Clinical Investigation Of Congenital Choledochal Cyst In Adult Patients

Object: To summarize the experience in diagnosis and Surgical treatment of congenital choledochal cysts(ccc)Methods: Clinical data of 50 patients with congenital choledochal cysts diagnosed and surgically treated in our hospital were retrospectively analyzed between 2000 to 2006.Clinical data and treatment: 50 patients were identified , 42 of them were female , and 8 were male . The oldest was 86-year-old, and the youngest was 18-year-old, and the mean age at presentation was 41. 2 years. Pain was the most common presenting symptom(86%), and then was the jaundice which occurred in 24% of patients, and fever was present in 18%, and abdominal mass was noted in 19% , and no symptoms in 2 patients (4%) . Cysts were classified according to the Todani modification of the system of Alonso-Lej: 47 of the patients were type I cysts , which are completely extrahepatic , and 2 of them had a biliary malignancy , and the other 2 of them had undergone prior biliary tract surgery . There were 2 patients with type III , which are choledochocele within the wall of the duodenum , and1 of them had a biliary malignancy . 1 patients had type IVa cysts, which are both extrahepatic and intrahepatic . No patients with type II (saccular diverticulum of the common duct), type IVb(multiple dilatations of the extrahepatic ducts and normal intrahepatic ducts), type V (dilatation is confined to intra-hepatic bile ducts, Caroli' s disease)cysts were found . Procedures used to diagnose cysts included ultrasonography (US) 50, computed tomography (CT) 40, retrograde cholangio-pancreatography (ERCP) 10, magnetic resonance cholangio-pancreatography (MRCP)23, and the accuracy were 74%, 85%, 90% , 95. 6% respectively. Our operative treatment included choledochal cystectomy, cholecystectomy, and Roux-Y hepatico —jejunostomy in 42 patients which were type I cysts . 2 patients previously operated on had undergone partial cyst resection and Roux-Y cyst jejunostomy, and had the total choledochal cystectomy, and Roux-Y hepaticojejunostomy . 1 patient with type I cyst had emergency operation of T tube drainage for acute obstructive suppurative cholangitis(AOSC) . 2 patients with type I cyst had choledochal cystectomy, cholecystectomy, Roux-Y hepaticojejunostomy and lymph cleaning of hepatoduodenal ligament because of biliary malignancy by freezing pathobiology in the operation . Pancreaticoduodenectomy and total cystectomy were performed in 1 patients because of biliary malignancy by freezing pathobiology in the operation, the other type III cyst was unoperated on because of asymptomatic. Operation was terminated in a patient with a IV-A cystbecause of extensive intrahepatic duct involvement. 2, Result and follow-up visit:Pathobiology demonstrate that all the 48 patients were congenital choledochal cysts . Pathology findings of 2 type I and 1 type III cyst pantients were malignant degeneration (6%) . Patient with AOSC didn' t have further operation, because her family member refused , and she was discharged after for MOF. Postoperative recovery was uneventful in all of the other patients. Our patients after a follow-up visit range 2 months to 6 years , and the mean follow-up visit was 28. 6 months. 1 type I patient suffered cholangitis 1 year later, and was recovered by using antibiotics, no anastomotic calibre stricture in patient. There was no cholangiocarcinoma and no evidence of jaundice, cholangitis, or pancreatitis to suggest possible stricture of the biliary anastomoses in all of the patients.Conclusions:Mostly clinical representation of congenital choledochal cyst is abdominal pain in adult patients, no patients possess all three symptom (abdominal mass, bellyache and jaundice) in this group. Resultingly this disease usually first represent abdominal pain , then diagnosis must depend on imaging examine method . Ultrasonography (US) serves as an important first choose tool for diagnosis of congenital choledochal cysts. When the ultrasonography showed cannot reveal the connection of cyst andbile duct system, we can choose else examine method, such as MRCP and ERCP etc. MRCP is more accurately than ERCP, and MRCP is no traumatic examine method, thus we consider that MRCP should be performed best between the two examine method . Because of the long-term consequences of cholangitis, liver cirrhosis, pancreatitis, and cancer , and an associated biliary malignancy correlated with age , Once the diagnosis has been established in adult , the patient should be treated by operation . Choledochal cystectomy Roux-en-Y hepaticojejunostomy is a perfect operation of biliary tract reconstruction.