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。
To study the changes in diagnosis and treatment of pediatric choledochal cyst in the past 10 years, a retrospective analysis was made in 79 children with choledochal cyst, who were admitted into our hospital from 1982 to 1998. Results show that in the past years, the clinical manifestation of choledochal cyst in children have become less obvious for earlier consultation. B-mode ultrasounscanning should be the first choice since it aids in the diagnosis of choledochal cyst as well as its related and complicated diseases. Choledochectomy is the only radical treatment for choledochal cyst in children.
【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.
ObjectiveTo observe apoptosis and proliferation of choledochus wall epithelial cell and fibrocyte, to understand the effects of apoptosis and proliferation on choledochal cyst development.MethodsThirty two cases of cystic dilatation,35 cases of cylindrical dilatation，and 25 cases of cholangiectasis caused by choledocholith were collected. All specimens were offered by department of hepatobiliarypediatric surgery. The apoptosis related index (bcl2 and bax) and cell proliferation index (PCNA) were detected by the immunohistochemical technique; Apoptosis was detected by TUNEL method. ResultsThere was serious mucosal epithelial cell damage in cystic dilatation group. In cylindrical dilatation group there was a damage similar to that of the cystis dilatation group, but the damage was not serious. In control group there was little damage in the duct wall, but there was a low positive rate of apoptosis of 〔epithelium cell (2.74±1.00)% and fibroblast (2.95±0.87）%〕, and a low bcl2 and bax’s expression rate, and a high PCNA’s expression rate 〔epithelium cell (3.74±1.00)%, fibroblast (3.71±1.77)%〕. There was no obvious difference between cylindrical dilatation group and cystic dilatation group (Pgt;0.05): the PCNA’s expression rate was low 〔(0.99±0.51)% and (0.90±0.38)% respectively〕, the bax expression rate was high in remaining epithelial cell, and the positive rate of bax was apparently higher than that of bcl2 (P＜0.05), the positive rate of the apoptosis cell was high 〔(13.94±4.77)%, (7.51±3.46)%〕; the expression rate PCNA were high 〔(9.91±2.91)%,(9.70±3.18)%〕, and expression rate of bax’s was low in the fibre tissue, the positive rate of bcl2 was markedly higher than that of bax, and the positive rate of the apoptosis cell was low 〔(3.74±2.12)%,(4.46±2.41)%〕. There were no marked difference between the two groups (Pgt;0.05). The expression of bcl2 and bax had marked difference both in cylindrical dilatation group and cystic dilatation group and as compared to control group (P＜0.05). ConclusionApoptosis has certain promoting effect in the course of choledochal cyst formation.
目的探讨成人Ⅰ型胆总管囊肿的诊断和治疗。方法回顾性分析1997年1月至2004年7月期间收治的8例成人Ⅰ型胆总管囊肿的临床资料。结果5例行胆总管囊肿全切除、RouxenY肝管空肠吻合术； 2例行囊肿部分切除、RouxenY囊肿空肠吻合术； 1例行囊肿部分切除、 RouxenY肝管空肠吻合术，术中常规行胆道镜检查，无一例手术死亡。8例患者术后平均随访2．8年(1~7年)，未发现胆道恶性肿瘤。1例行囊肿部分切除的患者，在术后出现3次右上腹绞痛，1次急性胆管炎表现，均经支持、对症、抗感染等治疗后好转。 结论 成人Ⅰ型胆总管囊肿的诊断主要依靠B超、逆行胰胆管造影(ERCP)或磁共振胆胰管造影（MRCP）检查，囊肿全切除、RouxenY肝管空肠吻合是安全、有效的手术方式，其疗效比较满意； 囊肿部分切除、RouxenY囊肿空肠吻合术虽疗效不及完整囊肿切除令人满意，但对于在技术上难以作到囊肿完全切除者，部分囊肿切除是明智的选择，建议术中常规胆道镜检查。
Object To evaluate the significance of double common bile duct （DCBD） in hepatobiliary surgery. Metheds The data of diagnosis and treatment of two patients with DCBD in our hospital between Jul. to Dec. 2010 were analyzed retrospective， and the related literatures were reviewed. Results The right hepatic bile duct of DCBD due to mistaking it for cystic duct in 1 case was accidental injuried during laparoscopic cholecystectomy. Another example，the DCBD was confirmed by intraoperative exploration and choledochoscopic examination， at the same time with chole-dochal cyst， anomalous pancreaticobiliary ductal junction （APBDJ）， primary hepatolithus， and choledocholith， and then operation was performed. Two cases were typeⅤb of DCBD. A total of 32 English literatures were reviewed. Since the beginning of 1932 English literature had reported 100 cases of DCBD. The type Ⅱand typeⅢwere the most common type of DCBD， and the typeⅤonly 10 cases. There were 27 cases of DCBD in twenty-five Chinese articles from 1994 to 2012. The typeⅤwas the most common type of DCBD. The accessory common bile duct （ACBD） opening in the duod-enum， gastric， and pancreatic duct were the most common. The common complications included stone， APBDJ， choled-ochal cyst， tumor etc. Conclusions DCBD is a very rare anatomic variation of extrahepatic bile duct， often accompanied by calculus of bile duct and common bile duct cyst， APBDJ， and other biliary anatomy abnormality， and potentially carci-nogenic potential. The existence of DCBD may increase the risk of iatrogenic bile duct injury and complexity of biliary operation. In view of this， this abnormality of extrahepatic duct should be paid with close attention during operation.
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.
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.
【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。