妊娠期胆总管囊肿的诊治分析.doc

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1、妊娠期胆总管囊肿的诊治分析【摘要】目的探讨妊娠期胆总管囊肿的临床特征、诊断和治疗方案。方法收集自2003年以来收治的3例妊娠期胆总管囊肿的临床资料，进行随访与回顾性分析。结果3例患者均为Ⅰ型胆总管囊肿，术前均有急性胆管炎发作史，1例患者孕22周因严重的胆管炎经非手术治疗无效而急诊行胆总管T管外引流术，术后出现先兆流产而行引产，于术后3月行囊肿切除胆管空肠Roux-Y吻合术。另2例均发生于妊娠晚期（孕34周,孕36周），经非手术治疗控制胆管炎症状后，继续妊娠，于足月剖腹产后第6天及2周行囊肿切除胆管空肠Roux-Y吻合术。3例患者随访至今均情况良好。结论妊娠期胆总管囊肿

2、以B超作为首选检查手段，对于B超无法确诊的患者，可选用MRCP，妊娠期无症状者以随访为主，待分娩后再行胆总管囊肿切除术；对于有症状而经非手术治疗无效者，行胆总管T管外引流术，分娩后再行囊肿切除术。【关键词】胆总管囊肿妊娠外科手术AnalysisofdiagnosisandtreatmentofcongenitalcholedochalcystinpregnancyAbstractObjectiveTodiscusstheclinicalfeature,diagnosisandtreatmentmethodforcongenitalcholedochalcystinpr

3、egnancies.MethodsTheclinicaldataofthreepatients,diagnosedofcongenitalcholedochalcystinpregnancywerecollectedsince2003.Follow-upandretrospectiveanalysiswｅｒｅcarriedout.ResultsThreepatientswerealldiagnosedastypeⅠcholedochalcystswithacutecholangitis.ThefirstpatientwasgivenaT-tubebiliarydrai

4、nageemergentlybecauseoftheseriouscholangeitisinher22weeks’pregnancyafterconservativetreatment.Postoperatively，shewasdiagnosedofthreatenedabortionandthenwasgiveninducedlabor.Threemonthslater,thepatientacceptedcystresectionandRoux-Ycholangio-jejunostomy.Theothertwopatientsbothdiagnosedoft

5、hesamediseaseinlatepregnantstage(34weeksand36weeks，respectively)，acceptedconservativetherapytocontrolthecholangitisandkeptpregnancyuntilfullterm.ThentheyrespectivelyunderwentcystresectionandRoux-Ycholangio-jejunostomyonthe6thand14thdayaftercesareansection.Follow-upresultsshowedthatthree

6、patientswereallverywelluptonow.ConclusionBultrasoundshouldbeconsideredastherecommendedtestindiagnosingcholedochalcysts.Iftheresultofultrasoundtestcan’tconfirmthedisease,MRCPshouldbechosen.Forthepatientswithoutanysymptoms，follow-upshouldbegivenandtheoperationofcystresectionandRoux-Ycysto

7、jejunostomyshouldbedoneafterdelivery.Forthepatientswhoseconditiondidnotimproveduringconservativetherapy，Ttubebiliarydrainageshouldbechosenfirstly，butcystresection5combinedwithRoux-Ycholangio-jejunostomyshouldbedoneafterdelivery.Keywordscholedochalcyst；pregnancy；surgery近年来发生于妊娠或