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,2026,(03):232-237.[doi:10.3760/cma.j.cn101785-202510011]
产前识别的胆总管囊肿临床症状危险因素分析与手术时机探讨
- Title:
- 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
- 摘要:
- 目的 分析产前识别的先天性胆总管囊肿(congenital choledochal cyst,CDC)患儿出现临床症状的危险因素,并探讨其手术时机。方法 回顾性分析2018年1月至2025年5月于福建省儿童医院接受手术治疗的病例资料,纳入标准为产前彩超提示CDC、术后病理确诊且手术年龄＜12个月,排除分期手术及合并其他严重结构畸形的病例,最终纳入44例患儿。根据术前是否出现临床症状(呕吐、黄疸、排陶土样便等)分为症状组(15例)和非症状组(29例),比较两组临床资料及术后结局;非症状组进一步按手术时机分为早期手术组(≤3个月,19例)和晚期手术组(＞3个月,10例),分析两组术前肝功能及术后结局差异。采用受试者操作特征曲线评估囊肿大小对临床症状的预测价值。结果 单因素分析显示,症状组诊断胎龄[22(20,26)周]早于非症状组[24(24,32)周](P=0.016),Todani Ⅳ型囊肿占比(4/15)高于非症状组(1/29)(P=0.039),术前γ-谷氨酰转肽酶、直接胆红素水平及囊肿最大长径[57(42,77)mm比34(29,42)mm]、最大宽径[48(23,54)mm比22(18,34)mm]均显著大于非症状组(P＜0.05)。症状组术后住院时间[11(10,18)d]长于非症状组[8(7,9.5)d](P=0.003),但两组手术时间、术后并发症发生率差异无统计学意义(P＞0.05)。非症状组中,早期手术组与晚期手术组的术前肝功能指标、手术时间、术后住院时间及并发症发生率差异均无统计学意义(P＞0.05)。动态监测显示,两组囊肿大小均呈增长趋势,且症状组囊肿长径、宽径增长速度均快于非症状组。术前囊肿长径预测临床症状的曲线下面积为0.789,最佳截断值44 mm,灵敏度73%,特异度79%;囊肿宽径曲线下面积为0.783,最佳截断值36 mm,灵敏度73%,特异度81%。结论 产前诊断胎龄早、Todani Ⅳ型囊肿是CDC患儿生后出现临床症状的危险因素;囊肿动态增长速度及大小阈值(长径＞44 mm、宽径＞36 mm)可作为临床症状的预测指标,建议据此采取个体化评估策略,对符合指征者尽早手术干预。
- 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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备注/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