Diagnosis And Treatment Of Atypical Extrahepatic Choledochal Cyst In Adults

Objective: To explore the clinical manifestations,imaging features and the therapeutic effects of different surgical methods on the patients with extrahepatic choledochal cyst and stone in atypical adults,so as to provide clinical reference for the diagnosis and treatment of extrahepatic choledochal cyst and stone in atypical adults.Methods: From january 2014 to january 2019,44 cases of atypical adult extrahepatic choledochal cyst with calculus were collected.according to the different operation methods,44 cases were divided into two groups: group a was choledochocystectomy + cholecystectomy + Roux-en-Y cholangiojejunostomy group,26 cases in total,15 in laparoscopic group(A1 group),11 in open group(A2 group);group B was choledochotomy + cholecystectomy + t-tube drainage,18 cases in total,all of which were laparoscopic operation.The general situation and imaging characteristics of the patients were briefly described,and the indexes of operation time,intraoperative hemorrhage and intestinal peristalsis recovery time between A1 and A2,as well as the recent complications: bile leakage,postoperative hemorrhage,intestinal leakage and long-term complications: cholangitis,recurrent choledocholithiasis,pancreatitis,canceration and other indexes betweenA and B,A1 and A2 were retrospectively analyzed.Results: Long-term complications in group A: the incidence rate of bile duct stones with cholangitis and pancreatitis was significantly lower than that in group B,p < 0.05,the difference was statistically significant.Compared with group A2,the operation time,intraoperative blood loss,short-term complications and long-term complications in group A1 were p > 0.05,with no significant difference.The recovery time of postoperative intestinal peristalsis in group A1 was lower than that in group A2(p < 0.05),and the difference was statistically significant.Conclusion:Atypical adult patients with extrahepatic choledochal cyst and calculus are not uncommon in clinic,which is difficult to distinguish from secondary cholangiectasis,and easy to be misdiagnosed and mistreated.It has some characteristics in imaging and choledochoscopy.Its operation mode: choledochocystectomy + Roux-en-Y choledochojejunostomy is better than simple choledochotomy + T-tube drainage.Peritoneoscope operation has more advantages than traditional open hand operation and is worthy of clinical promotion.