담관낭 절제술 후의 후기 합병증
Late Complications after Excisional Operation for Choledochal Cyst
윤유석, 김선회, 안영준, 장진영, 박용현,
소속 상세정보
윤유석 ( Yoon Yoo-Seok )
서울대학교 의과대학 외과학교실
김선회 ( Kim Sun-Whe )
서울대학교 의과대학 외과학교실
안영준 ( Ahn Young-Joon )
서울대학교 의과대학 외과학교실
장진영 ( Jang Jin-Young )
서울대학교 의과대학 외과학교실
박용현 ( Park Yong-Hyun )
서울대학교 의과대학 외과학교실
KMID : 0371320040660020116
Abstract
Purpose: Even after excision of choledochal cyst, late postoperatve complications can develop. This study was conducted to examine the long-term outcome of cyst excision.
Methods: Of 50 choledochal cysts treated over a 10-year period (1991-2000), excluding cancer and rare types, 39 patients (type Ⅰ : 21, Ⅳa : 18) who underwent cyst excision were reviewed to evaluate the late outcome.
Results: Median follow-up period was 24 months after surgery. Late complications (5 intrahepatic duct stone, 4 cholangitis, 4 pancreatitis, and 1 malignancy) developed in 14 (35.9%) patients. Of the 5 patients with intrahepatic duct stone 2 underwent choledochoscopic stone removal, one of whom additionally underwent balloon dilatation for anastomotic stricture, The remaining 3 patients were free of symptoms and didn´t need further management. Of the 4 patients with cholangitis, one underwent left lateral sectionectomy for remaining intrahepatic cyst in type Ⅳa and another patient balloon dilatation for anastomotic stricture. The remaining 2 patients developed cholangitis because of incomplete excision and ascending cholangitis, and they were conservatively managed. Of the 4 patients with pancreatitis, 2 developed pancreatitis because of pancreas divisum and probably residual distal cyst. The symptoms of all four patients with pancreatitis were mild and treated with conservative management. Periampullary cancer developed 18 months after cyst excision in one patient.
Conclusion: To minimize hepatopancreatobiliary complications and malignancy after cyst excision, complete excision of the extrahepatic bile duct should be performed. Moreover, long-term follow-up is necessary because of these late complications.
키워드
담관낭;담관낭 절제술;후기 합병증;Choledochal cyst;Cyst excision;Late complications
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