KH Lee, YH Tam, EKW Chan, JDY Sihoe, GST Cheung, JWC Mou

Abstract

Choledochal cyst is a rare but potentially serious disease with a wide spectrum of presentation. The definitive treatment is an ultra-major operation aiming at complete cyst excision and reconstruction with a hepatico-jejunostomy. In current years, we have applied the laparoscopic technique in this condition. A retrospective review was carried out on our experience in the past 20 years. In the series, there were 75 patients, with laparoscopic surgery attempted in 39 and successfully performed in 36. Of the 75 patients, postoperative complications included intra-abdominal collections (8), bile leak (5), and postoperative small bowel intussusception (1). At a median follow-up of 7.5 years, 10 patients had encountered problems including adhesive small bowel obstruction (4), cholangitis (3), pancreatitis (1), requirement for liver transplant (1) and one mortality due to an unrelated problem. In conclusion, with appropriate management, a good outcome can usually be achieved but long-term follow-up is required for possible late problems.

膽總管囊腫是一種罕見但潛在嚴重疾患的病變。確實的治療是一項超大型手術，包括完全囊腫切除和肝管空腸吻合術。現今，我們對這個情況已應用腹腔鏡技術，回顧我們在過去20年的經驗，共有75名病人，其中39人曾嘗試腹腔鏡手術，另36人則成功接受腹腔鏡手術。在75名患者裡的術後併發症包括腹腔內積聚（8）、膽漏（5）和手術後小腸套疊（1）。隨訪的年齡中位數是7.5歲，10名患者遇到的問題包括黏連性小腸梗阻（4）、膽管炎（3）、胰腺炎（1）及需要接受肝臟移植（1），並有一名病童在沒有出現相關問題的情況下死亡。總而言之，給與適當的處理，常可達到理想的療效，但需要長期隨訪以肯定有否晚發性問題出現。