| ObjectiveTo explore the clinical characteristics and surgical treatment of adult patients with congenital cholangiectasia,and to provide a certain clinical reference value for the surgical diagnosis and treatment and the choice of surgical methods.MethodsThe data of 45 adult patients with congenital cholangiectasis treated by surgical operation from September 2004 to February 2019 in Qianfoshan Hospital of Shandong Province were analyzed retrospectively.All the patients were diagnosed according to clinical manifestation,iconography data and postoperative pathology.Clinical classification was carried out according to todani classification.Treatment methods: all 45 cases were treated by surgical operation.35 cases underwent common bile duct cyst resection +anastomosis of hepatic duct jejunum Roux-en-Y,5 cases of which underwent Laparoscopic choledochal cyst excision;5 cases underwent common bile duct cyst resection + anastomosis of hepatic duct jejunum Roux-en-Y + left hepatic lobectomy;2 cases underwent cholecystectomy + Choledocholithotomy + T tube drainage;a case underwent common bile duct cyst resection + choledocholithotomy + T tube drainage;a case underwent Cholecystectomy + common bile duct cyst resection + Whipple operation;a cases underwent cholecystectomy + extrahepatic cholangiectomy + duodenal incision of choledochal cyst +anastomosis of hepatic duct jejunum Roux-en-Y.The methods of follow-up were outpatient follow-up and telephone follow-up.ResultAmong the 45 patients,the ratio of male to female was 1 to 2.75,the age was 18 to 77 years,the average age was 41.6±18.5 years.Among them,77.78% of the patients had abdominal pain and 48.89% of the patients had jaundice or abnormal liver function.11.11% of the patients had fever and 8.89% of the patients had nausea and vomiting,11.11% of the patients had no obvious symptoms.All the 45 patients were examined by B-ultrasound before operation,the diagnostic rate was 80.00% and 34 cases were examined by CT,the diagnostic rate was 90.91% and 19 cases were examined by MRCP,the diagnostic rate was 100% and a case was examined by ERCP,and the diagnosis rate was 100%.All the patients were diagnosed with choledochal cysts by Intraoperative exploration and postoperative pathological findings.Of all the patients,22 cases with cholangitis(48.89%),17 cases with cholelithiasis(37.78%);3 cases with pancreatitis(6.67%);3 cases with adenocarcinoma of bile duct(6.67%);1 case with perforation of bile duct(2.22%);1 case with carcinoma of duodenal papilla(2.22%);1 case high grade intraepithelial neoplasia of bile duct(2.22%).Postoperative intraperitoneal hemorrhage occurred in 1 patient,biliary fistula in 2 patients,pancreatic fistula in 2 patients and incision infection in 5 patients after operation.The follow-up period was 2 months to 13 years,and the follow-up rate was 82.22%.Among 4 patients with tumor,2 cases of tumor patients died because of tumor recurrence and 2 case of tumor patients did not have tumor recurrence.Intrahepatic bile duct stones were found in 3 patients after surgery.One patient recurred after 14 months and underwent reoperation.Choledocholithiasis was found in one elderly patient one month after external drainage,and underwent choledocholithotomy.The other cases had no complications such as biliary tract infection,cholelithiasis,anastomotic stricture and malignant change.The long-term complication rate was15.56%.ConclusionImaging examination is needed for diagnosis.B-ultrasound can be used as the first choice and MRCP is the gold standard for diagnosis.The specific operation methods should be determined according to different types of cysts and pathological features.Type I can be treated with common bile duct cyst resection + anastomosis of hepatic duct jejunum Roux-en-Y and Laparoscopic choledochal cyst excision is also safe and feasible.Partial hepatectomy can be performed for type Ⅳ or Ⅴ complicated with intrahepatic bile duct cysts,and one stage external drainage may be performed with severe biliary tract infection. |
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