跳转到内容

总胆管囊肿

维基百科，自由的百科全书
总胆管囊肿
异名胆管囊肿
总胆管囊肿的不同类型
症状腹痛、黄疸、右上腹肿块[1][2][3][4]
并发症胆管炎、胰腺炎、囊肿内结石、肝脓疡、肝硬化、门静脉高压、恶性病变（胆管癌、胆囊癌）[1][2][5][6][7][8][9]
起病年龄多数在儿童时期确诊[1]
病程终生，除非手术切除
类型Todani分类 I-V型[10]
病因胰胆管汇合异常 (APBDU) 为主[11][12][13]
风险因素女性、亚洲人、年龄增长（针对癌变风险）[1][14][15][12]
诊断方法影像学检查（超声波、CT、MRCP）、ERCP[15][16][17]
鉴别诊断肝囊肿、胰腺假性囊肿、胆道黏液性囊状肿瘤
预防无法预防
治疗手术切除囊肿 + 胆道重建（多数类型）；内视镜治疗（第三型）[15][18][19]
药物抗生素（处理胆管炎）
预后良好（5年生存率>95%），若无癌变[1]
患病率亚洲约1/13,000，西方约1/150,000[15]
死亡数主要与癌变相关[1]
分类和外部资源
医学专科肠胃学, 外科
ICD-11LB20.20
ICD-9-CM751.69、​576.8
OMIM603003
DiseasesDB2527
eMedicine172099、​366004、​934267
Orphanet480501
[编辑此条目的维基数据]

总胆管囊肿（英语：Choledochal cysts, CCs），又称胆管囊肿，是一种罕见的先天性疾病，指肝内或肝外胆管出现囊状扩张。[1] 大约八成病例在儿童时期确诊，常出现右上腹肿块、腹痛和黄疸等症状。[2][3][4] 近年来，由于电脑断层扫描 和磁力共振成像 等横断面影像学技术的普及，成年人确诊的个案有所增加。[20] 女性发病率约为男性的四倍。[1][14] 此外，此病在亚洲人群中较常见，发病率约为1/13,000，而在西方人群中则约为1/150,000。[15] 主要治疗目标是透过手术处理，以减低胆管炎和恶性病变（癌症）等并发症的风险。[15]

分类

[编辑]

1959年，Alonso-Lej等人首次提出总胆管囊肿的分类系统，根据肝外胆管扩张的性质分为三型。[21] 其后，Todani及其同事在此基础上，加入了肝内胆管囊肿（卡罗利氏病），形成了目前广泛使用的Todani分类法，共分为五型：[10]

  • 第一型：总肝管或总胆管呈梭状或囊状扩张，肝内胆管正常。（此型最常见，尤其在儿童中[15]）
  • 第二型：总胆管壁上出现一个局限性的憩室，位于十二指肠上方。
  • 第三型：胆管末端在十二指肠内壁的部分呈囊状扩张，也称为胆管囊肿 (choledochocele)。
  • 第四型：分为IVa（肝内和肝外胆管同时扩张）和IVb（仅肝外胆管多处扩张，肝内胆管正常）。（此型在成人中较常见[15]）
  • 第五型：仅肝内胆管扩张，程度不一，也称为卡罗利氏病 (Caroli Disease)。[10]

病理生理学与病因

[编辑]

虽然总胆管囊肿的确切病因尚不完全清楚，但目前主流观点认为，大多数病例的形成与胰胆管汇合异常（英语：Anomalous Pancreaticobiliary Duct Union, APBDU）有关。[11][12][13]

正常情况下，胰管和总胆管在进入十二指肠前会先汇合成一条短的共同通道（长约0.2-1.0厘米），并被奥迪氏括约肌 (Sphincter of Oddi) 包围。[22] APBDU是指这个共同通道过长（通常大于10毫米），且汇合点位于括约肌控制范围之外。这使得胰液容易逆流进入胆道系统，胰液中的酶（特别是胰蛋白酶和磷脂酶A2）会侵蚀胆管壁，引起慢性炎症、压力增高，最终导致胆管扩张形成囊肿。[23][24] 支持此理论的证据包括：在总胆管囊肿的囊液中检测到高浓度的胰酶[24]；高达96%的总胆管囊肿患者被发现有APBDU，而没有此病的人中只有约2%有此异常。[25] Komi等人根据胰管和总胆管汇合的角度和形态，将APBDU进一步分为不同类型。[26]

另一种相关异常是胰胆管连接异常（英语：pancreaticobiliary maljunction），指胰管和总胆管在十二指肠壁外汇合，这与第一型和第四型囊肿有关，亦被认为会增加胆道癌风险，即使没有合并总胆管囊肿。[27][28]

总胆管囊肿的发生也可能与遗传因素有关，曾有家族内多人发病的报告。[29] 此外，有研究发现囊肿狭窄部分的神经节细胞数量明显减少，类似先天性巨结肠症的病理变化，提示神经节细胞迁移异常也可能是发病机制之一。[30]

并发症

[编辑]

总胆管囊肿若不处理，可能引发多种并发症。患者可能出现腹痛和黄疸等症状。一项研究显示，约84.5%的患者有症状，15.5%无症状。成年患者较常出现腹痛，儿童则较常出现黄疸。[1]

其他相关并发症包括：

恶性病变

[编辑]

最令人担忧的并发症是恶性病变（癌变）。报告的癌变发生率约为3-5%[1]，但真实发生率仍不清楚。一项综合分析显示，在5780名患者中，癌变发生率为7.5% (434例)。[2]

癌变风险与以下因素相关：

  • 年龄增长：风险随年龄显著增加，儿童患者的风险虽然存在但相对较低。[12] 这可能与胆道上皮长期暴露于逆流的胰液中有关，尤其是在有APBDU的患者中。
  • 囊肿类型：第一型和第四型囊肿的癌变风险较高，第五型较低，而第二型和第三型则极少发生癌变。[19]

最常见的恶性肿瘤是胆管癌和胆囊癌。[2] 病理学上，腺癌最常见，占73-84%；其他类型包括未分化癌 (anaplastic carcinoma, 10%)、未定型癌 (undifferentiated cancer, 5-7%) 和鳞状细胞癌 (5%)。[38]

影像学诊断

[编辑]

放射学和内视镜影像是诊断总胆管囊肿的基石。初步检查通常从超声波 或电脑断层扫描 开始。超声波在儿童中较常用，成年人则较多使用CT。[1]

关键影像特征是胆管与囊状扩张区域相连。[39] 确定囊肿与胆道系统相通非常重要，这有助于区分总胆管囊肿和肝脏的黏液性囊状肿瘤 (Mucinous Cystic Neoplasm, MCN)，后者通常不与胆道相通。[39] 同时，胆管扩张不应由可识别的机械性梗阻引起。[40] 使用肝胆对比剂（显影剂）可能有助于确定囊肿是否与胆道系统连接。[41]

完全勾画出囊肿的解剖结构对于制定恰当的治疗方案至关重要。在超声波或CT之后，可能需要进行更详细的胆管造影术，例如：

由于治疗方法主要取决于囊肿类型，准确的影像学分型和范围评估至关重要。此外，若计划进行手术，术前影像需清楚显示胆管与胰管的关系，因为解剖变异很常见。[44] 同时，在手术前应控制好任何潜在的胆道感染，可能需要使用广谱抗生素和/或进行内视镜或经皮引流。

治疗

[编辑]

历史上，曾采用囊肿肠道吻合术 (cyst enterostomy) 治疗总胆管囊肿，但这种方法术后长期并发症发生率高，如吻合口狭窄、黄疸、胆管炎、需要再次手术，且无法消除胆管癌的风险。[18] 尽管部分切除或囊肿肠道吻合术可以缓解胆道梗阻，但为了根除癌变风险，目前标准的治疗方法是进行完整的囊肿切除，尤其是对于癌变风险较高的第一型和第四型囊肿。[15][18] 治疗方案主要根据囊肿的Todani分类来决定。

根据囊肿类型治疗

[编辑]

第一型 (Type I)

[编辑]

第一型囊肿的标准治疗是完整切除囊肿，并进行Roux-en-Y肝管空肠吻合术（英语：Hepaticojejunostomy, HJ）来重建胆道。[38]

如果囊肿延伸至胰头内，有时可能需要进行胰十二指肠切除术才能完全切除。然而，通常可以小心地将胰头内的囊肿壁完整剥离出来（"coring out"），避免进行PD。医生需要权衡残留囊肿的风险与PD手术本身较高的并发症风险。[38]

胆道重建通常采用标准的HJ。肝管十二指肠吻合术 (英语：Hepaticoduodenostomy, HD) 曾被视为一种选择，优点是术后可经内视镜进入胆道，但因十二指肠移动度有限、吻合口张力问题，以及可能有增加胃癌和胆道癌的风险（因胆道持续暴露于胰液中），现已基本弃用。[45][46] 因此，完整囊肿切除加HJ重建是第一型囊肿的首选治疗。

成年患者由于可能经历反复胆管炎和慢性炎症，手术切除有时比儿童更具挑战性。[47] 特别是囊肿后壁可能与门静脉紧密粘连，使得完整切除非常困难或风险过高。在这种情况下，可以考虑切除囊肿前壁，并电灼 (fulguration) 后壁黏膜。如果粘连过于严重或患者有严重门静脉高压，胆总管囊肿空肠吻合术 (choledochocystojejunostomy) 仍是一种选择，但效果较差。[6][7][32]

第二型 (Type II)

[编辑]

第二型囊肿的处理取决于囊肿颈部的大小。如果颈部较小，可以直接结扎或缝合关闭开口。如果颈部较大，可能需要在切除囊肿后，于T型管上缝合关闭胆管缺损，或者连同相邻的部分胆管一并切除（英语：en-bloc excision），再进行Roux-en-Y HJ重建。[48] 现有数据未能明确显示一并切除胆管并重建是否优于单纯切除囊肿。[49]

第三型 (Type III)

[编辑]

第三型囊肿，即胆管囊肿，其恶性病变风险非常低。[19][12][50] 由于其位于十二指肠内，完整手术切除需要进行PD或经十二指肠切除，技术要求高且并发症风险较大。因此，目前公认的处理方法是采用内视镜治疗，例如内视镜括约肌切开术 (英语：endoscopic sphincterotomy) 或括约肌成形术 (英语：sphinteroplasty)。[15][19][51][52][53][12][54]

对于胆管囊肿，ERCP通常能比MRCP更清晰地显示导管解剖结构。[55] 内视镜方法允许清楚地辨认胰胆管解剖，这对于避免损伤胰管至关重要。[56][57][58] 内视镜治疗已被证明效果持久，长期效果良好。[53]

第四型 (Type IV)

[编辑]

第四型囊肿的治疗较具挑战性，因为其肝内和肝外病变的分布情况多样。[59][60]

  • 如果病变主要影响单侧肝脏，首选的治疗方法是进行部分肝切除，同时切除肝外病变胆管，并进行Roux-en-Y HJ重建。通常，从肝切除术中获益最大的患者是那些伴有肝内胆管扩张和狭窄、肝内胆管结石或肝脏实质萎缩的患者，因为这些情况更容易导致胆汁淤积、脓疡、胆管炎、肝内胆管结石和癌变。[59][60]
  • 有趣的是，第四型囊肿患者的癌变似乎更常发生在肝外胆管部分。[59] 因此，切除主要的肝外病变胆管对于降低癌变风险至关重要。[59]
  • 部分第四型囊肿患者可能同时合并胆管囊肿的成分，这些患者也可能受益于经十二指肠的括约肌成形术。[61][62][6][63]
  • King's College医院根据肝外胆管扩张的外观（囊状或梭状）对第四型囊肿进行了进一步分类，发现两者在临床表现和病理生理上可能存在差异。[64][65][66][67]

第五型 (Type V) - 卡罗利氏病

[编辑]

第五型囊肿，即卡罗利氏病 (Caroli Disease)，其处理尤其复杂。

  • 如果病变局限于肝脏的某一部分，部分肝切除是首选的治疗方法。
  • 对于肝内病变广泛、无法进行肝切除的患者，可以考虑进行肝脏移植。
  • 其他干预措施，如胆道引流手术，通常无法有效预防反复发作的胆管炎。[12][68]
  • 对于双侧肝脏受累的患者，治疗重点应放在处理胆管炎和优化肝功能上。[69][70][71][72]
  • 虽然曾尝试过肝外胆道减压或胆管十二指肠/空肠吻合等内引流术，但由于病变位于处理点的远端（肝内），这些方法效果往往不佳。[73]

肝切除和肝移植都取得了良好的效果。一项研究报告，肝切除术后5年生存率为97%，肝移植术后为89%。[68] 其他研究也证实了手术治疗（包括切除和移植）能有效改善症状和并发症。[74][75][76]

微创手术治疗

[编辑]

除了传统的开腹手术，微创手术，包括腹腔镜和机械臂辅助技术，也已成功应用于总胆管囊肿的治疗。这类手术对医生的微创技术和肝胆外科经验要求较高，但经验丰富的外科医生可以取得良好的技术效果。[77]

微创手术在儿童患者中应用更为普遍。[78] 虽然样本量通常较小，数据有限，但现有证据表明，微创手术与开腹手术相比，术后并发症发生率没有显著差异。[78] 多项研究报告了在成年患者中使用微创方法切除囊肿并重建胆道的良好技术效果和可接受的术后并发症率。[79][80][81][82] 甚至有数据提示，腹腔镜囊肿切除术不仅安全可行，还可能降低并发症风险，尤其是在儿童患者中。[83]

与腹腔镜相比，机械臂手术平台可能更有利于进行精密的肝管空肠吻合术重建。[84] 有研究报告即使在一岁以下的婴儿中，使用机械臂平台也是安全的。[85] 随著经验的积累，越来越多的医学中心开始采用微创技术治疗总胆管囊肿。[86]

预后

[编辑]

总胆管囊肿的手术通常耐受性良好。早期并发症可能包括吻合口渗漏，晚期可能出现吻合口狭窄，但两者都不常见。

手术后的总体预后良好，5年生存率达到95.5%。[1] 主要术后并发症的发生率在儿童和成人之间相似，但成人患者的总体术后并发症（如血清肿、伤口感染、肝周脓疡）发生率可能更高，而儿童则相对较易出现吻合口漏或胃肠道穿孔。[1] 不意外地，如果在切除囊肿时已发现合并恶性肿瘤，患者的预后会显著变差。[1]

参考资料

[编辑]
  1. ^ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 Soares KC, Kim Y, Spolverato G, Maithel S, Bauer TW, Marques H, et al. Presentation and clinical outcomes of choledochal cysts in children and adults: a multi-institutional analysis. JAMA Surg. June 2015, 150 (6): 577–584. PMID 25875090. doi:10.1001/jamasurg.2015.0226. 
  2. ^ 2.0 2.1 2.2 2.3 2.4 Sastry AV, Abbadessa B, Wayne MG, Steele JG, Cooperman AM. What is the incidence of biliary carcinoma in choledochal cysts, when do they develop, and how should it affect management?. World J Surg. February 2015, 39 (2): 487–492. PMID 25318999. doi:10.1007/s00268-014-2831-5. 
  3. ^ 3.0 3.1 Edil BH, Cameron JL, Reddy S, Lum Y, Lipsett PA, Nathan H, et al. Choledochal cyst disease in children and adults: a 30-year single-institution experience. J Am Coll Surg. May 2008, 206 (5): 1000–1005; discussion 1005–1008. PMID 18471734. doi:10.1016/j.jamcollsurg.2007.12.045. 
  4. ^ 4.0 4.1 de Vries JS, de Vries S, Aronson DC, Bosman DK, Rauws EA, Bosma A, et al. Choledochal cysts: age of presentation, symptoms, and late complications related to Todani's classification. J Pediatr Surg. November 2002, 37 (11): 1568–1573. PMID 12407541. doi:10.1053/jpsu.2002.36186. 
  5. ^ Kendrick ML, Nagorney DM. Bile duct cysts: contemporary surgical management. Curr Opin Gastroenterol. May 2009, 25 (3): 240–244. PMID 19349860. doi:10.1097/mog.0b013e328329887c. 
  6. ^ 6.0 6.1 6.2 6.3 6.4 6.5 Nagorney DM, McIlrath DC, Adson MA. Choledochal cysts in adults: clinical management. Surgery. October 1984, 96 (4): 656–663. PMID 6207633. 
  7. ^ 7.0 7.1 Ono J, Sakoda K, Akita H. Surgical aspect ot cystic dilatation of the bile duct. An anomalous junction of the pancreaticobiliary tract in adults. Ann Surg. February 1982, 195 (2): 203–208. PMC 1352381 可免费查阅. PMID 7059231. doi:10.1097/00000658-198202000-00014. 
  8. ^ 8.0 8.1 Lipsett PA, Pitt HA, Colombani PM, Boitnott JK, Cameron JL. Choledochal cyst disease. A changing pattern of presentation. Ann Surg. November 1994, 220 (5): 644–652. PMC 1234458 可免费查阅. PMID 7979606. doi:10.1097/00000658-199411000-00007. 
  9. ^ 9.0 9.1 Martin LW, Rowe GA. Portal hypertension secondary to choledochal cyst. Ann Surg. November 1979, 190 (5): 638–639. PMC 1344621 可免费查阅. PMID 496312. doi:10.1097/00000658-197911000-00013. 
  10. ^ 10.0 10.1 10.2 Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts: Classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg. August 1977, 134 (2): 263–269. PMID 888911. doi:10.1016/0002-9610(77)90359-2. 
  11. ^ 11.0 11.1 Tyson GL, El-Serag HB. Risk factors for cholangiocarcinoma. Hepatology. July 2011, 54 (1): 173–184. PMC 3125475 可免费查阅. PMID 21488076. doi:10.1002/hep.24351. 
  12. ^ 12.0 12.1 12.2 12.3 12.4 12.5 12.6 Søreide K, Søreide JA. Bile duct cyst as precursor to biliary tract cancer. Ann Surg Oncol. March 2007, 14 (3): 1200–1211. PMID 17180258. doi:10.1245/s10434-006-9294-3. 
  13. ^ 13.0 13.1 Chang J, Jang JY, Kang MJ, Jung W, Shin YC, Kim SW. Clinicopathologic differences in patients with gallbladder cancer according to the presence of anomalous biliopancreatic junction. World J Surg. May 2016, 40 (5): 1211–1217. PMID 26661121. doi:10.1007/s00268-015-3359-z. 
  14. ^ 14.0 14.1 Xia HT, Yang T, Liu Y, Liang B, Wang J, Dong JH. Proper bile duct flow, rather than radical excision, is the most critical factor determining treatment outcomes of bile duct cysts. BMC Gastroenterol. August 2018, 18 (1): 129. PMC 6106823 可免费查阅. PMID 30134906. doi:10.1186/s12876-018-0862-3. 
  15. ^ 15.00 15.01 15.02 15.03 15.04 15.05 15.06 15.07 15.08 15.09 15.10 Soares KC, Arnaoutakis DJ, Kamel I, Rastegar N, Anders R, Maithel S, et al. Choledochal cysts: presentation, clinical differentiation, and management. J Am Coll Surg. December 2014, 219 (6): 1167–1180. PMC 4254470 可免费查阅. PMID 25442249. doi:10.1016/j.jamcollsurg.2014.04.023. 
  16. ^ 16.0 16.1 16.2 Park DH, Kim MH, Lee SK, Lee SS, Choi JS, Lee YS, et al. Can MRCP replace the diagnostic role of ERCP for patients with choledochal cysts?. Gastrointest Endosc. September 2005, 62 (3): 360–366. PMID 16111953. doi:10.1016/j.gie.2005.04.026. 
  17. ^ 17.0 17.1 17.2 Kim SH, Lim JH, Yoon HK, Han BK, Lee SK, Kim YI. Choledochal cyst: comparison of MR and conventional cholangiography. Clin Radiol. May 2000, 55 (5): 378–383. PMID 10814541. doi:10.1053/crad.2000.0438. 
  18. ^ 18.0 18.1 18.2 Ronnekleiv-Kelly SM, Soares KC, Ejaz A, Pawlik TM. Management of choledochal cysts. Curr Opin Gastroenterol. May 2016, 32 (3): 225–231. PMID 26885831. doi:10.1097/mog.0000000000000256. 
  19. ^ 19.0 19.1 19.2 19.3 Martin RF. Biliary cysts: a review and simplified classification scheme. Surg Clin North Am. April 2014, 94 (2): 219–232. PMID 24679415. doi:10.1016/j.suc.2014.01.011. 
  20. ^ Stringer MD, Dhawan A, Davenport M, Mieli-Vergani G, Mowat AP, Howard ER. Choledochal cysts: lessons from a 20 year experience. Arch Dis Child. December 1995, 73 (6): 528–531. PMC 1511414 可免费查阅. PMID 8554366. doi:10.1136/adc.73.6.528. 
  21. ^ Alonso-Lej F, Rever WB J, Pessagno DJ. Congenital choledochal cyst, with a report of 2, and an analysis of 94, cases. Int Abstr Surg. January 1959, 108 (1): 1–30. PMID 13625059.  温哥华格式错误 (帮助)
  22. ^ Sugiyama M, Atomi Y. Endoscopic ultrasonography for diagnosing anomalous pancreaticobiliary junction. Gastrointest Endosc. March 1997, 45 (3): 261–267. PMID 9087834. doi:10.1016/s0016-5107(97)70268-2. 
  23. ^ Iwai N, Yanagihara J, Tokiwa K, Shimotake T, Nakamura K. Congenital choledochal dilatation with emphasis on pathophysiology of the biliary tract. Ann Surg. January 1992, 215 (1): 27–30. PMC 1242369 可免费查阅. PMID 1731691. doi:10.1097/00000658-199201000-00003. 
  24. ^ 24.0 24.1 Iwai N, Tokiwa K, Tsuto T, Yanagihara J, Takahashi T. Biliary manometry in choledochal cyst with abnormal choledochopancreatico ductal junction. J Pediatr Surg. October 1986, 21 (10): 873–876. PMID 3772885. doi:10.1016/s0022-3468(86)80011-2. 
  25. ^ Park SW, Koh H, Oh JT, Han SJ, Kim S. Relationship between anomalous pancreaticobiliary ductal union and pathologic inflammation of bile duct in choledochal cyst. Pediatr Gastroenterol Hepatol Nutr. September 2014, 17 (3): 170–177. PMC 4198200 可免费查阅. PMID 25302261. doi:10.5223/pghn.2014.17.3.170. 
  26. ^ Lee HK, Park SJ, Yi BH, Lee AL, Moon JH, Chang YW. Imaging features of adult choledochal cysts: a pictorial review. Korean J Radiol. Jan–Feb 2009, 10 (1): 71–80. PMC 2627190 可免费查阅. PMID 19182506. doi:10.3348/kjr.2009.10.1.71. 
  27. ^ Funabiki T, Matsubara T, Miyakawa S, Ishihara S. Pancreaticobiliary maljunction and carcinogenesis to biliary and pancreatic malignancy. Langenbeck's Arch Surg. January 2009, 394 (1): 159–169. PMID 18414907. doi:10.1007/s00423-008-0336-0. 
  28. ^ Horaguchi J, Fujita N, Kobayashi G, Noda Y, Ito K, Takasawa O. Clinical study of choledochocele: is it a risk factor for biliary malignancies?. J Gastroenterol. April 2005, 40 (4): 396–401. PMID 15891822. doi:10.1007/s00535-005-1554-7. 
  29. ^ Iwasaki J, Ogura Y, Nakagawa S, Kato K, Kondo A, Shiraki K. Familial occurrence of congenital bile duct dilatation. World J Gastroenterol. February 2008, 14 (6): 941–943. PMC 2681163 可免费查阅. PMID 18205271. doi:10.3748/wjg.14.941. 
  30. ^ Kusunoki M, Saitoh N, Yamamura T, Fujita S, Takahashi T, Utsunomiya J. Choledochal cysts. Oligoganglionosis in the narrow portion of the choledochus. Arch Surg. August 1988, 123 (8): 984–986. PMID 3395199. doi:10.1001/archsurg.1988.01400320070014. 
  31. ^ Okada A, Nakamura T, Higaki J, Okumura K, Kamata S, Oguchi Y. Congenital dilatation of the bile duct in 100 instances and its relationship with anomalous junction. Surg Gynecol Obstet. October 1990, 171 (4): 291–298. PMID 2218710. 
  32. ^ 32.0 32.1 32.2 Rattner DW, Schapiro RH, Warshaw AL. Abnormalities of the pancreatic and biliary ducts in adult patients with choledochal cysts. Arch Surg. September 1983, 118 (9): 1068–1073. PMID 6193145. doi:10.1001/archsurg.1983.01390090052012. 
  33. ^ 33.0 33.1 Swisher SG, Cates JA, Hunt KK, Robert ME, Bennion RS, Thompson JE, et al. Pancreatitis associated with adult choledochal cysts. Pancreas. September 1994, 9 (5): 633–637. PMID 7809024. 
  34. ^ Okada A, Oguchi Y, Kamata S, Ikeda Y, Kawashima Y, Saito R. Common channel syndrome--diagnosis with endoscopic retrograde cholangiopancreatography and surgical management. Surgery. May 1983, 93 (5): 634–642. PMID 6845087. 
  35. ^ Ramond MJ, Huguet C, Danan G, Rueff B, Benhamou JP. Partial hepatectomy in the treatment of Caroli's disease. Report of a case and review of the literature. Dig Dis Sci. April 1984, 29 (4): 367–370. PMID 6705806. doi:10.1007/bf01318526. 
  36. ^ Mercadier M, Chigot JP, Clot JP, Langlois P, Lansiaux P. Caroli's disease. World J Surg. February 1984, 8 (1): 22–29. PMID 6710289. doi:10.1007/bf01658359. 
  37. ^ Ando H, Ito T, Kaneko K, Seo T. Congenital stenosis of the intrahepatic bile duct associated with choledochal cysts. J Am Coll Surg. November 1995, 181 (5): 426–430. PMID 7582203. 
  38. ^ 38.0 38.1 38.2 38.3 Machado NO, Chopra PJ, Al-Zadjali A, Younas S. Choledochal cyst in adults: etiopathogenesis, presentation, management, and outcome-case series and review. Gastroenterol Res Pract. 2015, 2015: 602591. PMC 4383394 可免费查阅. PMID 25861244. doi:10.1155/2015/602591. 
  39. ^ 39.0 39.1 Anderson MA, Bhati CS, Ganeshan D, Itani M. Hepatobiliary mucinous cystic neoplasms and mimics. Abdom Radiol (NY). May 2022, 47 (5): 1683–1693. PMID 34633506. doi:10.1007/s00261-021-03303-5. 
  40. ^ Mortelé KJ, Ros PR. Cystic focal liver lesions in the adult: differential CT and MR imaging features. Radiographics. Jul-Aug 2001, 21 (4): 895–910. PMID 11452064. doi:10.1148/radiographics.21.4.g01jl16895. 
  41. ^ Lewis VA, Adam SZ, Nikolaidis P, Wood C, Wu JG, Yaghmai V, et al. Imaging of choledochal cysts. Abdom Imaging. August 2015, 40 (6): 1567–1580. PMID 25762482. doi:10.1007/s00261-015-0381-4. 
  42. ^ Hung MH, Lin LH, Chen DF, Huang CS. Choledochal cysts in infants and children: experiences over a 20-year period at a single institution. Eur J Pediatr. September 2011, 170 (9): 1179–1185. PMID 21431301. doi:10.1007/s00431-011-1429-2. 
  43. ^ Sacher VY, Davis JS, Sleeman D, Casillas J. Role of magnetic resonance cholangiopancreatography in diagnosing choledochal cysts: case series and review. World J Radiol. August 2013, 5 (8): 304–312. PMC 3755792 可免费查阅. PMID 24003351. doi:10.4329/wjr.v5.i8.304. 
  44. ^ Anbarasu A, Deshpande A. Successful management of a post-choledochal cyst excision pancreatic fistula in an adult patient: a case report and literature review on risk factors. Surg J (N Y). January 2022, 8 (1): e41–e45. PMC 8859416 可免费查阅. PMID 35198822. doi:10.1055/s-0041-1742175. 
  45. ^ Todani T, Watanabe Y, Toki A, Ogura K, Wang ZQ. Co-existing biliary anomalies and anatomical variants in choledochal cyst. Br J Surg. June 1998, 85 (6): 760–763. PMID 9667705. doi:10.1046/j.1365-2168.1998.00697.x. 
  46. ^ Takeshita N, Ota T, Yamamoto M. Forty-year experience with flow-diversion surgery for patients with congenital choledochal cysts with pancreaticobiliary maljunction at a single institution. Ann Surg. December 2011, 254 (6): 1050–1053. PMID 21869666. doi:10.1097/SLA.0b013e3182243550. 
  47. ^ Lilly JR. The surgical treatment of choledochal cyst. Surg Gynecol Obstet. July 1979, 149 (1): 36–42. PMID 441919. 
  48. ^ Ouaïssi M, Kianmanesh R, Belghiti J, Ragot E, Mentha G, Adham M, et al. Todani type II congenital bile duct cyst: European multi-center study of the French surgical association and literature review. Ann Surg. July 2015, 262 (1): 130–138. PMID 25072449. doi:10.1097/sla.0000000000000761. 
  49. ^ Benhidjeb T, Münster B, Ridwelski K, Rudolph B, Mau H, Lippert H. Cystic dilatation of the common bile duct: surgical treatment and long-term results. Br J Surg. March 1994, 81 (3): 433–436. PMID 8156356. doi:10.1002/bjs.1800810337. 
  50. ^ Lobeck IN, Dupree P, Falcone RA J, Lin TK, Trout AT, Nathan JD, et al. The presentation and management of choledochocele (type III choledochal cyst): a 40-year systematic review of the literature. J Pediatr Surg. April 2017, 52 (4): 644–649. PMID 27816211. doi:10.1016/j.jpedsurg.2016.10.008.  温哥华格式错误 (帮助)
  51. ^ Ladas SD, Katsogridakis I, Tassios P, Tastemiroglou T, Vrachliotis T, Raptis SA. Choledochocele, an overlooked diagnosis: report of 15 cases and review of 56 published reports from 1984 to 1992. Endoscopy. April 1995, 27 (3): 233–239. PMID 7614912. doi:10.1055/s-2007-1005677. 
  52. ^ Martin RF, Biber BP, Bosco JJ, Howell DA. Symptomatic choledochoceles in adults. Endoscopic retrograde cholangiopancreatography recognition and management. Arch Surg. May 1992, 127 (5): 536–538; discussion 538–539. PMID 1575717. doi:10.1001/archsurg.1992.01420050056007. 
  53. ^ 53.0 53.1 Masetti R, Antinori A, Coppola R, Coco C, Mattana C, Crucitti A, et al. Choledochocele: changing trends in diagnosis and management. Surg Today. 1996, 26 (4): 281–285. PMID 8727565. doi:10.1007/bf00311589. 
  54. ^ Han M, Yang N, Zhang H, Ran X. Endoscopic management of a type III choledochal cyst (choledochocele) using snare resection without balloon-catheter assistance. VideoGIE. March 2021, 6 (3): 134–135. PMC 7940881 可免费查阅. PMID 33718765. doi:10.1016/j.vgie.2020.11.015. 
  55. ^ Katabathina VS, Kapalczynski W, Dasyam AK, Anaya-Baez V, Menias CO. Adult choledochal cysts: current update on classification, pathogenesis, and cross-sectional imaging findings. Abdom Imaging. August 2015, 40 (6): 1971–1981. PMID 25550193. doi:10.1007/s00261-014-0344-1. 
  56. ^ Powell CS, Sawyers JL, Reynolds VH. Management of adult choledochal cysts. Ann Surg. May 1981, 193 (5): 666–676. PMC 1345166 可免费查阅. PMID 7235681. doi:10.1097/00000658-198105000-00018. 
  57. ^ Komi N, Takehara H, Kunitomo K. Choledochal cyst: anomalous arrangement of the pancreaticobiliary ductal system and biliary malignancy. J Gastroenterol Hepatol. Jan-Feb 1989, 4 (1): 63–74. PMID 2656891. doi:10.1111/j.1440-1746.1989.tb00808.x. 
  58. ^ Komi N, Takehara H, Kunitomo K, Miyoshi Y, Yagi T. Does the type of anomalous arrangement of pancreaticobiliary ducts influence the surgery and prognosis of choledochal cyst?. J Pediatr Surg. June 1992, 27 (6): 728–731. PMID 1501055. doi:10.1016/s0022-3468(05)80102-2. 
  59. ^ 59.0 59.1 59.2 59.3 Lee SE, Jang JY, Lee YJ, Choi DW, Lee WJ, Cho BH, et al. Choledochal cyst and associated malignant tumors in adults: a multicenter survey in South Korea. Arch Surg. October 2011, 146 (10): 1178–1184. PMID 22006871. doi:10.1001/archsurg.2011.243. 
  60. ^ 60.0 60.1 Xia HT, Dong JH, Yang T, Zeng JP, Liang B. Extrahepatic cyst excision and partial hepatectomy for Todani type IV-A cysts. Dig Liver Dis. November 2014, 46 (11): 1025–1030. PMID 25092051. doi:10.1016/j.dld.2014.07.007. 
  61. ^ Ando H, Kaneko K, Ito F, Seo T, Ito T. Operative treatment of congenital stenoses of the intrahepatic bile ducts in patients with choledochal cysts. Am J Surg. June 1997, 173 (6): 491–494. PMID 9207182. doi:10.1016/s0002-9610(97)00013-5. 
  62. ^ Chijiiwa K, Tanaka M. Late complications after excisional operation in patients with choledochal cyst. J Am Coll Surg. August 1994, 179 (2): 139–144. PMID 8044272. 
  63. ^ Uno K, Tsuchida Y, Kawarasaki H, Ohmiya H, Honna T. Development of intrahepatic cholelithiasis long after primary excision of choledochal cysts. J Am Coll Surg. December 1996, 183 (6): 583–588. PMID 8957465. 
  64. ^ Davenport M, Stringer MD, Howard ER. Biliary amylase and congenital choledochal dilatation. J Pediatr Surg. March 1995, 30 (3): 474–477. PMID 7760248. doi:10.1016/0022-3468(95)90059-4. 
  65. ^ Davenport M, Basu R. Under pressure: choledochal malformation manometry. J Pediatr Surg. February 2005, 40 (2): 331–335. PMID 15750921. doi:10.1016/j.jpedsurg.2004.10.015. 
  66. ^ Turowski C, Knisely AS, Davenport M. Role of pressure and pancreatic reflux in the aetiology of choledochal malformation. Br J Surg. September 2011, 98 (9): 1319–1326. PMID 21710471. doi:10.1002/bjs.7588. 
  67. ^ Kronfli R, Davenport M. Insights into the pathophysiology and classification of type 4 choledochal malformation. J Pediatr Surg. December 2020, 55 (12): 2642–2646. PMID 32560953. doi:10.1016/j.jpedsurg.2020.05.017. 
  68. ^ 68.0 68.1 Mabrut JY, Kianmanesh R, Nuzzo G, Castaing D, Boudjema K, Létoublon C, et al. Surgical management of congenital intrahepatic bile duct dilatation, Caroli's disease and syndrome: long-term results of the French Association of Surgery Multicenter Study. Ann Surg. November 2013, 258 (5): 713–721; discussion 721. PMID 24121275. doi:10.1097/sla.0000000000000269. 
  69. ^ De Kerckhove L, De Meyer M, Verbaandert C, Mourad M, Sokal E, Goffette P, et al. The place of liver transplantation in Caroli's disease and syndrome. Transpl Int. May 2006, 19 (5): 381–388. PMID 16611285. doi:10.1111/j.1432-2277.2006.00292.x. 
  70. ^ Habib S, Shakil O, Couto OF, Demetris AJ, Fung JJ, Marcos A, et al. Caroli's disease and orthotopic liver transplantation. Liver Transpl. March 2006, 12 (3): 416–421. PMID 16498659. doi:10.1002/lt.20719. 
  71. ^ Harring TR, Nguyen NT, Liu H, Goss JA, O'Mahony CA. Caroli disease patients have excellent survival after liver transplant. J Surg Res. October 2012, 177 (2): 365–372. PMID 22579298. doi:10.1016/j.jss.2012.04.022. 
  72. ^ Scharschmidt BF. Human liver transplantation: analysis of data on 540 patients from four centers. Hepatology. Jan-Feb 1984, 4 (1 Suppl): 95S–101S. PMID 6363073. doi:10.1002/hep.1840040723. 
  73. ^ Witlin LT, Gadacz TR, Zuidema GD, Kridelbaugh WW. Transhepatic decompression of the biliary tree in Caroli's disease. Surgery. February 1982, 91 (2): 205–209. PMID 7055163. 
  74. ^ Fahrner R, Dennler S, Dondorf F, Ardelt M, Rauchfuss F, Settmacher U. Liver resection and transplantation in Caroli disease and syndrome. J Visc Surg. April 2019, 156 (2): 91–95. PMID 30057303. doi:10.1016/j.jviscsurg.2018.06.001.  温哥华格式错误 (帮助)
  75. ^ Kassahun WT, Kahn T, Wittekind C, Mössner J, Caca K, Hauss J, et al. Caroli's disease: liver resection and liver transplantation. Experience in 33 patients. Surgery. November 2005, 138 (5): 888–898. PMID 16291388. doi:10.1016/j.surg.2005.05.002. 
  76. ^ Ulrich F, Pratschke J, Pascher A, Neumann UP, Lopez-Hänninen E, Jonas S, et al. Long-term outcome of liver resection and transplantation for Caroli disease and syndrome. Ann Surg. February 2008, 247 (2): 357–364. PMID 18216544. doi:10.1097/SLA.0b013e31815cca88. 
  77. ^ Liem NT, Pham HD, Dung le A, Son TN, Vu HM. Early and intermediate outcomes of laparoscopic surgery for choledochal cysts with 400 patients. J Laparoendosc Adv Surg Tech A. August 2012, 22 (6): 599–603. PMID 22708790. doi:10.1089/lap.2012.0018. 
  78. ^ 78.0 78.1 Margonis GA, Spolverato G, Kim Y, Marques H, Poultsides G, Maithel S, et al. Minimally invasive resection of choledochal cyst: a feasible and safe surgical option. J Gastrointest Surg. May 2015, 19 (5): 858–865. PMID 25586552. doi:10.1007/s11605-014-2722-y. 
  79. ^ Liu Y, Yao X, Li S, Liu W, Liu L, Liu J. Comparison of therapeutic effects of laparoscopic and open operation for congenital choledochal cysts in adults. Gastroenterol Res Pract. 2014, 2014: 670260. PMC 3997910 可免费查阅. PMID 24803888. doi:10.1155/2014/670260. 
  80. ^ Tian Y, Wu SD, Zhu AD, Chen DX. Management of type I choledochal cyst in adult: totally laparoscopic resection and Roux-en-Y hepaticoenterostomy. J Gastrointest Surg. September 2010, 14 (9): 1381–1388. PMID 20589446. doi:10.1007/s11605-010-1263-2. 
  81. ^ Duan X, Mao X, Jiang B, Wu J. Totally laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy for choledochal cyst in adults: a single-institute experience of 5 years. Surg Laparosc Endosc Percutan Tech. April 2015, 25 (2): e65–e68. PMID 25185578. doi:10.1097/sle.0000000000000091. 
  82. ^ Revathi G, Singh BK, Rathore YS, Chumber S. Laparoscopic management of type VI choledochal cyst with common bile duct stone: report of a case and review of literature. BMJ Case Rep. August 2021, 14 (8): e244393. PMC 8342717 可免费查阅. PMID 34348977. doi:10.1136/bcr-2021-244393. 
  83. ^ Lee C, Byun J, Ko D, Yang HB, Youn JK, Kim HY. Comparison of long-term biliary complications between open and laparoscopic choledochal cyst excision in children. Ann Surg Treat Res. March 2021, 100 (3): 186–192. PMC 7987048 可免费查阅. PMID 33758816. doi:10.4174/astr.2021.100.3.186. 
  84. ^ Morikawa T, Ohtsuka H, Takadate T, Ishida M, Miura T, Mizuma M, et al. Laparoscopic and robot-assisted surgery for adult congenital biliary dilatation achieves favorable short-term outcomes without increasing the risk of late complications. Surg Today. July 2022, 52 (7): 1077–1085. PMC 9203259 可免费查阅. PMID 34982249. doi:10.1007/s00595-021-02438-8. 
  85. ^ Xie X, Wu Y, Li K, Ai C, Wang Q, Wang C, et al. Preliminary experiences with robot-assisted choledochal cyst excision using the da vinci surgical system in children below the age of one. Front Pediatr. 2021, 9: 741098. PMC 8576030 可免费查阅. PMID 34778118. doi:10.3389/fped.2021.741098. 
  86. ^ Ihn K, Ho IG, Hong YJ, Jeon HJ, Lee D, Han SJ. Changes in outcomes and operative trends with pediatric robot-assisted resection of choledochal cyst. Surg Endosc. October 2022, 36 (10): 7465–7472. PMID 34935064. doi:10.1007/s00464-021-08844-w. 

外部链接

[编辑]
检索自“https://zh.wikipedia.org/w/index.php?title=總膽管囊腫&oldid=87807293”