目的:孕妇的胆道囊肿是一个复杂的医学问题,尤其是并发胆管炎的时候.这是一种严重且危及生命的诊断,可能严重危害准妈妈和胎儿。然而,怀孕期间,手术治疗会导致进一步的并发症和更高的胎儿死亡率。这里,我们提出了一种新的治疗方法,在怀孕期间对母亲和孩子都是安全的,最终治疗推迟到分娩后。
方法:在这项回顾性研究中,我们总结了6例妊娠期诊断为胆总管囊肿的成年患者的临床过程。治疗分两个阶段进行,首先,在超声引导下经皮胆囊造口术和持续负压吸引直至分娩,其次,当患者从分娩中恢复时,选择性胆总管囊肿切除术。
结果:6例患者均生下了健康的婴儿。四名患者患有I型胆总管囊肿,并接受了肝空肠Roux-en-Y吻合术。两名患者患有IV型胆总管囊肿。第一例IV型胆总管囊肿患者在继发性肝胆管和空肠之间进行了吻合,第二例患者进行了腹腔镜囊肿内引流术。胆囊引流或围手术期无严重并发症发生。
结论:根据我们的单中心经验,我们可以得出结论,通过本文提出的两个阶段策略,可以安全有效地治疗妊娠期胆总管囊肿伴胆管炎。第一阶段应为经皮胆囊造口术,然后在分娩后进行选择性手术治疗。
OBJECTIVE: Biliary cysts in pregnant women are a complex medical issue, especially when complicated with cholangitis. It is a serious and life-threatening diagnosis that can seriously endanger both the expectant mother and the fetus. However, during pregnancy, surgical treatment would lead to further complications and higher fetal mortality. Here, we propose a novel therapeutic approach that would be safe for both mother and child during pregnancy, with a definitive treatment postponed until after delivery.
METHODS: In this retrospective study we have summarized the clinical course of six adult patients diagnosed with choledochal cysts during pregnancy. Treatment was conducted in two stages, firstly, percutaneous cholecystostomy under ultrasound guidance and sustained negative pressure suction until delivery, and secondly, selective choledochal cyst excision when the patients recovered from delivery.
RESULTS: All the six patients gave birth to healthy babies. Four patients had Type-I choledochal cysts, and underwent Roux-en-Y hepaticojejunostomy surgery. Two patients had a Type-IV choledochal cyst. The first patient with Type-IV choledochal cyst underwent anastomosis between the secondary hepatic bile duct and jejunum and the second patient underwent laparoscopic cyst internal drainage. No serious complications were recorded after gallbladder drainage or during the perioperative period.
CONCLUSIONS: Based on our single-centre experience we can conclude that treatment of choledochal cyst with cholangitis during pregnancy can be conducted safely and efficiently through the two stages strategy that we proposed in this paper. The first stage should be percutaneous cholecystostomy followed by elective surgical treatment following delivery.