Experience in using needle-grasper assisted single-port laparoscopic hepaticojejunostomy to treat choledochal cysts in children / 中华肝胆外科杂志

Objective:To study the treatment efficacy and safety in using needle-grasper assisted single-port laparoscopic hepaticojejunostomy to treat choledochal cysts in children.Methods:The data of 41 patients with choledochal cysts treated at the Department of Pediatric Surgery, the First Affiliated Hospital of Xiamen University and the Second Hospital of Hebei Medical University from January 2018 to December 2021 were reviewed. There were 8 males and 33 females, aged (2.5±1.9) years. These patients were divided into the needle-grasper assisted single-port laparoscopic hepaticojejunostomy group (needle-grasper group, n=21) and the single-port laparoscopic hepaticojejunostomy group (control group, n=20). Operation time, intestinal function recovery time, gastric tube retention time, abdominal drain indwelling time, postoperative hospital stay, and perioperative complications were compared between the two groups. Results:All 21 children in the needle-grasper group underwent successful surgery without any need to convert to conventional laparoscopic or open surgery. The operation time (156.4±21.2) min was significantly shorter than the control group (218.3±28.6) min ( t=2.95, P=0.017). There were no significant differences in intestinal function recovery time, gastric tube retention time, abdominal drain indwelling time, postoperative hospital stay and perioperative complications between the two groups (all P>0.05). Parents were very satisfied with the cosmetic effect of the invisible scar after surgery. Conclusion:Needle-grasper assisted single-port laparoscopic hepaticojejunostomy was safe, reliable and the operation time was shorter than using a single-port to achieve minimally invasive and scarless surgery.

Bioinformatics analysis of differential expression genes and microRNA-messenger RNA regulatory network in biliary atresia / 中华实用儿科临床杂志

Objective:To mining differential expression genes (DEGs) and establish a regulatory network of dysregulated microRNAs (miRNAs) and messenger RNAs (mRNAs) in biliary atresia (BA) spectrum via bioinforma-tics analysis, and to explore the pathogenesis of BA.Methods:GSE46960 dataset was download from gene expression omnibus (GEO). DEGs between normal liver tissues and BA tissues were analyzed using the GEO2R analysis tool.The functional and pathway enrichment analyses of DEGs were performed utilizing the Database for Annotation, Visualization and Integrated Discovery (DAVID6.8). A protein-protein interaction (PPI) network was constructed using the PPI database (STRING11.0) and Cytoscape_v3.7.1 software, and thus key genes were analyzed.BA-related miRNAs were obtained using the human miRNA disease database (HMDD_V3.0) and target mRNAs were predicted by the miRNA target prediction database (miRDB). The intersection between the predicted target mRNAs and DEGs from the GSE46960 dataset was selected.The regulatory network of miRNA-mRNA was constructed using Cytoscape software.Results:A total of 565 DEGs, including 352 up-regulated ones and 213 down-regulated ones were identified.Among them, up-regulated DEGs were enriched in extracellular matrix(ECM)-receptor interaction, focal adhesion kinase (FAK), Amoebiasis, and the phosphoinositide 3 kinase/protein kinase B(PI3K/Akt) pathway.Down-regulated DEGs were enriched in metabolic signaling, biosynthesis of antibiotics and steroid biosynthesis pathway.From the PPI network, 10 key genes were screened out.A complex miRNA-mRNA regulatory network was constructed based on screened DEGs.Conclusions:Identified DEGs and miRNA-mRNA regulatory network constructed in this study may help clarify the molecular mechanisms of BA.This study provides a new direction to explore promising molecular targets for the diagnosis and treatment of BA.

Analysis on effect of single port laparoscopic traceless technology for child contralateral latent hernia / 重庆医学

Objective To explore the effect of single port laparoscopic traceless technology for child contralateral latent hernia.Methods Three hundred and twelve children cases of unilateral indirect inguinal hernia in Mianyang 404 Hospital from June 2013 to June 2016 were retrospectively analyzed.Among them,170 cases receivedsingle port laparoscopic traceless technology and 142 cases underwent common open surgery.The gender,age,recurrent rate,onset site of unilateral side,cases number of postoperative contralateral asynchrony hernia occurrence,cases number of contralateral vaginal process deformity found by laparoscopy and onset time of postoperative asynchrony hernia were compared between the two kinds of surgery.Results Among the 142 cases of common open surgery,male accounted for 97.8％ and female accounted for 2.2％,and the average age was (2.45±2.18) years old;the postoperative contralateral asynchrony hernia occurred in 5 cases (3.5％),in which 1 case (0.7％) was in the right side and 4 cases in the left side,the difference between them was statistically significant (x2 =5.30,P=0.01),the asynchrony hernia occurred in postoperative 8,14,18,20,24 months.Three cases (2.1 ％) had hernia relapse.The laparoscopic surgery had 170 cases,including 145 male cases (85.3％) and 25 female cases (14.7％),the average age was (2.44±2.15) years old.The intraoperation found 86 cases (50.6 ％) of latent hernia of contralateral vaginal process deformity,while the asynchrony inguinal indirect hernia was not found,1 case had the relapse in postoperative 18 months,the difference was statistically significant compared with the patients with open surgery (x2=10.12,P=0.01).Conclusion Single port laparoscopic surgery for treating child unilateral inguinal indirect hernia can accurately judge whether having contralateral latent hernia and simultaneously conducts the operation compared with the common open operation,its postoperative relapse rate and asynchrony hernia occurrence rate are significantly decreased.

Single-site intracorporeal purse-string stitching versus single-port extracorporeal knotting for laparoscopic inguinal inner ring closure in children: a comparative study / 中华普通外科杂志

Objective To compare the surgical and functional outcomes of single-site (transumbilical two-port) intracorporeal purse-suturing (IP) and single-port extracorporeal knotting (EK) for laparoscopic pediatric inguinal hernia (PIH) repair.Methods Between June 2008 and December 2014,358 PIH children underwent lapamscopic inguinal herniorrhaphy,including 126 treated by single-site intracorporeal purse string stitching using a needle-holder (IP group),and 232 by single-port extracorporeal knotting using an inner two-hook needle with preperitoneal hydrodissection (EK group).Results In all patients laparoscopic procedures were completed successfully without conversion.The operating time in IP group was significantly longer than that in EK group [unilateral:(20.4 ± 2.1) min vs.(9.4 ± 1.3) min,t=-5.23,P＜0.01;bilateral:(31.3 ±2.9) min vs.(15.2±1.7) min,t=-4.22,P＜0.01)].The hospital stay were similar between the two groups [(2.35 ±0.25) d vs.(2.38 ±0.18) d,t =-0.062,P ＞ 0.05].Five cases had intraoperative hematoma in the IP group while none in the EK group.One each suffered from recurrence in IP group and EK group.Three postoperative hydroceles were seen in IP group and one in EK group.Subcutaneous knot granulomas were seen in two in EK group.Conclusions Both IP and EK laparoscopic procedures are safe and feasible.With the assistance of preperitoneal hydrodissection technique,single-port laparoscopic EK herniorraphy is superior to single-site IP repair in easy performance and shorter operation time.

Efficacy Observation of Piperacillin/Tazobactam in the Treatment of Children with Congenital Megacolon Enteritis / 中国药师

Objective:To evaluate the curative effect and safety of piperacillin/tazobactam in the treatment of children with con-genital gegacolon enteritis. Methods:122 cases of congenital intestinal enteritis were randomly divided into two groups. The 72 pa-tients in the treatment group were treated with piperacillin/tazobactam sodium, and the 50 patients in the control group were treated with cefoperazone/sulbactam. The course of treatment was 714 days. The differences in C-reactive proteins, bolld leukocytes count and neutrophilic granulocyte percentage before and after the treatment, and the average treatment time in both groups were compared, and the efficacy and bacterial clearance were evaluated. Results:Between the treatment group and the control group, the differences in C-reactive protein, blood leukocytes count and neutrophilic granulocyte precentage before and after the treatment had no statistical signifi-cance(P>0. 05). The effective rete of the treatment group was 86. 11%,and that of the control group was 88%(P>0. 05). The pos-itive detection rate of pathogenic bacteria was 75. 41%, in which Escherichia coli was the first pathogenic bacteria. The bacterial clear-ance in the treatment group was 85. 96%, which was higher than that (80%) in the control group(P>0. 05). Conclusion:The effi-cacy of piperacillin/tazobactam in the treatment of children with congenital megacolon enteritis is more obvious with promising safety.

Research progress of minimally invasive surgery for congenital diaphragmatic hernia / 中华实用儿科临床杂志

Congenital diaphragmatic hernia(CDH) is characterized by a spectrum developmental defects in the diaphragm caused by embryogenesis disorders,and lead to incomplete fusion of elements which results in rise of the diaphragm.With the promotion of antenatal diagnosis,postoperation rehabilitation and neonatal intensive care unite,the mortality of CDH has been remarkably decreased.Nevertheless,the condition is uncommon enough that it has proven to be difficult to conduct prospective studies,leading to the lack of evidence of evidence-based medicine to explore the pathological mechanism and therapies.With the rise of endoscopic technique,the laparoscopy and thoracoscopy are also gradually carried out for the surgical management of CDH.Now,the minimally invasive surgery for CDH was reviewed.

Influence and clinical significance of chemotherapy on angiogenesis in pediatric difficult removal solid tumor / 中华实用儿科临床杂志

Objective To explore the influence and clinical significance of chemotherapy on the expressions of micro-vessel density (MVD) and vascular endothelial growth factor (VEGF) in pediatric difficult removal solid tumor.Methods From Jan.2002 to Jan.2012,totally 80 cases of the hospitalized pediatric patients with solid tumor (Ⅲ b-Ⅳb stage) were enrolled in this study in Department of Pediatric Surgery of the Second Hospital of Hebei Medical University.All of the tumors were identified as difficult removal malignant tumor by imageology and physical examinations.After biopsy of the tumors,these patients were divided into neuroblastoma group (25 cases),hepatoblastoma group (25cases) and Wilms' tumor group (30 cases).All patients in these 3 groups underwent chemotherapy respectively according to their different pathologic findings,thereafter,the tumor resections were performed.The resection rates of tumor in each groups were recorded and the expressions of MVD and VEGF between preoperative biopsy and postoperative specimens were detected and compared by immunohistochemistry in different groups.Results With chemotherapy,the resection rate of neuroblastoma was 80.00％ (20/25 cases),hepatoblastoma was 92.00％ (23/25 cases) and Wilms' tumor was 96.67％ (29/30 cases).There was no significant difference among them (x2 =4.286,P =0.117).Before chemotherapy,the positive expressions of VEGF in neuroblastoma,hepatoblastoma and Wilms' tumor were 80.00％ (20/25 cases),90.00％ (18/20 cases) and 83.33％ (25/30 cases) respectively,at the same time,the values of MVD were 48.39 ± 15.87,52.16 ± 16.12 and 46.82 ± 19.07.After chemotherapy,the expressions of VEGF and MVD in neuroblastoma,hepatoblastoma and Wilms' tumor were 52.00％ (13/25 cases),45.00％ (9/20 cases),30.00％ (9/30 cases) and 31.31 ± 14.21,25.19 ± 15.31 and 29.06 ± 13.05.Compared with the expressions of them in each group before chemotherapy,significant differences were found (all P ＜ 0.05).Conclusions Chemotherapy can efficiently promote the resection rate for pediatric difficult removal solid tumor.MVD and VEGF can be considered as the markers in evaluating the outcomes of chemotherapy and promoting the resection rate of tumors.

Research advances on the pathogenesis of congenital biliary atresia / 中华肝胆外科杂志

Biliary atresia is the most common obstructive cholangiopathy in infants.Its etiology and pathogenesis still remains unclear.Hypothetical mechanisms include genetic predisposition,viral infection,chronic inflammation or autoimmune-mediated bile duct injury,and congenital malformations of vessels or biliary tracts.The key pathogenesis is related to viral infection and immunoreaction.This review overviewed the research progress in the pathogenesis of biliary atresia in the past few years.

Laparoscopic-assisted transanal Soave pull-through procedure for Hirschsprung's disease and allied disorders / 中华普通外科杂志

ObjectiveTo explore the feasibility and outcomes of natural orifice transanal laparoscopic Soave procedure for Hirschsprung's disease and allied disorders (HAD).MethodsFrom March 2010 to December 2011,31 cases (at the age from 3 mos to 6 yrs) with Hirschsprung's disease or allied disorders (5 cases)underwent laparoscopic-assisted Soave pull-through procedure at two tertiary hospitals.We modified this technique by mobilizing the left hemicolon or whole colon via rectal muscular sleeve approach under transanal or transumbilical laparoscopic vision,then endorectal pull-through to completearectosigmoidectomyorsubtotalcolectomy. ResultsAllprocedureswerecompleted successfully.A rectosigmoidectomy was performed in 16 cases with classic HD and subtotal colectomy in 15 cases with extended HD and HAD.The average operative time was ( 117 ± 13) min.The length of the resected segment was 35 -80 cm,and the estimated blood loss was 5 -20 ml. One infant developed postoperative intestinal obstruction that required open exploration.Follow-up of one to 20 mos found no stoma stenosis or constipation recurrence. Enterocolitis developed in 1patient.ConclusionsTransanal or transumbilical laparoscopic-assisted Soave pull-through surgery is safe,effective and with a benefit of much less invasion and almost invisible scars.

Laparoscopic surgery for complex choledochal cysts / 中华普通外科杂志

Objective To summarize our experience of laparoscopic surgery for complex choledochal cysts (type Ⅳ-A). Methods The clinical data of 65 children of choledochal cyst undergoing laparoscopic choledochal cyst resection were retrospectively reviewed from 2002 to 2009 in our institute.Among those type Ⅳ-A cyst was found in 16 patients. Hepaticojejunostomy was performed using a Roux-en-Y jejunal loop after extrahepatic cyst excision and ductoplasty. Results Laparoscopic procedures were successfully performed in 16 patients with type Ⅳ-A cysts. The stenotic segment was splited or excised and a wide hepaticojejunostomy was completed at the porta hepatis in 8 patients with a stricture extending to the level of common hepatic duct. The constrictive confluence of the bilateral hepatic duct was incised and the bi-ductal cystojejunostomy was achieved at the bifurcation in 4 cases. A septum was found at the orifice of right hepatic duct and was excised through the hilar stoma in 2 cases. A downstream stricture of the left hepatic duct was incised from the hilum to the dilated segment along the lateral wall in 2 patients, so that a long intrahepatic cystojejunostomy was completed in an oblique course. Postoperative complications developed in 2 cases including temporary bile leakage in one case and anastomotic stricture in another. The intrahepatic cysts were remarkably reduced in size during the follow-up. Conclusions With the magnified laparoscopic view, the radical resection of extrahepatic cyst and correction of the intrahepatic bile ductal stenosis can be easily performed. Laparoscopic hepaticojejunostomy and/or intrahepatic cystojejunostomy is effective and safe for children with type Ⅳ-A choledochal cysts.

Splenic vessels thread ligature in laparoscopic splenectomy / 中华普通外科杂志

Objective To study the anatomy of splenic hilum blood vessels in order to thread ligature(endoligature)instead of using stapler during the process of laparoscopic splenectomy and to evaluate the prelimnary clinical results.Methods 41 children patients underwent laparoscopic splenectomy with this technique(endoligature)for various hematologic and autoimmune disorders,including 25 cases of hereditary spherocytosis,13 idiopathic thrombocytopenia purpura,and 3 hypersplenic granulocytopenia.The anatomy of splenic pedicle,the adjacent relation between splenic vessel and pancreas were detected by color Doppler ultrasonography preoperatively.The above-mentioned parameters were compared with that found intraoperatively.Results The relationships of splenic vessel and pancreas was of type Ⅰ in 24 cases and type Ⅱ in 17.In 31 cases,the major splenic blood vessels were ramified into branches 2 cm away from the hilum and in 10 it was within 2 cm as detected by preoperative ultrasonography.These characters were largerly identified by laparoscopic laparotomy,and in all the 41 cases laparoscopic splenectomy was successfully accomplished using this endoligature instead of vasculature stapler.There was no serious complication.The mean operating time was(114 ±31)min,the estimated blood loss was(51 ±23)ml.Conclusions Ultrasonography could identify the anatomic type of splenic vessel,and its relation with the pancreas.Endoligature in the management of splenic pedicles during laparoscopic splenectomy is safe and reliable.

Effectiveness of Laparoscopic Sutured Anastomosis of the Duodenum in Children / 中国微创外科杂志

Objective To evaluate the effectiveness of laparoscopic sutured anastomosis of the duodenum for children with congenital duodenal obstruction (CDO). Methods From February 2003 to July 2008,13 patients (aged 2 days to 12 years) with CDO underwent laparoscopic sutured anastomosis of the duodenum in our hospital. Among the cases,7 were newborns,3 were infants,and 3 were children. Laparoscopy showed duodenal atresia or stenosis in 7 cases,annular pancreas in 2 cases,superior mesenteric artery syndrome (SMAS) in 3 cases,and preduodenal portal vein in 1 case. Results Excepting the patient with preduodenal portal vein,who was converted to mini-laparotomy for duodenojejunostomy,all the cases were treated by laparoscopy. In 5 cases,the diaphragm was excised partially after a vertical incision was made at the anterior part of the duodenum,and then a transverse suture was completed; the 2 patients with duodenal atresia and the 2 with annular pancreas received diamond-shaped side-to-side duodenoduodenal anastomosis under a laparoscope; and the 3 cases of SMAS were treated by Roux-en-Y duodenojejunostomy. The mean operation time in this series was (97.0?18.2) min (range,75 to 180 min). No intraoperative complications occurred. The patients started oral intake in 2 to 5 days after the surgery,and resume a normal diet in 7 to 9 days. Before being discharged from the hospital,upper gastrointestinal tract imaging showed no evidence of obstruction in the patients.A follow-up up to 6 months to 4 years were available in 11 patients,among which 8 were followed for more than 1 year. During the period,the patient developed well. Conclusions The laparoscopic sutured anastomosis of the duodenum is feasible and effective for children. It can be performed in neonates securely as an excellent minimally invasive treatment for congenital duodenal obstruction.

Laparoscopic Rectopexy with Peritoneal Strips for Complete Rectal Prolapse in Children / 中国微创外科杂志

Objective To explore the feasibility and efficacy of laparoscopic rectopexy with peritoneal strips for severe complete rectal prolapse (SCRP) in children. Methods From August 2004 to October 2008,6 patients (aged 2 to 6 years with a mean of 3.5) with SCRP were treated in our hospital. The clinical data of the patients were reviewed. Under the laparoscope,two L-shaped peritoneal strips with the pedicle were cut from the incrassated and slack peritoneum of the pelvic cavity on bilateral sites of the rectum,and then were folded and sutured with the lateral wall of the free rectum with the ends being stitched on the fascia in front of the sacral promontory to suspend the rectum. Afterwards,the incisal margin of the peritoneum was sutured together with the anterior wall of the rectum in order to embed the peritoneal strips and reconstruct the pelvic peritoneum. Results All of the 6 cases of laparoscopy were completed successfully with a mean operation time of (120?24) min (ranged from 95 to 210 min). The blood loss was less than 10 ml in all of the cases. The patients received a mean of 28-month follow-up (range,6 to 54 months),during the period,none of them had recurrence or abnormal bowel movement. Conclusions Laparoscopic rectopexy with peritoneal strips is an effective and satisfactory treatment for SCRP with minimal invasion,quick recovery and a low-recurrence rate.

Effects of Laparoscopic and Open Appendectomy on Humoral Immunity and Protein Metabolism in Children / 中国微创外科杂志

0.05).Compared to OA group,the patients in the LA group had shorters periods of absolute diet and hospital stay(P=0.000,P=0.000).Conclusions LA has less influence on the humoral immunity and protein metabolism in children.Meanwhile the procedure is minimally invasive,patients recover quickly and are discharged earlier after the operation.

Laparoscopic sutured gastrojejunostomy without using stapling devices in children / 中国微创外科杂志

Objective To explore the method, safety, and efficacy of laparoscopic intracorporeal sutured gastrojejunostomy.Methods Three children with gastric outlet obstruction underwent laparoscopic sutured gastrojejunostomy from May to September 2005. Of them, two patients with pyloric stenosis secondary to peptic ulceration received a concomitant highly selective vagotomy. A suitable segment of jejunum was lifted over the transverse colon and apposed to the gastric antrum. A continuous 4/0 suture was conducted at the seromuscular layer making the two organs together. Then the stomach and adjacent jejunum were incised with an ultrasonic scalpel. A side-to-side gastrojejunostomy was performed with full-thickness continuous suture of gastric and jejunal wall followed by anterior interrupted suture of seromuscular layers. Results All the intracorporeal sutured gastrojejunostomies were completed successfully under laparoscope. The operating time was 135, 150, and 180 min, respectively. The postoperative hospital stay was 6 d. There was no surgical complications. Postoperative follow-up at 8, 10, and 12 months, respectively, showed that all patients had normal diet and nutriture. Conclusions Laparoscopic sutured gastrojejunostomy is a safe and feasible technique, with advantages of minimal invasion, rapid recovery, and good cosmetic outcomes.

Laparoscopic resection of massive splenomegaly for hereditary spherocytosis in children: Report of 7 cases / 中国微创外科杂志

Objective To explore the feasibility and t he efficacy of laparoscopic splenectomy of massive splenomegaly in the treatment o f hereditary spherocytosis in children. Methods Seven children with massive splenomegaly underwent laparoscopic splenectomy. Their age ranged 1~14 years (mean, 8.8 years), and their body weight was 10~57 kg (mean, 33.8 kg) . Three children had an accompanying cholelithiasis: 2 of them received a concom itant cholecystectomy and 1 of them, cholecystotomy. Results A ll the operations were successfully performed under laparoscope, and hand-assist ed splenectomy through a small incision was applied in 1 child because of bleedi ng of the splenic vein. The duration of operation was 50~150 min (mean, 90 min), the intraoperative blood loss was 30~500 ml (mean, 117 ml), and the length of h ospitalization, 4~10 d (mean, 5.5 d). The red blood cell counts had significantl y increased 3 days following the operation (t=2.652, P

Laparoscopic Ladd’s procedure for intestinal malrotation in children / 中国微创外科杂志

Objective To explore the feasibility of laparoscopic Ladd’s procedure and its indications for intestinal malrotation accompanying midgut volvulus. Methods Laparoscopic Ladd’s procedure was performed in 15 children from July 2002 to March 2006. The procedure was performed using three trocars. Under laparoscopic visualization, the midgut volvulus was untwisted by grasping and pulling the intestine, the Ladd’s band was divided and broadened, the duodenum and the small intestine were mobilized, and finally an appendectomy was performed through an abdominal wall port. Results Laparoscopic Ladd’s procedure was completed successfully in the 15 children. Of them, 1 patient with duodenal web, 1 patient with paraduodenal hernia, and 1 patient with ectopic pancreas also had a concomitant procedure. The operative time was 45~150 min (mean, 75 min). The patients began to take food on 1~3 postoperative day. There was no surgical complications. The length of postoperative hospital stay ranged 4~6 days (mean, 5 days). Follow-up observations in 12 patients for 1~42 months (mean, 21 months) showed normal development and free of symptoms.Conclusions Laparoscopic Ladd’s procedure is a safe and effective technique. It can be performed in neonates and applicable subacute midgut volvulus, but may be unadvisable for acute volvulus with abdominal distention.

Laparoscopic massive splenectomy combined with selective pericardial devascularization using endoligature technique / 中国微创外科杂志

Objective To summarize the experience of laparoscopic massive splenectomy combined with selective pericardial devascularization using endoligature technique. Methods By using silk ligature and hamonic scapel or the LigaSure, 6 patients with portal hypertension and esophagogastric varices underwent laparoscopic massive splenectomy and selective pericardial devascularization. Results All the operations were completed successfully under laparoscope. The intraoperative blood loss was 80~200 ml (mean, 130 ml). None of the patients required blood transfusion or conversion to open procedure. The operation time was 150~210 min (mean, 190 min). There were no surgical complications. All the patients resumed to normal activities 5 days after operation. Follow-up observations for 3~10 months (mean, 8 months) revealed no recurrent variceal hemorrhage. Conclusions Laparoscopic massive splenectomy combined with selective pericardial devascularization using endoligature technique is a feasible, effective, safe, little hemorrhagic, and minimally invasive procedure for portal hypertension with esophagogastric varices.

Value of intraoperative cholangiopancreatography for radical resection of congenital choledochal cyst / 中国普通外科杂志

Objective To evaluate intraoperative cholangiopancreatography in understanding pathologic changes of congenital choledochal cyst(CCC) with anomalous junction of pancreaticobiliary duct(APBD) and for rational operative procedure. Methods Eighty-two CCC cases were examined by intraoperative cholangiopancreatography(ICP). The morphologies of the biliary tract and types of APBD were recorded. Results Of the 82 CCC cases there were 35 cases of Todani Ia,9 cases of Ib,28 cases of Ic and 10 cases of Ⅳ.APBD was diagnosed in 73 cases and classified according to Komi classification. Of them,37 cases were classified as type I of APBD (bile duct drains into pancreatic duct),30 cases as type II (pancreatic duct drains into bile duct) and 6 cases as type III (complicated APBD with patent accessory pancreatic duct). Of the 44 cases with choledochal cystic dilatations,33 cases were of type I. Of the 29 biliary fusiform dilatations,21 were of type II. Of 21 patients with pancreatitis,17 were of type II (? 2=33.14,P