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2.
Rev. cuba. pediatr ; 92(4): e1167, oct.-dic. 2020.
Article in Spanish | LILACS, CUMED | ID: biblio-1149923

ABSTRACT

Las dilataciones congénitas de los conductos biliares, son poco frecuentes y se pueden descubrir en cualquier etapa de la vida, incluido el período prenatal. Es una afección que puede ser asintomáticas, ocasionar síntomas escasos o producir graves complicaciones, razones por las cuales, la actitud actual del especialista se enfoca hacia el diagnóstico temprano y el tratamiento correcto de las diferentes variantes de dilatación congénita de la vía biliar antes que aparezcan las complicaciones mencionadas. El objetivo de publicar esta guía responde a la necesidad de contar con herramientas actualizadas en el manejo de estas afecciones que permitan sistematizar la conducta y mejorar la calidad de la asistencia médica, la docencia y las investigaciones y está aprobada por la Sociedad Cubana de Cirugía Pediátrica. Se realizó una extensa revisión de la literatura científica basada en la mejor evidencia publicada mundialmente sobre el tema. Se presentan el concepto de esta afección, su epidemiología, clasificación, etiología, cuadro clínico, formas de presentación, diagnóstico y conducta a seguir con los diferentes tipos, así como las medidas posoperatorias y de seguimiento del paciente. Si todos los procedimientos se realizan de forma correcta y en el momento oportuno, el pronóstico es favorable en la mayoría de los casos(AU)


Congenital dilation in the biliary duct is not common and can be found in any stage of life, including the prenatal period. It is a condition that can be asymptomatic, causing scarse symptoms or producing severe complications; therefore, the current performance of specialists must be focused towards the early diagnosis and the accurate treatment of the different types of congenital dilation of the biliary tract before the above mentioned complications appear. The aim of publishing this guidelines has to do with the need of having updated tools for the management of these conditions which allow to systematize the behaviours and to improve the quality of medical care, teaching and researches, and also because it is approved by the Cuban Society of Pediatric Surgery. It was made an extensive review of the scientific literature based in the best evidences published worldwide on the topic. It is presented the concept of this condition, its epidemiology, classification, etiology, clinical picture, ways of presentation, diagnosis and behaviour to follow with the different types of it, as well as the patient's post-operative and follow-up measures. If all the procedures are made in a proper way and in the opportune moment, the prognosis is favorable in most of the cases(AU)


Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Infant , Child, Preschool , Child , Choledochal Cyst/surgery , Choledochal Cyst/epidemiology
3.
Article | IMSEAR | ID: sea-213258

ABSTRACT

Benign intra-abdominal cystic masses in children are rare and they have diverse etiopathogenesis, clinical presentation. The present study highlights the experience in the management of benign intra-abdominal cysts pertaining to the diverse etiologies associated with these lesions. The medical records of our hospital between November 2016 to November 2019 were retrospectively reviewed. Patients with cystic abdominal masses were studied with respect to less different clinical presentations, localization of masses, diagnostic tests, surgical aapproaches, histopathological examinations and outcome. Out of the 55 cases, most common lesion was a choledochal cyst. Miscellaneous diagnosis includes an omental cyst, urachal cyst and a pedunculated bile duct cyst. All the cystic lesions of the abdomen need to be considered as close differentials in clinical practice due to the common presentations and similar symptoms produced by these lesions. All the lesions were managed by exploratory laparotomy except two ovarian cysts which were managed with laparoscopic approach.

4.
Rev. chil. radiol ; 26(2): 76-78, jun. 2020. graf
Article in Spanish | LILACS | ID: biblio-1126197

ABSTRACT

Resumen: El coledococele es una dilatación quística del segmento distal del conducto biliar común que sobresale en el lumen duodenal. Estos comprenden menos del 2% de todos los casos reportados de quistes de colédoco (2). Los hallazgos imagenológicos del coledococele y de los quistes de duplicación duodenal son muy similares, ambos presentan además clínica variada e inespecífica, por lo que el diagnóstico definitivo suele ser durante la cirugía. Presentamos un caso de una paciente de 10 años que consulta por dolor abdominal con elevación de transaminasas que, tras estudio con resonancia magnética con colangioresonancia y EDA se diagnostica coledococele.


Abstract: Choledochocele is a cystic dilation of the distal segment of the common bile duct protruding into the duodenal lumen. Is also known as type III choledochal cyst according to Todani's classification. It is usually misdiagnosed as duodenal duplication cyst. Multislice spiral computed tomography and magnetic resonance cholangiopancreatography may be comparable to endoscopic retrograde cholangiography for diagnosis of choledochocele. We present a case of a 10-years-old girl presented with abdominal pain, elevation of transaminases and a magnetic resonance cholangiopancreatography (MRCP) scan that revealed a choledochocele.


Subject(s)
Humans , Female , Child , Choledochal Cyst/diagnostic imaging , Cholangiopancreatography, Magnetic Resonance
5.
Article in Chinese | WPRIM | ID: wpr-871017

ABSTRACT

Objective To investigate the clinical characteristics and risk factors of congenital choledochal cysts (CCC).Methods This retrospective study recruited 52 cases who were antenatally diagnosed with CCC and underwent surgical treatment after birth in Guangdong Women and Children Hospital from January 2013 to August 2018,with complete clinical data.According to the enlargement of cysts during pregnancy,they were divided into two groups:progressive group (≥ 15 mm,22) and stable group (<15 mm,30).Antenatal and postpartum ultrasound and MRI features of the two groups were analyzed.Clinical manifestations and biochemical examination results before and after operation were compared between the two groups.Other data,including amylase level in cyst fluid during operation,cholangiography findings,liver biopsy results,and post-operation follow-up,were also analyzed.Chi-square test,t (t1) test,and Pearson correlations tests were performed for data analysis.Results (1) The average age of the 52 patients at operation was 46(7-822) d.The cysts of all cases were first detected during 19-21 weeks of gestation.The maximum diameter of the cyst in the progressive group was larger than that in the stable group after 34 weeks of pregnancy [31-34 weeks:(31.1 ±8.4) vs (23.1 ± 6.6) mm,t=3.911;>34 weeks:(36.1 ± 6.8) vs (27.1 ± 7.3) mm,t=4.557;pre-operation:(51.8± 18.0) vs (34.0± 15.6) mm,t=3.809;all P<0.01].(2) In the progressive group,the cysts were irregular in shape and enlarged after birth.The common hepatic duct and intrahepatic bile duct were dilated and gradually distended after birth,while the distal end of the common bile duct was narrowed,thus to form a cone-like duct.Deposits could be seen inside the cysts after delivery.Irregular cysts were also presented in the stable group,and five of them had dilatation of common hepatic duct and intrahepatic bile duct after birth.However,no cone-like formation was seen,the distal end of the common bile duct was visible,and deposits in cysts were occasionally found.(3) Twenty-five patients underwent laparotomy,and seven of them showed increased amylase level in cyst fluid including four with 2-5 times above the upper limit of normal value (one in the progressive group and three in the stable group).The other three cases were all in the stable group and their amylase levels in cyst fluid were more than ten times of the upper limit.The level of direct bilirubin in the progressive group was higher than that in the stable group before the operation [18.40(2.50-113.30) vs 8.70(0.00-16.80) μmol/L,u=2.400,P<0.05].(4) Among the 52 cases,patients with type Ⅰ,Ⅳ and Ⅴ cyst accounted for 71.1% (37/52),26.9% (14/52) and 2.0% (1/52),respectively.All cases were followed up regularly six months to one year after the operation.Liver function and bilirubin became normal and the growth and development of the babies were similar to those of the same age.(5) Different degrees of liver fibrosis and inflammation were shown in 46(88.5%) cases and more severe in older babies among those who underwent surgery in the progressive group.The time at operation was not associated with the severity of liver fibrosis and inflammation in the stable group.Hepatic fibrosis and inflammation were more serious in the progressive group than in the stable group (fibrosis grading:x2=14.260,P=0.006;inflammatory activity grading:x2=9.904,P=0.019).Conclusions Larger diameter (≥ 30 mm) in the initial prenatal examination or a significant increase in cystic diameter (≥ 15 mm) during pregnancy are risk factors for early stenosis or occlusion in the distal end of common bile duct requiring close follow-up after birth.When jaundice or abnormal liver function occur and stool color becomes light,early surgical treatment (one to two months after birth,generally within three months) for CCC is recommended to rule out the anomalous union of the pancreaticobiliary duct and hepatic disorders,as well as the cystic biliary atresia.

6.
Article in Chinese | WPRIM | ID: wpr-861088

ABSTRACT

Objective: To investigate the value of dynamic contrast enhanced MRI (DCE-MRI) quantitative parameters for evaluation of liver fibrosis caused by pediatric congenital choledochal cyst (CCC). Methods: Totally 33 CCC children with liver fibrosis were included into case group, while 14 children were selected as control group. All children underwent liver DCE-MRI. Quantitative parameters were acquired with Tofts model,including volume transfer constant from blood plasma to extravascular extracellular space (Ktrans), transfer rate constant between extravascular extracellular space and blood plasma (Kep) and volume of extravascular extracellular space (Ve). The differences and correlations of the above parameters among different liver fibrosis stages were analyzed, and AUC of each parameter in diagnosing different grades of liver fibrosis were drawn. Results: Ktrans and Kep were significantly different among fibrosis subgroups (all P0.05) and negative correlation with liver fibrosis staging (r=-0.249, P>0.05). AUC for identifying normal vs fibrosis and mild vs advanced fibrosis by Ktrans and Kep were 0.949, 0.748 and 0.933, 0.731, and the cutoff values were 0.239,.0.186 and 1.814, 1.663, respectively. Conclusion: DCE-MRI perfusion parameters such as Ktrans and Kep are valuable for diagnosing and staging of liver fibrosis caused by CCC in children.

7.
Article in English | WPRIM | ID: wpr-843066

ABSTRACT

@#Peritonitis caused by biliary tract perforation is unsual. After other causes, such as trauma, biliary tract stone, cyst of choledocal duct, can be rule out, we should reconsider leakage or rupture of biliary tract. We report a 3 years old boy was administered to emergency room with abdominal distended, vomiting and diarrhea, low-grade fever, and diffuse abdominal pain. There’s no history of jaundice and abdominal pain before, neither trauma. Sign of peritonitis were found. The patient underwent laparotomy, perforation at common bile duct was found without any other disease. Intra abdominal drain was placed near the leak and primary repair was done with tube drain inside the duct. The pastient discharged after 8 days hospitalized uneventful.

8.
Article in Chinese | WPRIM | ID: wpr-798692

ABSTRACT

Objective@#To investigate the clinical characteristics and risk factors of congenital choledochal cysts (CCC).@*Methods@#This retrospective study recruited 52 cases who were antenatally diagnosed with CCC and underwent surgical treatment after birth in Guangdong Women and Children Hospital from January 2013 to August 2018, with complete clinical data. According to the enlargement of cysts during pregnancy, they were divided into two groups: progressive group (≥15 mm, 22) and stable group (<15 mm, 30). Antenatal and postpartum ultrasound and MRI features of the two groups were analyzed. Clinical manifestations and biochemical examination results before and after operation were compared between the two groups. Other data, including amylase level in cyst fluid during operation, cholangiography findings, liver biopsy results, and post-operation follow-up, were also analyzed. Chi-square test, t (t') test, and Pearson correlations tests were performed for data analysis.@*Results@#(1) The average age of the 52 patients at operation was 46(7-822) d. The cysts of all cases were first detected during 19-21 weeks of gestation. The maximum diameter of the cyst in the progressive group was larger than that in the stable group after 34 weeks of pregnancy [31-34 weeks: (31.1±8.4) vs (23.1±6.6) mm, t=3.911; >34 weeks: (36.1±6.8) vs (27.1±7.3) mm, t=4.557; pre-operation: (51.8±18.0) vs (34.0±15.6) mm, t=3.809; all P<0.01]. (2) In the progressive group, the cysts were irregular in shape and enlarged after birth. The common hepatic duct and intrahepatic bile duct were dilated and gradually distended after birth, while the distal end of the common bile duct was narrowed, thus to form a cone-like duct. Deposits could be seen inside the cysts after delivery. Irregular cysts were also presented in the stable group, and five of them had dilatation of common hepatic duct and intrahepatic bile duct after birth. However, no cone-like formation was seen, the distal end of the common bile duct was visible, and deposits in cysts were occasionally found. (3) Twenty-five patients underwent laparotomy, and seven of them showed increased amylase level in cyst fluid including four with 2-5 times above the upper limit of normal value (one in the progressive group and three in the stable group). The other three cases were all in the stable group and their amylase levels in cyst fluid were more than ten times of the upper limit. The level of direct bilirubin in the progressive group was higher than that in the stable group before the operation [18.40(2.50-113.30) vs 8.70(0.00-16.80) μmol/L, u=2.400, P<0.05]. (4) Among the 52 cases, patients with type Ⅰ, Ⅳ and Ⅴ cyst accounted for 71.1% (37/52), 26.9% (14/52) and 2.0% (1/52), respectively. All cases were followed up regularly six months to one year after the operation. Liver function and bilirubin became normal and the growth and development of the babies were similar to those of the same age. (5) Different degrees of liver fibrosis and inflammation were shown in 46(88.5%) cases and more severe in older babies among those who underwent surgery in the progressive group. The time at operation was not associated with the severity of liver fibrosis and inflammation in the stable group. Hepatic fibrosis and inflammation were more serious in the progressive group than in the stable group (fibrosis grading: χ2=14.260, P=0.006; inflammatory activity grading: χ2=9.904, P=0.019).@*Conclusions@#Larger diameter (≥30 mm) in the initial prenatal examination or a significant increase in cystic diameter (≥15 mm) during pregnancy are risk factors for early stenosis or occlusion in the distal end of common bile duct requiring close follow-up after birth. When jaundice or abnormal liver function occur and stool color becomes light, early surgical treatment (one to two months after birth, generally within three months) for CCC is recommended to rule out the anomalous union of the pancreaticobiliary duct and hepatic disorders, as well as the cystic biliary atresia.

9.
Article in English | WPRIM | ID: wpr-830443

ABSTRACT

@#Introduction: Choledochal cyst (CC) is a congenital cystic dilation of bile duct. Although considered a benign disorder, but CC has various complications like cholangitis, cholelithiasis, pancreatitis and malignant degeneration. The characteristic of this malformation are still not well documented in our region. We aimed to describe the characteristic of CC patients in Hasan Sadikin Hospital Bandung, Indonesia. Method: The medical records of patients that were diagnosed with CC between 2014 and 2017 were reviewed. We retrospectively collected demographic data, clinical symptoms, diagnostic imaging and surgical data. Results: Fifteen patients were diagnosed as CC, predominantly were girls (12 patients). The mean age was 63,47 months old (range from 7 to 144 months). Jaundic was found in all patients, followed by abdominal pain in 12 patients (80%) and abdominal mass in 9 patients (60%). The laboratory results showed signs of bile obstruction in 5 patients (33,3%). Diagnostic imaging using ultrasonography revealed 5 patients (33,3%) with CC type IV, whereas type I in 6 patients (40%). MRI was performed in 8 patients (53,3%) and CT Scan was performed in 5 patient (33,3%). Eleven patients (73,3%) underwent cyst excision and Roux-en-Y hepaticojejunostomy with liver biopsy. Conclusion: Our data suggested that CC predominantly found in girls, and abdominal pain was the most common symptom. Ultrasonography, MRI, and CT are imaging modalities use to diagnose CC. Surgical treatment should be done includes total cyst excision dan biliodigestive reconstruction.

10.
Clinics ; 75: e1539, 2020. tab, graf
Article in English | LILACS | ID: biblio-1089591

ABSTRACT

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 Outcome
11.
Pediátr. Panamá ; 48(2): 4-10, Agosto-Septiembre 2019.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1023494

ABSTRACT

Introducción: El quiste de colédoco es una condición poco frecuente, se caracteriza por una dilatación de la vía biliar intrahepática y extrahepática. La presentación clínica es variable e incluye principalmente la presencia de masa abdominal, vómitos, ictericia y dolor abdominal, Materiales y métodos: El objetivo de este estudio es determinar las características clínicas y epidemiológicas de pacientes con quiste de colédoco atendidos en el Hospital del Niño Dr José Renán Esquivel durante los años 2005 a 2018. Se realizó un estudio descriptivo retrospectivo, con interés en las características demográficas como edad, sexo, lugar de procedencia, grupo étnico y las características clínicas como síntomas, método diagnóstico, tipo de quiste reportado, histopatología, y complicaciones. Resultados: La n fueron 36 pacientes (n=25 femenino y n=11 masculinos). El grupo de edad de 0-4 años representó el 67% de los sujetos del estudio. Las principales manifestaciones clínicas fueron dolor abdominal, vómitos e ictericia. El método diagnóstico principal utilizado fue la ecografía abdominal. Principales complicaciones postquirúrgicas colangitis, pancreatitis y sangrado digestivo. La mayoría de los quistes clasificados son Todani IC Y IV. Conclusiones: El quiste de colédoco es una patología presente en Panamá con una frecuencia de 2.8 casos por año.


Introduction: Choledochal cysts are a rare condition, characterized by dilatation of the intrahepatic and extrahepatic bile ducts. The clinical presentation is variable and includes the presence of an abdominal mass, jaundice, fever, nausea, vomiting and abdominal pain. Materials and methods: The objective of this study is to determine the clinical and epidemiological characteristics of patients with choledochal cyst treated at the Hospital del Niño Dr. José Renán Esquivel during the years 2005 to 2018. A retrospective descriptive study was conducted, with interest in demographic characteristics such as age, sex, place of origin, ethnic group and clinical characteristics such as symptoms, diagnostic method, type of cyst reported, histopathology, complications. Results: The N were 36 patients (n = 25 female and n = 11 male). The age group of 0-4 years represented 67% of the study subjects. The main clinical manifestations were abdominal pain, vomiting and jaundice. The main diagnostic method used was the abdominal ultrasound. Main postsurgical complications cholangitis, pancreatitis and digestive bleeding. The majority of the classified cysts are Todani IC and IV. Conclusions: The choledochal cyst is a pathology present in Panama with 2.8 cases per year.

12.
Article in English | WPRIM | ID: wpr-762681

ABSTRACT

PURPOSE: Improvements in surgical techniques and a better understanding of the unique anesthetic requirements in neonates undergoing laparoscopy have suggested that laparoscopic surgery may be effective in newborns. This study therefore evaluated the safety and feasibility of laparoscopic excision of the cyst (LEC) in neonates. METHODS: This retrospective study included 43 neonates who underwent excision of choledochal cysts between November, 2001, and January, 2018, including 21 who underwent open excision and 22 who underwent LEC. Their perioperative and surgical outcomes were reviewed. The patients were followed up for a median 37 months (range, 3–141 months). RESULTS: Baseline characteristics did not differ significantly in the open and LEC groups. Mean intraoperative peak partial pressure of arterial CO2 (PaCO2) (45.5 mmHg vs. 48.0 mmHg) and total operation time (208.3 ± 71.0 minutes vs. 235.0 ± 47.2 minutes) were similar in both groups. Parents of the patients in the LEC group provided a more positive evaluation of scar scale and greater satisfaction with wound. No patient in either group experienced any critical complications. Three patients in the open excision group required readmission for cholangitis and 2 patients had ileus. No patient in the laparoscopic excision group experienced any postoperative complications during follow-up. CONCLUSION: Despite difficulties performing laparoscopic surgery in neonates, LEC was safe and feasible when intraperitoneal peak pressure was maintained under 10 mmHg and PaCO₂ was closely monitored by a pediatric anesthesiologist. Compared with open excision, LEC provided improved cosmetic outcomes without severe complications. Prospective randomized studies with large numbers of patients are warranted.


Subject(s)
Cholangitis , Choledochal Cyst , Cicatrix , Follow-Up Studies , Humans , Ileus , Infant , Infant, Newborn , Laparoscopy , Minimally Invasive Surgical Procedures , Parents , Partial Pressure , Postoperative Complications , Prospective Studies , Retrospective Studies , Wounds and Injuries
13.
Article in Chinese | WPRIM | ID: wpr-745330

ABSTRACT

Objective To investigate effects of complete resection of the cyst or incomplete resection with 3 ~ 5 mm remnant proximal cyst wall in treating adult type Ⅰ choledochal cyst (CC).Methods Medical records of 133 surgical patients with type Ⅰ CC from December 1995 to December 2017 in the First Affiliated Hospital of Zhengzhou University were reviewed retrospectively.According to whether to reserve the 3 ~ 5 mm cyst wall in proximal end of cyst,133 patients were divided into unreserved group (n =85) and reserved group (n=48),and the related indicators of the two groups were compared and analyzed.Results No significant difference was observed in age,sex ratio,clinical performance between the two groups(all P>0.05).And there was no statistical difference in the operation time,intraoperative blood loss,and biliary-intestinal anastomosis diameter between the two groups(all P>0.05).The main complications of the two groups were similar,including incision and abdominal infection,bile leakage,cholangitis,reflux cholangitis,bile duct stones and anastomotic stricture,and there was no statistical difference in the incidence of each complication.Biliary-intestinal anatomical site malignancy was observed in one patient with recurrent cholangitis in the reserved group in the 33th months.Conclusions There was no statistical difference in the incidence of early and late complications in two different methods of cyst management for treating adult type Ⅰ CC.Whether reserve the 3~5 mm cyst wall in proximal end of CC increases the risk of cancer still needs further studies.

14.
Article in English | WPRIM | ID: wpr-741331

ABSTRACT

Hepatic duct diverticulum is a rare form of choledochal cyst that does not fit into the most widely used Todani classification system. Because of its rarity, it may be difficult for clinicians to diagnose and treat it. Here, we present a case of left hepatic diverticulum in a 57-year-old woman with epigastric pain. At presentation, there were mild elevations in the liver function tests. Computed tomography and magnetic resonance cholangiopancreatography showed diverticulum-like cystic lesion with sludge ball near the confluence portion of both intrahepatic bile duct, but the origin of the lesion could not be identified. The clinical impression was type II choledochal cyst. Surgical excision was planned due to recurrent abdominal pain. The operative findings revealed diverticulum arising from left hepatic duct. Histopathology confirmed the lesion to be diverticulum lined by biliary epithelium. The patient had no postoperative complication and no further symptoms since the operation.


Subject(s)
Abdominal Pain , Bile Ducts , Bile Ducts, Intrahepatic , Cholangiopancreatography, Magnetic Resonance , Choledochal Cyst , Classification , Diverticulum , Epithelium , Female , Hepatic Duct, Common , Humans , Liver Function Tests , Middle Aged , Postoperative Complications , Sewage
15.
Article in Chinese | WPRIM | ID: wpr-732710

ABSTRACT

Choledochal cyst is one of the most common biliary deformities in children,and laparo scopic cyst excision and Roux-en-Y hepaticojejunostomy has become a common procedure for pediatric choledochal cyst in many medical centers up to now.However,conversions and complications are frequent especially in the early stage of the laparoscopic series including bleeding,anastomotic leakage and stenosis,intestinal obstruction,pancreatic fistula and acute pancreatitis,residual cyst,etc,some of which may even be lifethreatening.This review will introduce the reasons and the preventive measures of the complications of laparoscopic Roux-en-Y hepaticojejunostomy which aims to improve the security of laparoscopic hepaticojejunostomy for choledochal cysts in children.

16.
Article in Chinese | WPRIM | ID: wpr-755173

ABSTRACT

Objective To study the clinical value of enhanced recovery after surgery (ERAS) in the perioperative treatment of type Ⅰ (Todami,1975) biliary dilatation (BD) of children.Methods To retrospectively analyze the data of children with type Ⅰ BD who were treated in the General Surgery Department of Zhengzhou Children's Hospital from June 2014 to May 2018.A total of twenty children with type Ⅰ BD treated with ERAS and 20 children treated with the traditional method in our department were selected in this study using the random number table method.Postoperative indicators (including operation time,first defecation time,changes in amylase in blood and abdominal cavity exudates,length of hospital stay,and hospitalization fee) and relevant postoperative complications (including sore throat,nausea and vomiting,urethral pain,upper respiratory tract infection,incision wound infection,adhesive intestinal obstruction,anastomotic leakage and pancreatic fistula) of the ERAS group and the control group were compared.Results The first defecation time,length of hospital stay and hospitalization fee were significantly lower in the ERAS group than the control group (all P < 0.05) [first defecation time (1.98 ± 0.25) d vs.(2.25 ± 0.31) d;length of hospital stay (6.91 ± 1.25) d vs.(9.95 ± 1.53) d;hospitalization fee (23.32 ± 2.25)thousand yuan vs.(25.99 ±3.10) thousand yuan].Moreover,the incidences of sore throat,nausea and vomiting,urethral pain and upper respiratory tract infection were significantly lower in the ERAS group than the control group (all P < 0.05) [the incidences of sore throat (5.0% vs.45.0%);the incidences of sickness and vomiting (5.0% vs.30.0%);the incidences of urethral pain (5.0% vs.45.0%);the incidences of upper respiratory tract infection (5.0% vs.40.0%)].On the other hand,there were no significant differences in the mean operation times,changes in amylase levels in the blood or abdominal cavity exudates,incision wound infection,and incidences of adhesive intestinal obstruction,anastomotic leakage and pancreatic fistula (all P > 0.05).Conclusions ERAS for type Ⅰ BD surgery was safe and reliable in children.It effectively promoted recovery of postoperative gastrointestinal function and reduced the incidence of complications.

17.
Article in Chinese | WPRIM | ID: wpr-752939

ABSTRACT

Objective To explore the value of ultrasound in differential diagnosis of hepatic hilar cyst in neonates and infants. Methods The ultrasonographic characteristics of 93 children with hilar cysts under 6 months of age admitted to the General Surgery Department of Beijing Children′s Hospital. Affiliated to Capital Medical University from January 2014 to December 2018 were retrospectively analyzed. According to the surgical results,they were divided into two groups:cystic biliary atresia ( CBA) group and congenital choledochal cyst (CC) group,21 cases in the CBA group and 72 cases in the CC group. The size of cyst in hepatic portal area,the shape of gallbladder in empty stomach,the expansion of intrahepatic and extrahepatic bile ducts,the deposition of biliary sludge and the communication between cyst and intrahepatic bile duct were observed by ultrasound. Results The cyst volume of CBA group was 0. 4 ( 0. 1, 1. 3 ) cm3 , and that of CC group was 18. 3(5. 4,50. 3) cm3. The cyst volume of CBA group was significantly smaller than that of CC group (P<0. 01);19 cases had abnormal gallbladder morphology in CBA group and 4 cases in CC group (P<0. 01);1 case had biliary sludge in hilar cyst in CBA group and 51 cases had biliary sludge in cyst in CC group ( P <0. 01);no intrahepatic bile duct dilatation was observed in CBA group,and 54 cases had intrahepatic bile duct dilatation in CC group (P<0. 01);no cyst communicated with intrahepatic bile duct in CBA group,and all cysts communicated with intrahepatic bile duct in CC group (P <0. 01). Conclusion Gallbladder shape,cyst size,biliary sludge deposition,intrahepatic bile duct dilatation and the communication between cyst and intrahepatic bile duct can be used as sonographic features to differentiate CBA from CC.

18.
Article in Chinese | WPRIM | ID: wpr-800413

ABSTRACT

Objective@#To study the use of MRCP digital quantitative diagnosis in the differential diagnosis of choledochal cyst type Ic.@*Methods@#The clinical data of 41 patients with choledochal cyst type Ic, 47 patients with distal choledochal obstruction and 43 patients with simple gallbladder stones or polyps who were treated at the Eastern Hepatobiliary Surgery Hospital, PLA Naval Medical University from January 2010 to June 2016 were retrospectively analyzed. The diameters of the common bile duct, the left and the right hepatic ducts were measured and compared.@*Results@#The maximum diameter of the left hepatic duct (LHD), right hepatic duct (RHD) and common bile duct (CBD) were significantly different (all P<0.05) in patients with choledochal cyst type Ic compared to patients with distal choledochal obstruction. The CBD/LHD ratio and CBD/RHD ratio were significantly larger (P<0.05). For patients with choledochal cyst type Ic, when compared with patients with simple gallbladder stones or polyps, the maximum diameter of CBD was significantly larger (P<0.05), but the maximum diameters of LHD and RHD were not significantly different (both P>0.05), while the ratios of CBD/LHD and CBD/RHD were significantly larger (P<0.05). For patients with choledochal cyst type Ic, when compared with patients with simple gallbladder stones or polyps, the maximum diameter of CBD was significantly larger (P<0.05), the maximum diameter of LHD and RHD was also significantly larger (P<0.05), while the ratios of CBD/LHD and CBD/RHD were not significantly different (P>0.05). The proportion of pancreaticobiliary maljunction (PBM) in patients with type Ic choledochal cyst was significantly higher than patients with distal choledochal obstruction and simple gallstone or polyp (P<0.05).@*Conclusions@#For patients with choledochal cyst type Ic, their CBD shows obvious dilation, while there is no obvious dilation in LHD and RHD. It is helpful to conduct differential diagnosis of choledochal cyst type Ic by the use of MRCP to observe the presence of PBM and to quantitatively compare the CBD/LHD and CBD/RHD ratios.

19.
Article in Chinese | WPRIM | ID: wpr-796893

ABSTRACT

Objective@#To study the diagnosis and management of choledochal cyst in children with accessory hepatic ducts (AHD).@*Methods@#From November 2013 to June 2018, 14 patients with choledochal cyst with AHD were treated in Guangzhou Women and Children's Medical Center. The patients included 2 males and 12 females, and age ranged from 4 months to 3 years (median 2 years). All patients underwent MRCP before operation, and 2 underwent operative cholangiography through the AHD.@*Results@#Seven patients with choledochal cyst and AHD were demonstrated by preoperative MRCP and intraoperative exploration. One patient was suspected by preoperative MRCP to have AHD which was confirmed by surgical exploration. Preoperative MRCP failed to diagnose, but operative exploration revealed AHD in 6 patients. Anastomosis of the AHD to jejunum was performed laparoscopically in 8 patients and by open surgery in 1 patient. Six patients had the common hepatic duct and the AHD joined together to create a common channel which was then implanted as a single duct into a Roux loop, Three patients had the common hepatic duct and the AHD anastomosed separately to a Roux loop. All the patients recovered well after operation and they were discharged home without any complication. A follow-up which ranged from 0.5 to 5 years showed no jaundice, liver atrophy or liver abscess.@*Conclusions@#MRCP was important in the preoperative diagnosis of choledochal cyst with accessory hepatic duct in children. MRCP was difficult in diagnosing type II accessory hepatic ducts. In suspected or undiagnosed cases of AHD, surgical exploration helped to improve the diagnostic accuracy, avoided injury and guided correct surgical decisions. Reconstruction of AHD required joining the AHD to the common hepatic duct, or as a separate duct to jejunal anastomosis to a Roux-y-loop.

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Article in Chinese | WPRIM | ID: wpr-791493

ABSTRACT

Objective To study the diagnosis and management of choledochal cyst in children with accessory hepatic ducts ( AHD) . Methods From November 2013 to June 2018, 14 patients with choledochal cyst with AHD were treated in Guangzhou Women and Children 's Medical Center. The patients included 2 males and 12 females, and age ranged from 4 months to 3 years (median 2 years). All patients underwent MRCP before operation, and 2 underwent operative cholangiography through the AHD. Results Seven patients with choledochal cyst and AHD were demonstrated by preoperative MRCP and intraoperative explora-tion. One patient was suspected by preoperative MRCP to have AHD which was confirmed by surgical explo-ration. Preoperative MRCP failed to diagnose, but operative exploration revealed AHD in 6 patients. Anasto-mosis of the AHD to jejunum was performed laparoscopically in 8 patients and by open surgery in 1 patient. Six patients had the common hepatic duct and the AHD joined together to create a common channel which was then implanted as a single duct into a Roux loop, Three patients had the common hepatic duct and the AHD anastomosed separately to a Roux loop. All the patients recovered well after operation and they were discharged home without any complication. A follow-up which ranged from 0. 5 to 5 years showed no jaundice, liver atrophy or liver abscess. Conclusions MRCP was important in the preoperative diagnosis of choledochal cyst with accessory hepatic duct in children. MRCP was difficult in diagnosing type Ⅱ accessory hepatic ducts. In suspected or undiagnosed cases of AHD, surgical exploration helped to improve the diagnostic accuracy, avoided injury and guided correct surgical decisions. Reconstruction of AHD required joining the AHD to the common hepatic duct, or as a separate duct to jejunal anastomosis to a Roux-y-loop.

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