JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE) ›› 2021, Vol. 41 ›› Issue (3): 334-338.doi: 10.3969/j.issn.1674-8115.2021.03.008

• Clinical research • Previous Articles     Next Articles

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. 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

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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

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