Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
J Laparoendosc Adv Surg Tech A. 2020 Nov;30(11):1237-1241. doi: 10.1089/lap.2020.0433. Epub 2020 Jul 23.
The aim of this study was to compare the characteristics and the outcome between infants and young children with antenatally (AN) and postnatally (PN) detected choledochal cyst (CC) in a laparoscopic surgery center. A retrospective review was conducted for all children who underwent excision of CC and hepaticojejunostomy (HJ) before 36 months of age between October 2004 and October 2019. Thirty-nine children (28 girls and 11 boys) were included in this study. Twenty-one children had AN detected CC and 18 had PN detected CC. The median age at operation (AN vs. PN; 3 months vs. 15.5 months, < .001) and body weight (AN vs. PN; 5.6 kg vs. 10.5 kg, < .001) were significantly different between the two groups. Children in PN group has an increased risk of being symptomatic (AN vs. PN; 6 vs. 18, < .001) and having intervention before operation (AN vs. PN; 0 vs. 4, = .037). Laparoscopic excision was performed in all children in AN group and in 12 children (66.7%) in PN group ( = .006). Conversion to open HJ was performed in 4 children in AN group but none in PN group ( = .146). There was no statistical differences in success in laparoscopic operation ( = .257), median operative time ( = .094), postoperative complication ( = .576), and median length of hospital stay ( = .749). Despite younger age at operation, the outcome of laparoscopic excision of AN detected CC was comparable with PN detected CC. Earlier detection and operation decreased the risk of preoperative intervention.
本研究旨在比较腹腔镜手术中心中产前（AN）和产后（PN）发现的胆总管囊肿（CC）患儿的特征和结局。对 2004 年 10 月至 2019 年 10 月期间，36 个月龄以下行 CC 切除术和肝肠吻合术（HJ）的所有患儿进行回顾性分析。本研究共纳入 39 例患儿（28 名女孩和 11 名男孩）。21 例患儿为产前发现 CC，18 例为产后发现 CC。两组患儿的手术年龄（AN 与 PN：3 个月与 15.5 个月，<0.001）和体重（AN 与 PN：5.6kg 与 10.5kg，<0.001）差异有统计学意义。PN 组患儿出现症状的风险增加（AN 与 PN：6 与 18，<0.001），且术前干预的风险增加（AN 与 PN：0 与 4，=0.037）。AN 组患儿均行腹腔镜切除，PN 组患儿中 12 例行腹腔镜切除（66.7%，=0.006）。AN 组中有 4 例行腹腔镜转为开腹 HJ，而 PN 组中无患儿行此术式（=0.146）。腹腔镜手术成功率（=0.257）、手术时间中位数（=0.094）、术后并发症（=0.576）和住院时间中位数（=0.749）无统计学差异。尽管 AN 组患儿手术年龄较小，但腹腔镜切除 AN 型 CC 的效果与 PN 型 CC 相似。早期发现和手术可降低术前干预的风险。
