Sun Bin, Yu DongHai, Chen Ji, Tang YongHui, Wu Han
Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
Department of Gastroenterology, Nanjing Drum Tower Hospital, Nanjing, 210008, China.
Pediatr Surg Int. 2018 Aug;34(8):897-901. doi: 10.1007/s00383-018-4296-3. Epub 2018 Jun 5.
Congenital biliary dilatation (CBD) is usually associated with complications such as recurrent cholangitis, manifested as abdominal pain, vomiting, and jaundice. If cholangitis cannot be controlled by conservative treatment, a good therapeutic effect can be obtained through percutaneous biliary drainage or open T-tube drainage. We aimed to evaluate our experiences in biliary drainage through endoscopic retrograde cholangiopancreatography in children with cholangitis caused by CBD. From January 2014 to December 2017, 167 children with CBD were treated in our hospital. 17 patients (10.18%) with serious cholangitis caused by CBD underwent ERCP. There were 4 males and 13 females with an age range of 10-120 months (average 56.4 months). Placement of a biliary stent was attempted for biliary drainage through endoscopic retrograde cholangiopancreatography. Of the 17 patients studied, 13 children had jaundice and 15 had elevated aminotransferases. ERCP showed CBD in all patients and a common biliopancreatic duct in 12 of 17 patients (70.6%). Five patients underwent nasobiliary drainage and 12 patients underwent biliary drainage through double pigtail tubes. All patients achieved successful biliary drainage. Postoperative pancreatitis occurred in one patient. Biochemical indicators decreased significantly in 12 patients (70.6%) on the second postoperative day. The average length of hospital stay after surgery was 4.5 (range 3-7) days. No major complications related to ERCP were observed and all children had a good prognosis so far. Endoscopic biliary drainage is a safe, simple, and reliable technique. It can be used to resolve CBD-associated cholangitis, evaluate the biliary tract and pancreatobiliary duct junction, and guide pediatric surgeons to choose the right time and the correct procedure for CBD.
先天性胆管扩张症（CBD）通常伴有诸如复发性胆管炎等并发症，表现为腹痛、呕吐和黄疸。如果胆管炎无法通过保守治疗得到控制，经皮胆道引流或开腹T管引流可取得良好的治疗效果。我们旨在评估经内镜逆行胰胆管造影术对CBD所致胆管炎患儿进行胆道引流的经验。2014年1月至2017年12月，我院共治疗167例CBD患儿。17例（10.18%）由CBD引起的严重胆管炎患儿接受了ERCP治疗。其中男性4例，女性13例，年龄范围为10 - 120个月（平均56.4个月）。尝试通过经内镜逆行胰胆管造影术放置胆管支架进行胆道引流。在研究的17例患者中，13例患儿有黄疸，15例转氨酶升高。ERCP显示所有患者均有CBD，17例患者中有12例（70.6%）存在胆胰管合流异常。5例患者接受了鼻胆管引流，12例患者通过双猪尾管进行了胆道引流。所有患者均成功实现胆道引流。1例患者发生术后胰腺炎。12例患者（70.6%）术后第二天生化指标显著下降。术后平均住院时间为4.5天（范围3 - 7天）。未观察到与ERCP相关的严重并发症，所有患儿目前预后良好。内镜下胆道引流是一种安全、简单且可靠的技术。它可用于解决与CBD相关的胆管炎，评估胆道及胆胰管汇合处，并指导小儿外科医生为CBD选择合适的时机和正确的手术方式。
