Congenital choledochal cysts, also known as cystic dilatation of the common bile duct, are mostly congenital developmental malformations. Symptoms of congenital choledochal cyst symptoms appear in children and adults, according to statistics, 25% of cases diagnosed in the first year of life, 60% diagnosed before the age of 10 years, 23% diagnosed at the age of 40 years old, the oldest is 78 years old, the clinical manifestations of intermittent epigastric pain, right upper abdominal mass and jaundice, known as the triad of choledochal cysts, but only accounted for 1/3 of the total number of 55% to 60% of cases have abdominal pain, 60% to 75% have a mass, 65% to 80% of cases ~ 60% of cases have abdominal pain, 60% ~ 75% have a mass, 65% ~ 80% have jaundice, the clinical manifestations are quite different, can be completely painless, or for the epigastric abdomen can be tolerated by the dull pain, or even the right epigastric severe colic, jaundice is the most common symptom, in children is often the first symptom noticed, can be intermittent or progressive; infants with progressive jaundice. Congenital biliary atresia should be taken into account, jaundice can be severe skin tingling, feces gray, urine dark black for the manifestation of cholestasis, the degree of jaundice and biliary obstruction and the degree of infection is directly related to the epigastric or right quadrilateral ribs can be palpable swelling, large can occupy the whole right abdomen, look at the cystic sensation, fixed inactivity, small cysts can be slightly mobile, the occurrence of infection, then there is a clear tenderness and rebound pain, if it is a duodenal In the case of duodenal bile duct bulging, there are symptoms of duodenal obstruction, in addition, nausea, vomiting, anorexia, diarrhea, and weight loss, etc., and chills, fever, and an increase in the white blood cell count in the event of infection. According to the typical three symptoms of abdominal pain, jaundice and abdominal mass that appear intermittently since childhood, this disease should be considered, but some of them do not have the three symptoms, and the diagnosis should be made by combining with laboratory examination, abdominal ultrasound, CT and cholangiography. Treatment 1. Treatment during inflammatory attack. (1) Fasting and gastrointestinal decompression can reduce the secretion of bile and pancreatic fluid and reduce the pressure in the bile duct. (2) Application of antibiotics to control infection, biliary tract infections are common bacteria for gram stain-negative intestinal aerobic bacteria and anaerobic bacteria, mainly bacilli, cephalosporin and metronidazole can be used. (3) abdominal pain can be appropriate antispasmodic anticholinergic drugs. (4) Combined with acute septic cholangitis, severe obstructive jaundice, early liver failure in severe patients can be preceded by transduodenoscopic nasobiliary drainage or percutaneous hepatic puncture biliary drainage, initial yellowing and control of the infection before choosing surgical treatment. (5) Those with elevated serum amylase are treated as pancreatitis. (6) Actively prevent and treat shock, including blood transfusion and rehydration, correcting water, electrolyte and acid-base imbalance, and monitoring vital signs. (7) Strengthen liver protection and nutritional support therapy. Supplement all kinds of fat-soluble vitamins (A, D, K, etc.) to maintain good nutritional status. Once the diagnosis is made, surgical treatment should be taken. Surgery is not limited to drainage and resection. Diverticulum type and duodenal choledochal bulge type in principle, should try to use resection; only the common type because the cyst is too large, resection is difficult, may damage the surrounding important tissues, or in the acute stage of infection, only to take the drainage. There are two types of drainage: external drainage and internal drainage. External drainage is prone to hypotonic water loss, acidosis, electrolyte disorders, so unless in the last resort, such as severe infection or systemic condition is too poor, only in emergency surgery, through the gallbladder intubation or cyst pouch suture, to be after the systemic condition improves, and then to establish the biliary access. There are cyst duodenal anastomosis, cyst gastric anastomosis and cyst jejunostomy, but it is easy to cause gastrointestinal content reflux, resulting in ascending cholangitis. Therefore, some people advocate the use of the great curvature of the stomach into a tube and then anastomosed with the cyst; more common is to make a Roux cyst jejunum Y-type anastomosis, the use of a section of the 30cm long, go to the function of the intestinal tube and the cyst for the end of the side of the anastomosis, 70% to 80% of the cases can achieve a satisfactory outcome. After anastomosis of the cyst, if ascending cholangitis occurs, it causes anastomotic stenosis, and is prone to stone formation, but also due to inflammatory stimulation and secondary malignant changes, which often requires reoperation, which indicates that the initial cyst resection is more desirable. However, the mortality rate of resection is high, so some authors advocate that in the important structures, only the inner layer of the cyst wall is resected, while retaining a thin layer of the outer membrane of the cyst wall, for the total resection of the cyst, and then anastomose the proximal bile duct of the cyst to the Y-branch of the jejunum, or anastomose the opposite end of the bile duct plus the sphincter of Oddi molding operation. Even if total excision of the cyst is not possible, at least a large portion of the cyst wall should be removed as much as possible to minimize postoperative complications. The operative mortality rate of internal drainage is low, but the postoperative morbidity rate is high; the morbidity rate after total cystectomy is low, and the operative mortality rate has been reduced from 50% to about 5%. The higher the rate of correct preoperative diagnosis, the lower the operative mortality rate, in 1933 the rate of correct preoperative diagnosis was only 3%, has increased to 70% to 80%, so the safety of the operation has been significantly increased. The development of liver transplantation has improved the prognosis of intra- and extrahepatic biliary atresia. The prognosis has improved with the improvement in the technique of correct diagnosis, and the mortality rate of the disease has now been greatly reduced. The development of liver transplantation has improved the prognosis of intra- and extrahepatic biliary atresia.