Traditional Chinese And Western Medicine Diagnosis And Treatment Of Congenital Choledochal Cyst In Adult Patients

Object: To summarize the Traditional Chinese and western medicine diagnosis andtreatment experience of congenital choledochal cyst in adult patients.Method: Clinical data of32patients with congenital choledochal cysts diagnosedand treat in First affiliated hospital of Dalian Medical University from2003Mar. to2012Jun were retrospectively analyzed.1. Clinical data and treatmentIn the32patients, there were22female, and10male. The oldest of them was76-year-old, the youngest was18-year-old, and the mean age at presentation was38.4years old. Pain was the most common presenting symptom (90.6%), and then was thejaundice which occurred in18.7%, and fever was present in15.6%, and abdominal masswas in9.3%, and no symptoms in2patients. The patients with jaundice were classifiedby type of syndrome,4of them were yang jaundice and2were yin jaundice. Cysts wereclassified according to the Todani modification of the system of Alonso-Lej: thirty ofthe patients were type Ⅰ cysts, and2of them had undergone prior biliary tractsurgery. There was1patient with type Ⅱ,1patient had type Ⅳb cysts. No patientswith type Ⅲ、typeⅣa、 typeⅤ cysts were found. Treatment: All the32patients weretreat by operation, there were28Ⅰtype cysts patients、one Ⅱtype cysts patient andone Ⅳb patient had total choledochal cystectomy, and Roux-en-Y hepaticojejunostomy.Two patients with type Ⅰ cyst were performed choledochal cystectomy, Roux-en-Yhepaticojejunostomy and lymph cleaning of hepatoduodenal ligament because of biliarymalignancy by freezing pathobiology in the operation.2. Result and follow-up visit:Pathbiology demonstrates that the diagsis all the32patients was congenital choledochal cysts. Pathology findings of two typeⅠ cysts patients were malignantdegeneration(6.2%). Postoperative recovery was uneventful in all the patients.Among the32cases,27patients were fellow-up, the rate of fellow-up was84.3%.Fellow-up period ranged from3moths to4years, mean30.2moths. One malignantdisease patient was lost to fellow-up, and one malignant disease patient’s survival timewas3years. Three cases in type Ⅰ were suffered from acute cholangitis, afterconservative treat they all restored, all of the other patients were in excellent condition.Conclusions: The diagnosis of congenital choledochal cyst depends on the clinicalmanifestat and imaging examination. The early diagnosis and early treatment are thekey of this disease for prognosis, the patient should be treat by operation once thediagnosis has been established, and surgical excision of the cyst and bilioenterostomyare the basic principles of treatment.