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Asymptomatic Adult Choledochal Cyst

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무증상 성인 담관낭

Asymptomatic Adult Choledochal Cyst

Hyoun Jong Moon, M.D., Dongil Choi, M.D.

1

, Jin Seok Heo, M.D., Jae Won Joh, M.D., Yong Il Kim, M.D. and Seong Ho Choi, M.D.

Purpose: Surgical strategies for an adult choledochal cyst are influenced by the Todani-type, and the existence of a combined malignancy. This study was conducted to evaluate the characteristics of asymptomatic an adult choledochal cyst that influence the surgical strategy.

Methods: Fifty-seven adult patients (age 16 years) re- ceived an operation for a choledochal cyst, at the Samsung medical center, between Aug. 1995 and Jul. 2003. Asym- ptomatic patients were defined as those diagnosed inciden- tally with a choledochal cyst, who had no symptoms related with a choledochal cyst. Evaluation of PBM (pancrea- ticobiliary maljunction) was available in 38 patients with a proper cholangiogram.

Results: There were 15 and 42 asymptomatic and sympto- matic patients, respectively. The mean-age (38 years-old) and gender-ratio (M F=14 43) were no different between the two groups. In preoperative blood tests, the titers of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were slightly higher in the symptomatic group, but were still around the upper normal limit. The total bilirubin, amylase and CA19-9 levels were no different between the two groups. The operations in the symptomatic group required longer times and greater transfusion volumes than the asymptomatic group (4.5 vs.

3.5 hrs and 0.24 vs. 0 units, respectively). The proportion of the Todani-types, types of PBM, incidence of malignancy and gallstones were no different between the two groups.

Seven malignancies, 3 common bile duct cancers and 4 gall bladder cancers, were found, and an age 40 years was

the only risk factor of a combined malignancy.

Conclusion: There was no considerable difference to influence the surgical strategy between the asymptomatic and symptomatic choledochal cyst patients. However, old patients, especially over 40, may need a more aggressive surgical therapy. (J Korean Surg Soc 2004;66:226-230) Key Words: Choledochal cyst, Adult, Asymptomatic, Treat-

ment

: , , ,

Departments of Surgery and

1

Radiology, Samsung Medical

Center, School of Medicine, Sungkyunkwan University,

Seoul, Korea

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