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目的 了解胆总管囊肿的扩张形态与囊内压力及胆总管远端病变的关系。方法 先天性胆总管囊肿患儿 32例 ,年龄 3个月～ 13岁 ,平均 5 .6岁。术中行胆总管穿刺测囊内静息压力和灌注压力 (灌流速度 0 .5ml/min) ,同时行胆道造影和囊内胆汁胰淀粉酶浓度测定。结果 本组患儿囊状扩张型 19例 ,直径平均为 (8.1± 4.6 )cm ,梭形扩张型 13例 ,平均直径 (2 .8± 0 .5 )cm。囊状扩张型静息压力 (2 9.3± 12 .6 )mmHg(14～ 47mmHg) ,梭状扩张型 (9.5± 7.2 )mmHg ,前者较后者明显增高 ,P <0 .0 0 1。囊肿型灌流压力 (6 5 .6± 2 7.9)mmHg ,梭型 (4 2 .7± 18.4)mmHg ,有显著性差异 ,P <0 .0 5。从胆总管远端狭窄的直径上看 ,囊状扩张型较梭状扩张型明显减少 ,前者为 (0 .2± 0 .1)cm ,后者为 (0 .4± 0 .2 )cm ,P <0 .0 1;另外囊状扩张型胰胆合流共同管的长度较梭形扩张型长 ,P <0 .0 5。还有胆总管内胆汁中胰淀粉酶的浓度囊状扩张型较梭形扩张型低 ,前者 (2 430 .1± 3 0 96 .3)U ,后者(79387.1± 5 40 0 3.1)U ,P <0 .0 0 1。结论 胆总管囊肿扩张的形态与囊内压力和胆总管远端的梗阻有直接关系 ,囊状扩张型较梭形扩张型囊内压力高 ,胆总管远端狭窄直径小 ,共同管长 ,而胆汁淀粉酶浓度低 ,应及早手术治疗 ,避免
Objective To investigate the relationship between dilatation of choledochal cyst and intracapsular pressure and distal common bile duct disease. Methods 32 cases of children with congenital choledochal cyst, aged 3 months to 13 years, mean 5.6 years. Intraoperative choledocholithotomy puncture intra-ventricular resting pressure and perfusion pressure (perfusion rate 0.5ml / min), while cholangiography and cyst bile pancreatic amylase concentration determination. Results In this group, 19 cases were cystic dilatation with an average diameter of (8.1 ± 4.6) cm and fusiform dilatation in 13 cases with an average diameter of (2. 8 ± 0.5) cm. The values of resting pressure of cystic dilatation (2 9.3 ± 12.6) mmHg (14-47 mmHg) and shuttle dilatation (9.5 ± 7.2) mmHg were significantly higher than those of the latter (P <0.01). Cystoid perfusion pressure (65.6 ± 2 7.9) mmHg, shuttle type (42.7 ± 18.4) mmHg, there was a significant difference, P <0. From the narrow diameter of the distal common bile duct, the cystic dilatation was significantly less than the fusiform dilatation, the former (0 .2 ± 0 .1) cm, the latter (0 .4 ± 0 .2) cm, P <0 .0 1; other cystic dilated pancreaticobiliary condusion common tube length longer than the spindle-shaped dilatation, P <0. In addition, the concentration of pancreatic amylase in the bile duct of the common bile duct was lower than that of the fusiform dilatation, the former (2 430.1 ± 3.096.3) U and the latter (79387.1 ± 5 40 0 3.1) U, P <0 .0 0 1. Conclusion The dilatation of choledochal cyst is directly related to the intracapsular pressure and obstruction of the common bile duct. The pressure in the dilated capsule is higher than that in the fusiform dilatation capsule. The diameter of the distal common bile duct is small and the common duct is long. Amylase concentration is low, early surgical treatment should be avoided