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目的 对先天性胆管扩张症术后 5年以上获随访的 97例进行综合分析 ,探讨远期并发症的原因及防治措施 ,以提高远期疗效。方法 对患者的临床表现、必要的生化检查、B型超声、纤维胃十二指肠镜及 2 4h胃食管双 pH监测结果进行综合评价。 结果 ①发育营养佳 ,无任何自觉症状 ,检查无异常者 5 0例 ,或偶有上腹疼痛 ,胃纳不佳 ,检查无异常者 2 0例 ,共 70例 (72 .16 % )为优。②发育营养良 ,偶有或时有上腹疼痛 ,经纤维内窥镜检查 ,发现胆汁反流性胃炎、浅表性胃炎、十二指肠球炎共 15例临床无症状 ,B超检查肝内结石 8例 ,共 2 3例 (2 3.71% )为良。优良率为 95 .87% ,肝硬化门脉高压 2例 (2 .0 6 % ) ,癌变 2例死亡 (2 .0 6 % )。结论 先天性胆管扩张症术后远期并发症与术式选择、病灶切除不彻底、吻合口狭窄、十二指肠胃反流关系密切 ,应在术前全面了解肝内外胆管的形态、分布 ,术中应遵循病灶全部切除 ,胰胆分流 ,行肝管空肠Roux Y吻合术的原则 ,术后定期随访 ,消除隐患 ,早期发现并发症并及时处理。
Objective To analyze the 97 cases of congenital bile duct dilatation who were followed up more than 5 years after operation and explore the causes and prevention measures of long-term complications to improve the long-term curative effect. Methods The clinical manifestations of patients, the necessary biochemical tests, B-mode ultrasound, fibroscopic gastroduodenoscopy and 24 h gastro-esophageal pH monitoring results were comprehensively evaluated. Results ① good nutrition and development, without any symptoms, no abnormalities in the examination of 50 cases, or occasional upper abdominal pain, poor appetite, no abnormalities were 20 cases, a total of 70 cases (72.16%) as excellent . ② good nutrition development, occasional or sometimes upper abdominal pain, fiber endoscopy and found bile reflux gastritis, superficial gastritis, duodenal inflammation in a total of 15 cases asymptomatic, B-ultrasound liver 8 cases of internal stones, a total of 23 cases (2 3.71%) as good. The excellent and good rate was 95.87%, two cases of portal hypertension of liver cirrhosis (2.06%) and two cases of cancer died (2.06%). Conclusions Long-term complication and operation choice of congenital bile duct dilatation, incomplete resection of the lesion, stricture of the anastomosis, and close relationship of duodenal gastric reflux should be fully understood before operation. The morphology, distribution, Should follow the principle of total excision of the lesion, pancreaticobiliary shunt, Roux Y anastomosis of the hepatic duct and jejunum, and regular follow-up after operation to eliminate the hidden danger and early detection of complications and prompt treatment.