Zheng Weijun,Zhu Lanxin,Chen Fei,et al.Analysis of risk factors for clinical symptoms and exploration of surgical timing in prenatally identified congenital choledochal cysts[J].Journal of Clinical Pediatric Surgery,,():232-237.[doi:10.3760/cma.j.cn101785-202510011]
Analysis of risk factors for clinical symptoms and exploration of surgical timing in prenatally identified congenital choledochal cysts
- Keywords:
- Choledochal Cyst; Prenatal Diagnosis; Risk Factors; Surgical Procedures; Operative; Child
- Abstract:
- Objective To explore the risk factors for clinical symptoms in prenatally identified congenital choledochal cysts (CDC) and determine the optimal timing of surgical intervention.Methods A retrospective analysis was performed for the relevant clinical data of 44 CDC children operated from January 2018 to May 2025.Inclusion criteria: a) Prenatal ultrasonic hint of CDC; b) Confirmation by intraoperative cholangiography and postoperative pathology; c) Surgical age <12 months.Exclusion criteria: a) Staged surgery; b) Complicated with other severe structural malformations.Based upon the presence of preoperative clinical symptoms (vomiting,jaundice,clay-colored stools,etc.),they were assigned into two groups of symptomatic (n=15) and asymptomatic (n=29).The asymptomatic group was further subdivided into two sub-groups of early surgery (surgical age ≤3 months,n=19) and late surgery (surgical age ＞3 months,n=10).Clinical data and postoperative outcomes were compared between two groups.Preoperative liver function and postoperative outcomes were analyzed between early and late surgery subgroups.Receiver operating characteristic (ROC) curve was utilized for evaluating the predictive value of cyst size for clinical symptoms.Results Univariate analysis revealed that diagnostic gestational age was earlier in symptomatic group than that in asymptomatic group[22(20,26) vs.24(24,32) weeks](P=0.016).The proportion of Todani type Ⅳ cysts was higher in symptomatic group than that in asymptomatic group (4/15 vs.1/29) (P=0.039).Preoperative levels of gamma-glutamyl transpeptidase (GGT) and direct bilirubin (DBIL),as well as maximum cyst length[57(42,77) vs.34(29,42) mm]and width[48(23,54) vs.22(18,34) mm]in symptomatic group were significantly higher/larger than those in asymptomatic group (P<0.01 or P=0.002).Postoperative hospital stay was longer in symptomatic group than that in asymptomatic group[11(10,18) vs.8(7,9.5) day](P=0.003).However,no significant inter-group difference existed in operative duration or postoperative complication rate (P>0.05).Among asymptomatic children,no significant differences existed in preoperative liver function indices,operative duration,postoperative hospital stay or complication rates between early and late surgery groups (P>0.05).Dynamic monitoring revealed that cyst size spiked in both groups.And growth rates of cyst length and width were faster in symptomatic group than those in asymptomatic group.ROC curve analysis revealed that the area under the ROC curve (AUROC) of preoperative cyst length for predicting clinical symptoms was 0.789 with an optimal cut-off value of 44 mm (sensitivity 73%,specificity 79%).And AUROC of preoperative cyst width was 0.783 with an optimal cut-off value of 36mm (sensitivity 73%,specificity 81%). Conclusions Early prenatal diagnostic gestational age and Todani type IV cysts are risk factors for postnatal clinical symptoms in CDC children.Dynamic growth rate of cysts and size thresholds (length ＞44 mm,width ＞36 mm) may be employed as predictive indicators for clinical symptoms.Individualized evaluation strategy based upon these factors is recommended.Early surgical intervention should be considered for eligible individuals.
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Memo
收稿日期:2025-10-10。
基金项目:福建省医疗"创双高"(ETK2025009)
通讯作者:方一凡,Email:fyf0599@163.com