Aspecte de diagnostic și tratament chirurgical al chisturilor arborelui biliar

Abstract

Introducere: Incidența chistului arborelui biliar este de 1 caz la 100.000-150.000 populație, reprezentând circa 1% în structura patologiei căilor biliare. Deși reprezintă o patologie foarte rară care este diagnosticată ca regulă în aproximativ 80% la copii, se asociază cu manifestări clinice mai evidente la tineri și adulți, caracterizate prin complicații de caracter mecanic, infecțios sau malignizare. Material și metode: Studiul reprezintă analiza retrospectivă a 39 pacienți spitalizați în Clinica Chirurgie 2 pe parcursul a 13 ani. Tipul de afectare a arborelui biliar reprezentat conform clasificării Todani: tip I – 26 (66,6%) pacienți, tip II – 6 (15,3%) pacienți, tip III – 2 (5,1%) pacienți, tip IVa – 1 (2,5%) pacient, tip V – 4 (10,2%) bolnavi. Standardul de aur in diagnosticul acestei patologii este reprezentat de Rezonanța Magnetică Nucleară în regim colangiografic, importanță majora explimând și Colangiopancreatografia retrogradă endoscopică (CPGRE), CT și Echografia abdomenului. Managementul chirurgical utiliazat la acești pacienți a avut drept scop realizarea decompresiei biliare preoperatorii, excizia sectorului biliar afectat și restabilirea pasajului bilio-digestiv prin reconstrucție biliară cu utilizarea preponderenta a ansei izolate în Y a la Roux. Rezultate: Morbiditatea postoperatorie precoce a fost determinată de prezența fistulei biliare la 3 pacienți, complicații septice 1 caz. Perioada tardivă postoperatorie evaluată cu apariția colangitei cronice recidivante 7 cazuri, 4 bolnavi cu strictură a hepaticojejunoanastomozei. Mortalitatea postoperatorie 3%. Concluzii: Standardul de aur în diagnosticul chisturilor arborelui biliar îl reprezintă colangio-RMN. Intervenţia chirurgicală are ca scop, extirparea afecțiunii din cauza riscului complicaţiilor, malignizarea fiind cea mai severă, precum şi asigurarea unui drenaj biliodigestiv adecvat. * * * Introduction: The incidence of biliary cysts is 1:100.000-150.000 population, representing about 1% in the biliary diseases. Although it is a very rare pathology, diagnosed as a rule in approximately 80% in children, it is associated with more obvious clinical manifestations in young and adult, characterized by mechanical, infectious complications or malignization. Material and methods: The study is a retrospective analysis of 39 patients hospitalized in Department of Surgery No 2 in 13 years. The type of biliary tree damage represented by the Todani classification: type I - 26 (66.6%) patients, type II - 6 (15.3%) patients, type III - 2 (5.1% ) patients, type IVa - 1 (2.5%) patient, type V - 4 (10.2%) patients. The gold standard in the diagnosis of this pathology is represented by Magnetic Resonance Cholangiography (MRC), with major importance being Endoscopic Retrograde Cholangiopancreatography (ERCP), CT and abdominal echography. The surgical management was aimed for preoperative biliary decompression, excision of the affected biliary sector and restoration of the biliodigestive passage through biliary reconstruction, using preponderant the isolated Roux loup. Results: Early postoperative morbidity was determined by the presence of biliary fistula in 3 patients, septic complications - 1 case. Tardive postoperative period - recurrent chronic colangitis 7 cases, 4 patients with stricture of hepaticojejunal anastomosis. Postoperative mortality 3%. Conclusions: The gold standard in biliary cysts diagnosis is the MRC. Surgery is aimed at removing the cysts because of the risk of complications, malignization being the most severe, and ensuring an adequate biliodigestive drainage.

Introduction: The incidence of biliary cysts is 1:100.000-150.000 population, representing about 1% in the biliary diseases. Although it is a very rare pathology, diagnosed as a rule in approximately 80% in children, it is associated with more obvious clinical manifestations in young and adult, characterized by mechanical, infectious complications or malignization. Material and methods: The study is a retrospective analysis of 39 patients hospitalized in Department of Surgery No 2 in 13 years. The type of biliary tree damage represented by the Todani classification: type I - 26 (66.6%) patients, type II - 6 (15.3%) patients, type III - 2 (5.1% ) patients, type IVa - 1 (2.5%) patient, type V - 4 (10.2%) patients. The gold standard in the diagnosis of this pathology is represented by Magnetic Resonance Cholangiography (MRC), with major importance being Endoscopic Retrograde Cholangiopancreatography (ERCP), CT and abdominal echography. The surgical management was aimed for preoperative biliary decompression, excision of the affected biliary sector and restoration of the biliodigestive passage through biliary reconstruction, using preponderant the isolated Roux loup. Results: Early postoperative morbidity was determined by the presence of biliary fistula in 3 patients, septic complications - 1 case. Tardive postoperative period - recurrent chronic colangitis 7 cases, 4 patients with stricture of hepaticojejunal anastomosis. Postoperative mortality 3%. Conclusions: The gold standard in biliary cysts diagnosis is the MRC. Surgery is aimed at removing the cysts because of the risk of complications, malignization being the most severe, and ensuring an adequate biliodigestive drainage.