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Objective:To evaluate clinical characteristics and treatment of postoperative anastomotic stricture in pediatric congenital biliary dilatation patients.Methods:The clinical data of 24 children with postoperative anastomotic stricture from Apr 2012 to Oct 2019 in Beijing Children's Hospital was retrospectively analyzed.Results:There were 6 males and 18 females. Patients were divided into bile- leak group (BL, n=6) and non bile-leak group (NBL, n=18) based on whether there was anastomotic leakage after primary surgery. The main symptoms in BL group was persistent obstructive jaundice, and recurrent cholangitis in NBL group. Postoperative symptoms were first shown in an average of 7.0 months in BL group, compared to 59.0 months in NBL group, P<0.05. In BL group, 4 underwent redoing hepaticojejunostomy, 2 underwent anastomosis plasty. In NBL group, 3 underwent redoing hepaticojejunostomy, 15 did anastomosis plasty with multiple biliary stones found necessitating extraction. After reoperation, one patient had bile leakage, 2 patients had recurrent cholangitis within one-month, 21 patients had uneventful recovery. Five were found to have biliary stones in long-term follow-up. Conclusions:Biliary-enteric anastomotic leakage can cause stricture in postoperative patients of congenital biliary dilatation ,reoperation is necessary in symptomatic patients.
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OBJECTIVE: To identify the best mode for diagnosing and treating the patients with choledochal cysts. METHODS: A retrospective study was performed with medical records of patients diagnosed with choledochal cysts from January 1994 to December 2017. In all cases, the diagnosis was based on ultrasound examination. All the patients underwent cyst resection and were divided in two groups: bile enteric anastomosis in the high portion of the common hepatic duct or in the dilated lower portion. RESULTS: Eighty-one cases were studied. The age of presentation was 4 y 2 mo ± 4 y 1 mo, and the age for the surgical treatment was 5 y 5 mo ± 4 y 6 mo. In 61 cases, US was the only image examination performed. There were 67 cases of Todani type I (82.7%), 13 cases of type IV (16.0%) and one case of type III (1.2%). Nine patients (29.0%) in the first period and 2 patients (4.0%) in the second period presented with postoperative complications (p=0.016). CONCLUSION: In patients with choledochal cysts, US is the only necessary diagnostic imaging. Performing the bile enteric anastomosis in the lower portion of the common hepatic duct is safer and has a lower risk of complications.
Subject(s)
Humans , Child , Bile Ducts/diagnostic imaging , Biliary Tract Surgical Procedures/methods , Choledochal Cyst/surgery , Choledochal Cyst/diagnosis , Postoperative Complications , Choledochal Cyst/classification , Retrospective Studies , Ultrasonography , Treatment OutcomeABSTRACT
Objective To explore the prenatal ultrasound diagnosis and postnatal clinical outcomes of fetuses with hepatohilar cystic occupying lesions . Methods T his was a retrospective study that included all fetuses found to have hepatohilar cystic occupying lesions diagnosed by ultrasound in the First Affiliated Hospital of Sun Yat‐sen University between January 2008 and December 2017 . According to the morphology of the cyst and max diameter ,the cases were divided into four groups . Cases with polygonal cysts and max diameter over 30 mm were assigned to group 1 ,non‐polygonal cysts and max diameter over 30 mm to group 2 ,polygonal cysts and max diameter under 30 mm to group 3 ,non‐polygonal cysts and max diameter under 30 mm to group 4 . T he birth status ,ultrasound review image ,surgical treatment and pathological findings were tracked to analyze the prognosis of these fetuses . Results Among 47 cases of fetal hepatohilar cystic occupying lesions ,38 fetuses were born and 9 were terminated with only 1 case taking pathological examination . T here were 39 cases with pregnancy outcomes . T wenty‐seven cases ( 69 .2% ,27/39) were diagnosed as congenital biliary dilatation ( CBD) ,5 cases ( 12 .8% ,5/39) were found cysts resolved in postnatal ultrasound examinations . Biliary atresia was diagnosed in 3 cases ( 7 .8% ,3/39 ) by operation ; M esenteric cysts ( 5 .1% ,2/39) were diagnosed in 2 cases by ultrasound . One ( 2 .6% ,1/39) was diagnosed as double‐gallbladder by ultrasound . 1 ( 2 .6% , 1/39 ) was diagnosed as teratoma by operation . M ost cases were in the group 3 ,but there was no significant difference compared with other groups ( all P ＞ 0 .05) . Conclusions More than half of hepatohilar cystic occupying lesions diagnosed in prenatal ultrasound are proved to be CBD with good prognosis . T he cysts in few cases can be resolved after born . 7 .8% of cases are biliary atresia with poor prognosis ,w hich give messages to prenatal clinical consultation .
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Objective To study the expression pattern of interleukin-13 (IL-13) in the sera and liver tissue of biliary atresia. Methods 13 infants with biliatry atresia (BA) were studied. 10 children with congenital biliary dilatation (CBD) were studied as a control. Both the BA and CBD were confirmed at operation and histological examination on the liver tissue of biopsy. The sera level of IL-13 was measured by enzyme-linked immunosorbent assay. The expression of IL-13 mRNA in liver tissue was detected with Real-time quantitative reverse transcriptase-polymerase chain reaction. The expression of IL-13 protein in liver tissue was examined by western blotting. Results The IL-13 level in sera of BA was significantly lower than that of CBD group (154.5±18.23 pg/ml vs. 268.2±19.30 pg/ml,p<0.01). Compared with CBD group, the expression of IL-13 mRNA in liver tissue was significantly lower in BA (0.0150±0.0021 vs. 0.0320±0.0050, p=0.0220), and the expression of IL-13 protein was decreased (0.3446±0.0150 vs. 0.5765±0.0215, p=0.0122). Conclusions The expression of IL-13 in the sera and liver tissue of BA is significantly elevated. It may play a key role in the pathogenesis of BA and is worthy of further investigation.
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Objective To investigate the cause of postoperative pancreatitis in Congenital Biliary Dilatation(CBD), and to explore the preventive measures to decrease its occurrence. Methods Patients with CBD (n=22) were summarized during July 2010-March 2014 in Guiyang children's hospital, which include 8 cases of male, 14 cases of female;Cases that developed postoperative traumatic pancreatitis were taken as experimental group. Cases that did not developed it was used as control group. Ages are from 6 months old to 6 years and 9 months old. All patients were received cyst excision and hepatic duct-jejunum Roux- en- Y anastomosis. All postoperative patients are followed up regularly in clinic and by telephone. All followed up were from 3 months to 3 years with a comprehensive physical examination, routine blood test and urine amy?lase analysis. B-ultrasonic examination was used to understand pancreas recovery as well as the expansion of bile duct in the liver. Results Among the 22 cases, the postoperative 1st and 4th day blood amylase as well as 1st,4th and 7th day urine amylase in the experimental group are all higher than those in the control group with statistical difference ( P < 0.05). Patients in experiment group show low thermal and high leucocyte represent postoperative traumatic pancreatitis. All pa?tients were given trypsin inhibitor and anti-inflammatory treatment who were completely recovered after 4-9 days. All chil?dren growth developed normally, with only 2 cases of raised transaminase which were finally settled. Children showed no pan?creatitis and their ascending cholangitis, upper gastrointestinal angiography revealed no reflux gastritis. Conclusion The patients with CBD should receive surgery-cyst excision, hepatic duct-jejunum Roux-en-Y anastomosis early. During opera?tion, cysts decompression should be applied early. Besides these two procedures, interrupting pancreatic confluence and treat?ing pancreatic enzyme inhibitors postoperative can both help to decrease the occurrence of postoperative traumatic pancreatitis.
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We report a case of recrudescent cholangitis successfully treated with Kampo medicine. The patient was a 31-year-old female. She was diagnosed with congenital biliary dilatation, and underwent an operation for partial resection of the liver, and a choledocho-jejunostomy. However, the cholangitis returned two years ago, when she was 29 years old. She had repeated abdominal pain and fever, and at that time received treatment with antibiotics. She desired pregnancy, and was hoping that Kampo treatment would enable her to decrease the amount of antibiotic she was taking. We prescribed inchinkoto as a base treatment and added to daisaikoto or shosaikoto. We changed the prescription according to her symptoms. As a result, her antibiotic quantity was reduced markedly, she safely conceived, and kept taking Kampo medicine while she was pregnant. She remained in good condition throughout her pregnancy. Thus, we consider that Kampo medicine may be useful for treating recrudescent cholangitis after an operation for reconstruction of the biliary tract.
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Objective To evaluate the preoperative localization value of MRI and MRCP for congenital biliary dilatation.Methods 30 cases of congenital biliary dilatition diagnosed by either surgery or pathology were studied.MRI and MRCP findings of all these cases were analyzed.Results MRI and MRCP preoperative examination manifested the place of choledochal cyst and the relation between choledochal cyst and the biliary ductal system around in all 30 patients.Through surgery findings as follow,using Todani's classification,the accuracy of MRI and MRCP in evaluating the site and classification of congenital biliary dilatation was 100%,the accurate visualization rate of pancreatic duct was 73.3% and the junction of pancreaticobiliary duct was 33.3%.Conclusion MRI and MRCP manifestations are very reliable in preoperative localization of congenital biliary dilatation.