Department of Neonatal Surgery, Xian Childrens Hospital, Xian, Shaanxi, China.
Department of General Surgery, Capital Institute of Pediatrics, Beijing, China.
Pediatr Surg Int. 2021 Jun;37(6):731-736. doi: 10.1007/s00383-021-04886-2. Epub 2021 Apr 19.
With the advent of ultrasonography (US), perinatal diagnosis of biliary cystic malformation (BCM) has become more prevalent. BCM includes cystic biliary atresia (CBA) and choledochal cyst (CC). Both share similar ultrasonographic features and clinical manifestations, and yet the postnatal management is very different. This study was to assess whether CBA can be distinguished from CC by US.
We retrospectively studied the clinical data of 98 BCM patients aged less than 130 days between January 2013 and November 2015. The patients were divided into the CBA group and the CC group based on intraoperative cholangiography. The ultrasonographic features in each group were then analyzed.
Thirty-one children had CBA (type I: 24, type III: 7) and 67 children had CC (all: type I). The cyst volume did not show a significant change in the CBA group while the cyst volume increased postnatally in the CC group. Preoperative cyst volume can be used as a sensitive indicator to distinguish choledochal cyst from cystic biliary atresia. Gallbladder size in the two groups differed significantly (P = 0.034); 23 of 31 patients in the CBA group had atrophic gallbladder, whereas none of the patients in the CC group had atrophic gallbladder (P < 0.001). The triangular cord sign was detected in ten patients in the CBA group and in none of the patients in the CC group (P < 0.001).
Serial prenatal and postnatal ultrasonographic studies may help differentiate CBA from CC in the majority of BCM, facilitating prenatal counseling and postnatal management.
随着超声检查（US）的出现，胆系囊性畸形（BCM）的围产期诊断变得更为普遍。BCM 包括囊性胆管闭锁（CBA）和胆总管囊肿（CC）。两者具有相似的超声表现和临床表现，但出生后的管理却大不相同。本研究旨在评估 US 是否可用于区分 CBA 和 CC。
我们回顾性研究了 2013 年 1 月至 2015 年 11 月期间年龄小于 130 天的 98 例 BCM 患者的临床资料。根据术中胆管造影将患者分为 CBA 组和 CC 组。然后分析每组的超声特征。
31 例患儿为 CBA（I 型：24 例，III 型：7 例），67 例患儿为 CC（均为 I 型）。CBA 组囊肿体积无明显变化，CC 组囊肿体积在出生后增加。术前囊肿体积可作为敏感指标用于区分胆总管囊肿和囊性胆管闭锁。两组胆囊大小差异有统计学意义（P = 0.034）；CBA 组 31 例患儿中有 23 例胆囊萎缩，而 CC 组患儿均无胆囊萎缩（P < 0.001）。CBA 组 10 例患儿检测到三角索带征，而 CC 组患儿均未检测到（P < 0.001）。
产前和产后的系列超声研究可能有助于在大多数 BCM 中区分 CBA 和 CC，从而为产前咨询和产后管理提供便利。
