Qian Maning,Wang Jiawei,Sun Song,et al.Analysis of tratment effects and prognostic factors impacting children of pancreaticobiliary maljunction without obvious biliary dilatation under therapeutic endoscopic retrograde cholangiopancreatography[J].Journal of Clinical Pediatric Surgery,,():16-21.[doi:10.3760/cma.j.cn101785-202308003-004]
Analysis of tratment effects and prognostic factors impacting children of pancreaticobiliary maljunction without obvious biliary dilatation under therapeutic endoscopic retrograde cholangiopancreatography
- Keywords:
- Pancreaticobiliary Maljunction; Endoscopic Retrograde Cholangiopancreatography; Surgical Procedures; Operative; Child
- Abstract:
- Objective To explore the efficacy and risk factors of poor outcomes in children of pancreaticobiliary maljunction without obvious biliary dilatation (PBM-nonOBD) after duodenoscopy.Methods From January 2020 to December 2022,retrospective analysis was conducted 1-on children with PBM-nonOBD treated by duodenoscopy in Children’s Hospital of Fudan University.They were assigned into two groups of effective (n=24) and ineffective (n=20) treatment.Demographic profiles,clinical symptoms,laboratory tests and imaging studies were collected and the children were followed up.Univariate and multivariate Logistic regression analyses were performed for identifying the risk factors influencing the outcomes after endoscopy.Receiver operating characteristic (ROC) curve was plotted for evaluate the predictive value of the relevant risk factors.Results During an average follow-up period of (19.7±8.6) months,the effective rate was 54.5%(24/44).Post-endoscopic retrograde cholangiopancreatography pancreatitis was the most common postoperative adverse event (7/44,15.9%).Ultimately radical surgery (27.3%) and repeat endoscopy (15.9%) were required.No significant inter-group differences existed in such preoperative laboratory parameters as serum amylase,transaminases or bilirubin.B/D-type PBM subtype predominated in effective treatment group,accounting for 41.7%(10/24) and 37.5%(9/24) respectively.Univariate analysis indicated that younger age,longer common channel length and greater maximal diameter of common bile duct (CBD) were significant factors associated with poor outcomes after endoscopy (P<0.05).Multivariable Logistic regression analysis revealed that younger age (OR=1.645,95%CI:1.645-2.309) and longer common channel length (OR=0.720,95%CI:0.720-0.968) were independent factors associated with poor outcomes (P<0.05).Area under the ROC curve (AUC) was 0.838(95%CI:0.719~0.958) and 0.731(95%CI:0.567~0.894) and optimal cutoff values were 4.9 years and 8.8 mm respectively.Conclusions With minimal surgical trauma and no serious complications,duodenoscopy can effectively relieve symptoms in children of PBM-nonOBD.Young age and longer common channel length may be associated with poor postoperative outcomes after duodenoscopy.
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Memo
收稿日期:2023-8-1。
基金项目:国家自然科学基金面上项目(81873545); 上海市出生缺陷重点实验室开放基金项目(2022CSQX1005)
通讯作者:陈功,Email:chengongzlp@hotmail.com