胰门板降低技术在胰腺段胆总管囊肿切除术中的应用

doi:10.3969/j.issn.1674-8115.2021.03.008

上海交通大学学报(医学版) ›› 2021, Vol. 41 ›› Issue (3): 334-338.doi: 10.3969/j.issn.1674-8115.2021.03.008

胰门板降低技术在胰腺段胆总管囊肿切除术中的应用

王伟¹^,²(), 许鑫森¹, 杨传鑫¹^,², 陈炜¹, 王坚¹^,²()

^1.上海交通大学医学院附属仁济医院胆胰外科，上海 200127
^2.上海交通大学附属第六人民医院肝胆胰外科，上海 200233

收稿日期:2020-03-19 出版日期:2021-03-28 发布日期:2021-04-06
通讯作者: 王坚 E-mail:ww.wwj@163.com;dr_wangjian@126.com
作者简介:王伟（1983—），男，副主任医师，博士；电子信箱：ww.wwj@163.com。
基金资助:
上海交通大学医学院高水平地方高校创新团队(SSMU-ZDCX20180502);上海市领军人才项目;上海市“医苑新星”青年医学人才培养资助计划

Application of lowering of intrapancreatic plate approach to surgical management of intrapancreatic choledochal cyst

Wei WANG¹^,²(), Xin-sen XU¹, Chuan-xin YANG¹^,², Wei CHEN¹, Jian WANG¹^,²()

^1.Department of Biliary and Pancreatic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
^2.Department of Hepatobiliary and Pancreatic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China

Received:2020-03-19 Online:2021-03-28 Published:2021-04-06
Contact: Jian WANG E-mail:ww.wwj@163.com;dr_wangjian@126.com
Supported by:
Innovative Research Team of High-Level Local Universities in Shanghai(SSMU-ZDCX20180502);Program for Outstanding Academic Leader;Financial Assistance Scheme for Young Medical Personnel Training in Shanghai

摘要/Abstract

摘要：

目的·探讨胰门板降低技术在胰腺段胆总管囊肿切除术中的应用价值。方法·回顾性分析2016年1月—2019年12月于上海交通大学医学院附属仁济医院收治的15例董氏分型C2型的胆总管囊肿患者。采用胰门板降低技术对患者施行胰腺段胆总管囊肿切除术，术中验证术前对胆总管囊肿与主胰管汇合方式的判定，并对手术成功率、手术时间、术中输血率、术后并发症、术后病理结果、转归情况及随访情况（存活状况、远期并发症）进行分析。结果·7例（46.7%）患者呈现主胰管与胆总管囊肿远端的正常胆管汇合，8例（53.3%）呈主胰管与胆总管囊肿汇合，该术前判定结果得到术中证实。15例患者均经胰门板降低技术成功切除胰腺段胆总管囊肿，病变胆管残留率及主胰管损伤率均为0，手术时间为（170.0±22.7）min，术中输血率为0；其中有8例（53.3%）出现术后并发症，分别为生化级胰漏1例、B级胰漏1例、胃瘫1例、生化级胰漏合并胆漏1例、肠梗阻1例、生化级胰漏合并肠梗阻1例、腹腔积液伴感染1例、伤口感染1例。术后病理学结果显示，所有患者均为胆总管囊肿伴黏膜慢性炎。经治疗后，患者均痊愈出院。经5~48个月的术后随访显示，患者均生存良好，无胆肠吻合口狭窄、胆管扩张和胆管癌变的发生。结论·采用胰门板降低技术实施胰腺段胆总管囊肿切除术安全有效。

关键词: 胆总管囊肿, 胆管扩张症, 胰门板降低技术, 胰腺段胆总管囊肿

Abstract:

Objective·To investigate the application value of lowering of intrapancreatic plate approach in surgical management of intrapancreatic choledochal cyst.

Methods·From January 2016 to December 2019, 15 patients with choledochal cyst (Dong type C2) in Renji Hospital, Shanghai Jiao Tong University School of Medicine were retrospectively studied. All patients underwent intrapancreatic choledochal cyst excision through the lowering of intrapancreatic plate approach. Preoperative judgement of junction between choledochal cyst and main pancreatic duct would be verified in operation. The operative success rate, operation time, intraoperative blood transfusion rate, postoperative complications, postoperative pathological results, clinical outcome and follow-up (survival state and long-term complications) were analyzed.

Results·Preoperative judgement results of junction between choledochal cyst and main pancreatic duct were confirmed in operation. Main pancreatic duct joined with normal bile duct distal to choledochal cyst in 7 (46.7%) patients, and main pancreatic duct joined with choledochal cyst in 8 (53.3%) patients. All the 15 patients underwent successful intrapancreatic choledochal cyst excision through the lowering of intrapancreatic plate approach without remnant intrapancreatic choledochal cysts and main pancreatic duct damage. The operation time was (170.0±22.7) min, and the blood transfusion rate was 0. Postoperative complications occurred in 8 patients, including pancreatic leakage (grade biochemical), pancreatic leakage (grade B), gastroplegia, pancreatic leakage (grade biochemical) combined with bile leakage, intestinal obstruction, pancreatic leakage (grade biochemical) combined with intestinal obstruction, intraperitoneal effusion with infection and incision infection. Postoperative pathological results showed that all patients were diagnosed as choledochal cyst with chronic inflammation of mucosa. After treatment, all patients were cured and discharged.After 5?48 months of follow-up, all patients survived well, without the sign of anastomotic stricture after hepaticojejunostomy, biliary dilatation and carcinogenesis.

Conclusion·Intrapancreatic choledochal cyst excision through the lowering of intrapancreatic plate approach is safe and effective.

Key words: choledochal cyst, biliary dilatation, lowering of intrapancreatic plate approach, intrapancreatic choledochal cyst

中图分类号:

R657.4⁺4

王伟, 许鑫森, 杨传鑫, 陈炜, 王坚. 胰门板降低技术在胰腺段胆总管囊肿切除术中的应用[J]. 上海交通大学学报(医学版), 2021, 41(3): 334-338.

Wei WANG, Xin-sen XU, Chuan-xin YANG, Wei CHEN, Jian WANG. Application of lowering of intrapancreatic plate approach to surgical management of intrapancreatic choledochal cyst[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(3): 334-338.

图/表 3

图1 胰腺段胆总管囊肿与主胰管的汇合方式示意图Note:A. Main pancreatic duct joined with normal bile duct distal to choledochal cyst. B. Main pancreatic duct joined with choledochal cyst. Red line represents incision site.

Fig 1 Schematic diagram of junction between intrapancreatic choledochal cyst and main pancreatic duct

图2 董氏分型为C2型的胆总管囊肿患者的术前影像学评估Note:A/B. Detection of main pancreatic duct joined with normal bile duct distal to choledochal cyst by abdominal CT (A) and MRCP (B) examination. C/D. Detection of main pancreatic duct joined with choledochal cyst by abdominal CT (C) and MRCP (D) examination. Red arrow represents main pancreatic duct.

Fig 2 Preoperative imaging evaluation of patients with choledochal cyst (Dong type C2)

图3 采用胰门板降低技术行胆总管囊肿切除Note:A. Anatomy of hepatic duct proximal to choledochal cyst. B. Anatomy of common bile duct and pancreas covered by duodenum. C. Anatomy of branch from gastroduodenal artery. D. Exposure of intrapancreatic choledochal cyst. E/F. Treatment of the end of the choledochal cyst (F) with main pancreatic duct joining with normal bile duct distal to choledochal cyst (E). G/H. Treatment of the end of the choledochal cyst (H) with main pancreatic duct joining with choledochal cyst (G). I. choledochojejunostomy.

Fig 3 Resection of choledochal cyst through the lowering of intrapancreatic plate approach

参考文献 10

1	中华医学会外科学分会胆道外科学组. 胆管扩张症诊断与治疗指南(2017版)[J]. 中华消化外科杂志, 2017, 16(8): 767-774.
2	Fan F, Xu DP, Xiong ZX, et al. Clinical significance of intrapancreatic choledochal cyst excision in surgical management of type Ⅰ choledochal cyst[J]. J Int Med Res, 2018, 46(3): 1221-1229.
3	王坚. 胆管扩张症诊断与治疗的难点与对策[J]. 中华消化外科杂志, 2018, 17(12): 1146-1151.
4	Kim E, Kang MH, Lee J, et al. Two cases of plug or stone in remnant intrapancreatic choledochal cysts treated with endoscopic retrograde cholangiopancreatography[J]. Clin Endosc, 2017, 50(5): 504-507.
5	Xia HT, Yang T, Liang B, et al. Treatment and outcomes of adults with remnant intrapancreatic choledochal cysts[J]. Surgery, 2016, 159(2): 418-425.
6	Ando H, Kaneko K, Ito T, et al. Complete excision of the intrapancreatic portion of choledochal cysts[J]. J Am Coll Surg, 1996, 183(4): 317-321.
7	Liu YF, Sun JX, Guo S, et al. The distal classification and management of choledochal cyst in adults: based on the relation between cyst and pancreatic duct[J]. Medicine (Baltimore), 2017, 96(12): e6350.
8	Le Roy B, Gagnière J, Filaire L, et al. Pancreaticobiliary maljunction and choledochal cysts: from embryogenesis to therapeutics aspects[J]. Surg Radiol Anat, 2016, 38(9): 1053-1060.
9	Soares KC, Goldstein SD, Ghaseb MA, et al. Pediatric choledochal cysts: diagnosis and current management[J]. Pediatr Surg Int, 2017, 33(6): 637-650.
10	Cheung TT, Fan ST. Technical note on complete excision of choledochal cysts[J]. Hepatobiliary Pancreat Dis Int, 2013, 12(2): 218-221.

胰门板降低技术在胰腺段胆总管囊肿切除术中的应用

Application of lowering of intrapancreatic plate approach to surgical management of intrapancreatic choledochal cyst

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 3

参考文献 10

相关文章 0

编辑推荐

Metrics