Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China.
J Pediatr Surg. 2013 Oct;48(10):2061-6. doi: 10.1016/j.jpedsurg.2013.05.022.
The treatment of type IV-A choledochal cyst is particularly difficult and remains a challenge because of the rareness and the various presentations of the disease involving not only the extrahepatic but also the intrahepatic biliary tract. The purpose of this study is to analyze our clinical experience for surgical treatment of type IV-A choledochal cyst, and compare between children and adults.
During a 10-year period of time (2000-2010), clinical data of 81 consecutive patients with type IV-A choledochal cyst were retrospectively analyzed. We divided these patients into two groups, the child group (age ≤ 18 years) and the adult group (age >18 years). According to whether the patient received additional liver resection, patients were divided into a extrahepatic cystectomy (EHC) group and an additional liver resection (LR) group. The long-term outcomes after surgery were evaluated in two groups.
Of all 81 patients, there were 17 children and 64 adults; 16 children and 35 adults belonged to EHC group, one child and 29 adults belonged to LR group. The morbidity of biliary stricture and/or lithiasis in the adults was significantly higher than that in the children (p = 0.041 < 0.05). In the EHC group, the reoperation rate of adults was significantly higher than that of children (p = 0.019 < 0.05). For adult patients, the morbidity of biliary stricture and/or lithiasis and the reoperation rate in EHC group was significantly higher than that in LR group (p = 0.037 < 0.05 and p = 0.026 < 0.05 respectively). Five adults were found to have cholangiocarcinoma within a follow-up period, while no child was found to. However, for adult patients, no significant discrepancy was observed between EHC group and LR group (p = 0.366 > 0.05).
The present study suggests that the children have better outcomes than adults for patients with type IV-A choledochal cyst after EHC, while LR brings better outcomes than EHC for adult patients.
IV-A 型胆总管囊肿的治疗特别困难，仍然是一个挑战，因为该病不仅涉及肝外胆管，还涉及肝内胆管，而且其表现多种多样，较为罕见。本研究旨在分析我们对 IV-A 型胆总管囊肿的外科治疗经验，并比较儿童和成人之间的差异。
在 10 年期间（2000-2010 年），回顾性分析了 81 例 IV-A 型胆总管囊肿连续患者的临床资料。我们将这些患者分为两组，即儿童组（年龄≤18 岁）和成人组（年龄>18 岁）。根据患者是否接受额外的肝切除术，将患者分为肝外囊肿切除术（EHC）组和额外肝切除术（LR）组。评估两组患者的术后长期疗效。
81 例患者中，有 17 例为儿童，64 例为成人；EHC 组中，有 16 例儿童和 35 例成人，LR 组中，有 1 例儿童和 29 例成人。成人的胆管狭窄和/或结石发病率明显高于儿童（p = 0.041 < 0.05）。在 EHC 组中，成人的再次手术率明显高于儿童（p = 0.019 < 0.05）。对于成人患者，EHC 组的胆管狭窄和/或结石发病率以及再次手术率明显高于 LR 组（p = 0.037 < 0.05 和 p = 0.026 < 0.05）。5 例成人在随访期间被发现患有胆管癌，而儿童中没有发现。然而，对于成人患者，EHC 组和 LR 组之间没有显著差异（p = 0.366 > 0.05）。
本研究表明，对于 IV-A 型胆总管囊肿患者，EHC 后儿童的疗效优于成人，而 LR 对成人患者的疗效优于 EHC。
