Choledochal cystic diseases
Tóm tắt
Cystic disease of the intrahepatic and extrahepatic bile ducts results in rare malformations with a variable presentation. The majority of patients present during childhood with symptoms of abdominal pain, cholangitis, and an abdominal mass. A palpable mass is unusual in adults, and adult patients tend to present with recurrent cholangitis, pancreatitis, or rarely portal hypertension. The cause of this disorder also is debated, with both congenital and acquired origins postulated. The gold standard for the treatment of choledochal cysts is complete excision with the establishment of biliary flow into the gastrointestinal tract. The well described malignant potential of the cyst and the high rate of recurrent cholangitis with internal drainage procedures mandate cyst excision when possible. In the event of extensive scarring or malignant changes of the cyst, the posterior wall of the cyst may be left in situ to avoid endangering the portal vessels, which are found posteriorly. Alternatively, various endoscopic or percutaneous interventions may provide symptomatic relief. However, every effort should be directed towards complete resection of the cyst and the re-establishment of biliary-enteric continuity.
Tài liệu tham khảo
Nunez-Hoyo M, Lees CD, Hermann RE: Bile duct cysts: experience with 15 patients. Am J Surg 1982, 144:295–299.
Cheney M, Rustad DG, Lilly JR: Choledochal cyst. World J Surg 1985, 9:244–249. An excellent review article discussing the embryology and surgical treatment of choledochal cysts.
Buckel EG, Nagorney DM: Choledochal cysts in adult life. In Surgery of the Liver and Biliary Tract, edn 2. Edited by Blumgart LH. Edinburgh: Churchill Livingstone; 1994:1183–1195.
Mori K, Akimoto R, Kanno M, et al.: Anomalous union of the pancreaticobiliary system without dilation of the common bile duct or tumor: case reports and literature review. Hepato-Gastroenterology 1999, 46:142–148.
Okada A, Nakamura T, Higaki J, et al.: Congenital dilatation of the bile duct in 100 instances and its relationship with anomalous junction. Surg Gynecol Obstet 1990, 171:291–298.
Kato T, Hebiguchi T, Kasai M: Etiology of congenital choledochal cyst. Tohoku J Exp Med 1980, 131:135–142.
Kusunoki M, Saitoh N, Yamamura T, et al.: Choledochal cysts: oligoganglionosis in the narrow portion of the choledochus. Arch Surg 1988, 123:984–986.
Shimotake T, Iwai N, Yanagihara J, et al.: Innervation patterns in congenital biliary dilatation. Eur J Pediatr Surg 1995, 5:256–270.
Tyler KL, Sokol RJ, Oberhaus SM, et al.: Detection of reovirus RNA in hepatobiliary tissue from patients with extrahepatic biliary atresia and choledochal cysts. Hepatology 1998, 27:1475–1482.
Iwata F, Uchida A, Miyaki T, et al.: Familial occurrence of congenital bile duct cysts. J Gastroenterol Hepatol 1998, 13:316–319.
Wearn FG, Wiot JF: Choledochocoele: not a form of choledochal cyst. J Assoc Can Radiol 1982, 33:110–112.
Jesudason SR, Govil S, Mathai V, et al.: Choledochal cysts in adults. Ann R Coll Surg Engl 1997, 79:410–413.
Chaudhary A, Dhar P, Sachdev A, et al.: Choledochal cysts-differences in children and adults. Br J Surg 1996, 83:186–188.
Bismuth H, Krissat J: Choledochal cystic malignancies. Ann Oncol 1999, 10(suppl 4):S94-S98. Provides an analysis of the literature in regard to cancer associated with choledochal cysts. Excellent clinical recommendations.
Todani T, Wantabe Y, Toki A, et al.: Co-existing biliary anomalies and anatomical variants in choledochal cyst. Br J Surg 1998, 85:760–763.
Shemesh E, Czerniak A, Klein E, Avigad I: The role of endoscopic retrograde cholangiopancreatography in the diagnosis and treatment of adult choledochal cyst. Surg Gynecol Obstet 1998, 167:423–426.
Shocket E, Hallenbeck GA, Hayles AB: Choledochal cyst: report of cases. Proc Staff Meet Mayo Clinic 1955, 30:83–89.
Neuhaus H: Intrahepatic stones: the percutaneous approach. Can J Gastroenterol 1999, 13:467–472.
Elrad H, Mayden KL, Ahart S, et al.: Prenatal ultrasound diagnosis of choledochal cyst. J Ultrasound Med 1985, 4:553–555.
Watanabe Y, Toki A, Todani T: Bile duct cancer developed after cyst excision for choledochal cyst. J Hepatobiliary Pancreat Surg 1999, 6:207–212.
Sing H, Han H, Chan KL, et al.: Early and late results of excision of choledochal cysts. J Pediatr Surg 1997, 32:1563–1566.
Terblanche J, Worthley CS, Spence RA, Krige JE: High or low hepaticojejunostomy for bile duct strictures? Surgery 1990, 108:828–834.
Linderberg CG, Hammarstrom LE, Holmin T, Lundstedt C: Cholangiographic appearance of bile-duct cysts. Abdom Imaging 1998, 23:611–616. Describes the classification of Alonso-Lej and Todani, and makes special reference to the common channel theory and its appearance during cholangiography.