoperative complications if the wrong operative procedure is chosen. Therefore, we sought to review the relationship between operative procedure for types I and IV-A (Todani's classification) congenital choledochal cyst with PBM, and long-term treatment outcome.Subjects and Methods: A retrospective review was carried out of 144 patients who underwent flow diversion surgery in our institution during the 40-year period from 1968 to 2008 and who did not have a coexisting malignant tumor at the time of surgery.Results: Of these 144 patients, 137 underwent complete cyst excision and 7 underwent pancreas head resection as flow diversion surgery. The follow-up periods ranged from 1 to 345 months and from 1 to 271 months (average, 100.2 and 94.1) in patients with type I and type IV-A cysts, respectively. Regarding surgical treatment outcome, postoperative progress was good in 130 (90.3%) of the 144 patients. Fourteen patients required hospitalization for long-term postoperative complications such as cholangitis, pancreatitis, intrahepatic calculi, pancreatic calculus, and carcinogenesis during postoperative follow-up. Of these, 2 patients who underwent surgery for type IV-A cysts died because of secondary biliary cirrhosis with liver failure and advanced intrahepatic cholangiocarcinoma, respectively.Conclusions: The present study shows that flow diversion surgery for congenital choledochal cysts with PBM significantly reduces the risk of subsequent development of malignancy in the biliary tract, and it is vital to choose the appropriate operative procedure to prevent occurrence of these postoperative complications.