Kim Soo-Hong, Cho Yong-Hoon, Kim Hae-Young
Department of Pediatric Surgery, Pusan National University Children's Hospital, Yangsan, Korea.
Pediatr Gastroenterol Hepatol Nutr. 2020 May;23(3):259-265. doi: 10.5223/pghn.2020.23.3.259. Epub 2020 May 8.
Perforation of choledochal cyst (CC) is a relatively rare clinical presentation in pediatric populations and difficult to predict preoperatively. We assess the clinical implications by comparing clinical parameters based on a single-center experience between perforated and nonperforated CC to facilitate the appropriate management for future interventions.
A total of 92 cases of CC in pediatric patients (aged <18 years) who received surgical management between January 2003 and December 2018 at a Pusan National University Children's Hospital were reviewed. After screening the clinical features of perforated cases, we compared the demographic findings, clinical characteristics, and some laboratory results between the perforated and nonperforated groups.
Perforated CC was identified in 8 patients (8.7%), and nonperforated CC in 84 patients (91.3%). Perforation can be classified into three categories: free perforation of cyst (3 cases), pinpoint perforation of cyst (2 cases), and necrotic change of cyst (3 cases). CC perforation occurred significantly more commonly in patients aged <24 months. Clinically, the perforated group showed significantly higher frequency of fever and higher C-reactive protein (CRP) level during the initial visit.
Perforation is more likely to be suspected in patients aged <24 months presenting together with fever and high CRP level in the initial visit. It is also necessary to keep in mind that it indicates not only a possibility of complicated disease status regardless of its association with stones but also a difficulty of applying a minimal invasive procedure and relatively increased length of hospital stay.
胆总管囊肿（CC）穿孔在儿科人群中是一种相对罕见的临床表现，术前难以预测。我们通过比较基于单中心经验的穿孔性和非穿孔性CC的临床参数来评估其临床意义，以便为未来的干预措施提供适当的管理依据。
回顾了2003年1月至2018年12月在釜山国立大学儿童医院接受手术治疗的92例年龄小于18岁的儿科胆总管囊肿患者。在筛选出穿孔病例的临床特征后，我们比较了穿孔组和非穿孔组之间的人口统计学结果、临床特征和一些实验室检查结果。
8例患者（8.7%）被诊断为穿孔性CC，84例患者（91.3%）为非穿孔性CC。穿孔可分为三类：囊肿游离穿孔（3例）、囊肿针尖样穿孔（2例）和囊肿坏死改变（3例）。CC穿孔在年龄小于24个月的患者中明显更常见。临床上，穿孔组在初次就诊时发热频率和C反应蛋白（CRP）水平明显更高。
对于初次就诊时年龄小于24个月且伴有发热和高CRP水平的患者，更有可能怀疑穿孔。还需要记住的是，这不仅表明无论是否与结石相关都存在疾病复杂状态的可能性，还意味着应用微创手术存在困难且住院时间相对延长。
