Liu Denghui,Xiao Xiaoyi,Liu Yuanzhuo,et al.Diagnosis and treatment of choledochal cysts complicated with complications in children[J].Journal of Clinical Pediatric Surgery,2026,(03):220-226.[doi:10.3760/cma.j.cn101785-20251120-00071]
术前伴并发症的儿童胆总管囊肿临床诊治分析
- Title:
- Diagnosis and treatment of choledochal cysts complicated with complications in children
- Keywords:
- Child; Choledochal Cysts; Complication; Diagnosis; Treatment
- 摘要:
- 目的 总结术前伴并发症的儿童胆总管囊肿(choledochal cyst,CDCs)临床特点及诊治经验。方法 本研究为回顾性病例系列研究,收集湖南省儿童医院普外科2015年1月至2024年12月收治的176例术前伴并发症的CDCs患儿临床资料。男40例,女136例;发病年龄2个月15天至9岁,中位发病年龄4岁8个月。并发症类型:胆道穿孔37例、胆源性胰腺炎53例、胆管炎+梗阻性黄疸+肝功能受损86例。对上述患儿的临床特点及诊治经验进行总结分析。结果 37例胆道穿孔患儿中,31例并发胆汁性腹膜炎,一期行胆道外引流术,2~3个月后二期行胆总管囊肿根治术(胆囊+胆总管囊肿切除术+肝管-空肠Roux-en-Y吻合术);6例为隐匿性胆道穿孔,一期行胆总管囊肿根治术。53例胆源性胰腺炎患儿,术前予抗感染、降酶、抑酸治疗或内镜下鼻胆管引流,待淀粉酶接近正常后行一期胆总管囊肿根治术。86例合并胆管炎、梗阻性黄疸及肝功能受损的患儿,术前予消炎、利胆、减黄治疗,或经内镜逆行胰胆管造影放置鼻胆管引流;待黄疸减退、转氨酶接近正常后,58例行一期胆总管囊肿根治术,23例行一期胆道外引流+二期根治术,5例因内镜下逆行胰胆管造影术失败而改行外引流术,后再行二期根治术。所有接受胆管外引流的患儿中,7例出现水电解质紊乱,4例后期发生T管脱落,经积极治疗均于2~3个月后行根治性手术。患儿术后随访15~41个月,中位随访时间22个月。术后9例有反复胆管炎发作史,4例有慢性胰腺炎史,均经保守治疗缓解;12例术后并发肠梗阻,其中4例接受外科手术治疗。结论 对术前伴并发症的CDCs患儿需早期识别与诊断,根据患儿具体病情及全身状况选择合理的处理手段和手术方式,可有效减少术后并发症的发生。
- Abstract:
- Objective To summarize the clinical characteristics,diagnostic and therapeutic experience of choledochal cysts (CDCs) with complications in children.Methods For this retrospective case series study,the relevant clinical data were reviewed for 176 children withfrom January 2015 to December 2024.There were 40 boys and 136 girls with an age range of 2 months and 15 days to 9 years and a median age of 4 years and8months.The complications included biliary perforation (BP,n=37),biliary pancreatitis (n=53) and cholangitis with obstructive jaundice and liver dysfunction (n=86).The major clinical manifestations were abdominal pain,fever,vomiting and scleral icterus.Most of them had two or more clinical manifestations or complications.Results Among 37 BP children,31 cases with biliary peritonitis underwent one-stage external biliary drainage.It was followed by two-stage radical resection of choledochal cyst (cholecystectomy+choledochal cyst resection+Roux-en-Y hepaticojejunostomy) at Month (2-3).Six cases of occult BP underwent one-stage radical resection of choledochal cyst directly.For 53 children with biliary pancreatitis,preoperative measures included anti-infection,enzyme reduction,acid suppression and endoscopic nasobiliary drainage.One-stage radical resection of choledochal cyst was performed after amylase returned to near normal.For 86 children with cholangitis with obstructive jaundice and liver dysfunction,preoperative interventions were anti-inflammation,cholagogues,jaundice reduction and nasobiliary drainage via Endoscopic retrograde cholangiopancreatography (ERCP) were performed.After jaundice subsided and transaminase returned to near normal,one-stage radical resection of choledochal cyst (n=58) and one-stage external biliary drainage + staged radical surgery (n=5).In 5 children,external drainage was followed by two-stage radical surgery due to failed endoscopic retrograde cholangiopancreatography (ERCP).Among those with external biliary drainage,there were electrolyte disturbances (n=7) and T-tube dislodgment in later period (n=4).Radical surgery was performed at Month 2-3 after active interventions.The postoperative follow-up period was 15 to 41 months with a median follow-up time of 22 months.Nine children had a history of recurrent cholangitis after surgery and 4 had a history of chronic pancreatitis after surgery.All of them were relieved by conservative measures.And 4/12 children were operated due to postoperative intestinal obstruction.Conclusions Early identification and precise diagnosis are necessary for children with CDCs complicated with preoperative complications.Selecting appropriate treatments and surgical approaches based upon specific conditions and general profiles of children may effectively lower the occurrence of postoperative complications.
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备注/Memo
收稿日期:2025-11-20。
基金项目:湖南省省级科技计划资助(2020SK50501,2023JJ30323)
通讯作者:李勇,Email:liyongpuwaike@163.com