先天性胆道拡張症の手術 : とくに総胆管十二指腸側末端部の処理法について

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In connection with operative procedure for congenital dilatation of bile duct, we analysed the relationship between transection of the lower portion of the common bile duct and its complications. Among 83 patients who had undergone total excision of the dilated extrahepatic bile duct, one was complicated by a pancreatic juice fistula and 13 by elevation of the serum amylase level following definitive surgery. The transection maneuvers of 77 patients were categorized into four groups retrospectively. In group I the lower portion of the common bile duct was torn off spontaneously during dissection of duct in 8 cases, and in Group II it was ligated and severed in 27 cases at the narrow segment without any conformation of a pancreatic and the common bile duct junction. In Group III, 38 cases underwent almost total removal of the intrapancreatic bile duct after conformation of the junction by selective cholangiograms. In Group IV, four cases received the same procedure under direct exposure of the main pancreatic duct. Although the postoperative complications were seen in only the cases of Groups 3 and 4, the extrahepatic bile duct including the intrapancreatic bile duct should be resected to avoid late complications, such as carcinoma in the residual duct wall. Since, we think, surgeons can transect the lower portion of the com-mon bile duct just proximal to the junction by applicating the selective cholangiogram, it is unnecessary to expose the pancreatic duct in all case when total removal is performed.
日本小児外科学会の論文
1988-10-20

先天性胆道拡張症の手術 : とくに総胆管十二指腸側末端部の処理法について

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