Tratamiento quirúrgico de la dilatación quística congénita de la vía biliar
Surgical treatment of congenital cystic dilatation of the biliary tract
Enrique Artigues Sánchez de Rojas1
, Eugenia Pareja Ibars, Ricardo Fabra Ramis, Antonio Vázquez Prado, Francisco Cárdenas Cauqui, Ramón Trullenque Peris
Autor para correspondencia
eartigues@hotmail.com
Correspondencia: Dr. E. Artigues Sánchez de Rojas. Avda. Autopista del Saler, 12-23. 46013 Valencia. España.
Correspondencia: Dr. E. Artigues Sánchez de Rojas. Avda. Autopista del Saler, 12-23. 46013 Valencia. España.
Servicio de Cirugía General y Digestiva (Prof. R. Trullenque Peris). Hospital General Universitario. Valencia. España.
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Trullenque Peris). Hospital General Universitario. Valencia. España." ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "1" "correspondencia" => "Correspondencia: Dr. E. Artigues Sánchez de Rojas. Avda. Autopista del Saler, 12-23. 46013 Valencia. España." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Surgical treatment of congenital cystic dilatation of the biliary tract" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaAceptado" => "2002-09-30" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec198261" "palabras" => array:3 [ 0 => "Dilatación vía biliar" 1 => "Quiste de colédoco" 2 => "Enfermedad de Caroli" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec198260" "palabras" => array:3 [ 0 => "Dilatation of the biliary tract" 1 => "Choledochal cyst" 2 => "Caroli’s disease" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La dilatación quística congénita de la vía biliar (DQCVB) es una afección poco frecuente en nuestro medio. Pese a ser una enfermedad congénita, aproximadamente un tercio de los casos no se diagnostican en la infancia. Se clasifican en varios tipos, siendo el tipo I, o dilatación fusiforme de la vía biliar extrahepática, el más frecuente, presentándose en el 50-90% de casos, según las series.</p> <span class="elsevierStyleSectionTitle">Pacientes y método</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se presentan los resultados de una serie de pacientes adultos ingresados en nuestro hospital durante los últimos 25 años con el diagnóstico de DQCVB; dicha serie consta de 11 pacientes, 8 mujeres y 3 varones, con una edad media de 41,8 años. Se revisan los antecedentes personales, la clínica, las exploraciones complementarias realizadas, la anatomía de la vía biliar y la encrucijada biliopancreática, la clasificación, las técnicas quirúrgicas llevadas a cabo, el análisis histopatológico de las piezas de resección, la evolución postoperatoria y el seguimiento a medio y largo plazo.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La variante más frecuente fue el tipo I (8 casos); el tamaño medio de la dilatación quística fue de 6,2 cm; la existencia de un canal común largo se pudo objetivar en tres de los 11 casos (27%); la técnica quirúrgica más empleada fue la exéresis completa del quiste, seguida de reconstrucción mediante hepaticoyeyunostomía en Y de Roux (7 casos); en un caso, la anatomía patológica informó de un adenocarcinoma adenopapilar infiltrante en la pared del quiste, y en otro de una metaplasia intestinal focal; un paciente falleció en el postoperatorio a consecuencia de un cuadro de sepsis.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Reafirmar la implicación de la existencia de un canal común largo en la fisiopatogenia de la DQCVB, la necesidad de disponer preoperatoriamente de un conocimiento de la anatomía de la vía biliar y la unión biliopancreática, y la indicación de elección de resección de la vía biliar afectada, con reconstrucción de la misma mediante hepaticoyeyunostomía en Y de Roux.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Congenital cystic dilatation of the biliary tract is infrequent in Spain; although the anomaly is congenital, approximately one-third of cases are not diagnosed in childhood. Various types of the anomaly have been classified and the most common is type I, or fusiform dilatation of the extrahepatic biliary tract, which accounts for 50-90% of cases depending on the series.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We present the results of a series of adult patients admitted to our hospital in the last 25 years with a diagnosis of congenital cystic dilatation of the biliary tract. Our series consisted of 11 patients, 8 women and 3 men, with a mean age of 41.8 years.We reviewed the patients’ personal history of previous diseases, clinical features, complementary investigations performed, anatomy of the biliary tract and biliary-pancreatic junction, classification, surgical techniques used, histopathological analysis of the surgical specimens, postoperative course and medium- and long-term follow-up.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The most frequent variant was type I (eight patients). The mean size of cystic dilatation was 6.2 cm. A long common canal was found in three of the eleven patients (27%). The most frequently used surgical technique was total excision of the cyst followed by reconstruction through Yen- Roux hepaticojejunostomy (seven patients). Histopathological analysis revealed an infiltrating adenopapillary adenocarcinoma in the cystic wall in one patient and focal intestinal metaplasia in another. One patient died in the postoperative period due to sepsis.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">we reaffirm the involvement of a long common canal in the physiopathogenesis of congenital cystic dilatation of the biliary tract and the need for preoperative knowledge of the anatomy of the biliary tract and biliary-pancreatic junction. The surgical treatment of choice is total resection of the cyst with reconstruction through Y-en-Roux hepaticojejunostomy.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:50 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Octubre | 33 | 8 | 41 |
| 2024 Septiembre | 56 | 5 | 61 |
| 2024 Agosto | 54 | 9 | 63 |
| 2024 Julio | 54 | 5 | 59 |
| 2024 Junio | 56 | 10 | 66 |
| 2024 Mayo | 55 | 9 | 64 |
| 2024 Abril | 57 | 14 | 71 |
| 2024 Marzo | 49 | 30 | 79 |
| 2024 Febrero | 78 | 28 | 106 |
| 2024 Enero | 65 | 15 | 80 |
| 2023 Diciembre | 77 | 54 | 131 |
| 2023 Noviembre | 64 | 22 | 86 |
| 2023 Octubre | 121 | 15 | 136 |
| 2023 Septiembre | 67 | 12 | 79 |
| 2023 Agosto | 54 | 23 | 77 |
| 2023 Julio | 56 | 29 | 85 |
| 2023 Junio | 64 | 13 | 77 |
| 2023 Mayo | 79 | 13 | 92 |
| 2023 Abril | 43 | 8 | 51 |
| 2023 Marzo | 67 | 17 | 84 |
| 2023 Febrero | 47 | 8 | 55 |
| 2023 Enero | 53 | 12 | 65 |
| 2022 Diciembre | 47 | 13 | 60 |
| 2022 Noviembre | 119 | 26 | 145 |
| 2022 Octubre | 59 | 39 | 98 |
| 2022 Septiembre | 77 | 31 | 108 |
| 2022 Agosto | 75 | 31 | 106 |
| 2022 Julio | 51 | 18 | 69 |
| 2022 Junio | 33 | 27 | 60 |
| 2022 Mayo | 50 | 16 | 66 |
| 2022 Abril | 40 | 22 | 62 |
| 2022 Marzo | 51 | 20 | 71 |
| 2022 Febrero | 48 | 9 | 57 |
| 2022 Enero | 66 | 15 | 81 |
| 2021 Diciembre | 57 | 11 | 68 |
| 2021 Noviembre | 47 | 13 | 60 |
| 2021 Octubre | 48 | 11 | 59 |
| 2021 Septiembre | 31 | 10 | 41 |
| 2021 Agosto | 91 | 16 | 107 |
| 2021 Julio | 42 | 13 | 55 |
| 2021 Junio | 64 | 10 | 74 |
| 2021 Mayo | 73 | 11 | 84 |
| 2021 Abril | 133 | 14 | 147 |
| 2021 Marzo | 91 | 9 | 100 |
| 2021 Febrero | 70 | 6 | 76 |
| 2021 Enero | 69 | 17 | 86 |
| 2020 Diciembre | 63 | 9 | 72 |
| 2020 Noviembre | 60 | 19 | 79 |
| 2020 Octubre | 54 | 13 | 67 |
| 2020 Septiembre | 54 | 16 | 70 |
| 2020 Agosto | 56 | 15 | 71 |
| 2020 Julio | 48 | 8 | 56 |
| 2020 Junio | 35 | 15 | 50 |
| 2020 Mayo | 24 | 13 | 37 |
| 2020 Abril | 31 | 15 | 46 |
| 2020 Marzo | 60 | 11 | 71 |
| 2020 Febrero | 61 | 11 | 72 |
| 2020 Enero | 75 | 27 | 102 |
| 2019 Diciembre | 82 | 31 | 113 |
| 2019 Noviembre | 39 | 16 | 55 |
| 2019 Octubre | 98 | 18 | 116 |
| 2019 Septiembre | 144 | 21 | 165 |
| 2019 Agosto | 48 | 18 | 66 |
| 2019 Julio | 49 | 32 | 81 |
| 2019 Junio | 112 | 28 | 140 |
| 2019 Mayo | 289 | 120 | 409 |
| 2019 Abril | 128 | 27 | 155 |
| 2019 Marzo | 39 | 7 | 46 |
| 2019 Febrero | 30 | 11 | 41 |
| 2019 Enero | 31 | 5 | 36 |
| 2018 Diciembre | 25 | 12 | 37 |
| 2018 Noviembre | 45 | 13 | 58 |
| 2018 Octubre | 73 | 13 | 86 |
| 2018 Septiembre | 21 | 8 | 29 |
| 2018 Agosto | 11 | 4 | 15 |
| 2018 Julio | 21 | 3 | 24 |
| 2018 Junio | 19 | 7 | 26 |
| 2018 Mayo | 19 | 2 | 21 |
| 2018 Abril | 26 | 2 | 28 |
| 2018 Marzo | 25 | 3 | 28 |
| 2018 Febrero | 27 | 1 | 28 |
| 2018 Enero | 30 | 1 | 31 |
| 2017 Diciembre | 33 | 5 | 38 |
| 2017 Noviembre | 24 | 3 | 27 |
| 2017 Octubre | 40 | 2 | 42 |
| 2017 Septiembre | 32 | 1 | 33 |
| 2017 Agosto | 36 | 5 | 41 |
| 2017 Julio | 43 | 0 | 43 |
| 2017 Junio | 39 | 2 | 41 |
| 2017 Mayo | 35 | 8 | 43 |
| 2017 Abril | 35 | 0 | 35 |
| 2017 Marzo | 34 | 35 | 69 |
| 2017 Febrero | 50 | 3 | 53 |
| 2017 Enero | 54 | 3 | 57 |
| 2016 Diciembre | 55 | 5 | 60 |
| 2016 Noviembre | 70 | 5 | 75 |
| 2016 Octubre | 180 | 6 | 186 |
| 2016 Septiembre | 79 | 7 | 86 |
| 2016 Agosto | 43 | 5 | 48 |
| 2016 Julio | 81 | 5 | 86 |
| 2016 Junio | 144 | 15 | 159 |
| 2016 Mayo | 164 | 8 | 172 |
| 2016 Abril | 116 | 10 | 126 |
| 2016 Marzo | 121 | 6 | 127 |
| 2016 Febrero | 81 | 21 | 102 |
| 2016 Enero | 104 | 7 | 111 |
| 2015 Diciembre | 77 | 6 | 83 |
| 2015 Noviembre | 103 | 3 | 106 |
| 2015 Octubre | 107 | 10 | 117 |
| 2015 Septiembre | 97 | 12 | 109 |
| 2015 Agosto | 140 | 9 | 149 |
| 2015 Julio | 191 | 5 | 196 |
| 2015 Junio | 157 | 4 | 161 |
| 2015 Mayo | 153 | 8 | 161 |
| 2015 Abril | 21 | 5 | 26 |
| 2015 Marzo | 25 | 7 | 32 |
| 2015 Febrero | 21 | 2 | 23 |
| 2015 Enero | 72 | 3 | 75 |
| 2014 Diciembre | 142 | 5 | 147 |
| 2014 Noviembre | 114 | 6 | 120 |
| 2014 Octubre | 120 | 2 | 122 |
| 2014 Septiembre | 86 | 4 | 90 |
| 2014 Agosto | 83 | 5 | 88 |
| 2014 Julio | 88 | 3 | 91 |
| 2014 Junio | 120 | 2 | 122 |
| 2014 Mayo | 90 | 2 | 92 |
| 2014 Abril | 89 | 2 | 91 |
| 2014 Marzo | 78 | 0 | 78 |
| 2014 Febrero | 74 | 3 | 77 |
| 2014 Enero | 68 | 3 | 71 |
| 2013 Diciembre | 74 | 1 | 75 |
| 2013 Noviembre | 46 | 3 | 49 |
| 2013 Octubre | 82 | 7 | 89 |
| 2013 Septiembre | 76 | 6 | 82 |
| 2013 Agosto | 74 | 2 | 76 |
| 2013 Julio | 7 | 1 | 8 |
| 2003 Febrero | 4695 | 0 | 4695 |
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