Honda Masaki, Shimojima Naoki, Maeda Yutaro, Ito Yoshifumi, Miyaguni Kazuaki, Tsukizaki Ayano, Abe Kiyotomo, Hashimoto Makoto, Ishikawa Miki, Tomita Hirofumi, Shimotakahara Akihiro, Hirobe Seiichi
Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan.
Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
Pediatr Surg Int. 2023 Jan 11;39(1):79. doi: 10.1007/s00383-023-05363-8.
The effects of disease classification and the patient's preoperative condition on the difficulty of performing a laparotomy for pediatric congenital biliary dilatation (CBD) have not been fully elucidated.
The present study retrospectively analyzed 46 pediatric CBD laparotomies performed at the study center between March 2010 and December 2021 and predictors of operative time. The patients were separated into a short operative time group (SOT) (≤ 360 min, n = 27) and a long operative time group (LOT) (> 360 min, n = 19).
The preoperative AST and ALT values were higher, and the bile duct anastomosis diameter was larger, in the LOT. Correlation analysis demonstrated that the maximum cyst diameter, preoperative neutrophil-to-lymphocyte ratio, AST, ALT, AMY, and bile duct anastomosis diameter correlated positively with operative time. Multivariate analysis identified the maximal cyst diameter, preoperative AST, and bile duct anastomosis diameter as significant factors affecting surgical time. Postoperatively, intrapancreatic stones and paralytic ileus were observed in one patient each in the SOT, and mild bile leakage was observed in one patient in the LOT.
The maximum cyst diameter, preoperative AST, and bile duct anastomosis diameter have the potential to predict the difficulty of performing a pediatric CBD laparotomy.
疾病分类和患者术前状况对小儿先天性胆管扩张症（CBD）剖腹手术难度的影响尚未完全阐明。
本研究回顾性分析了2010年3月至2021年12月在研究中心进行的46例小儿CBD剖腹手术及手术时间的预测因素。将患者分为手术时间短组（SOT）（≤360分钟，n = 27）和手术时间长组（LOT）（> 360分钟，n = 19）。
LOT组术前AST和ALT值较高，胆管吻合口直径较大。相关性分析表明，最大囊肿直径、术前中性粒细胞与淋巴细胞比值、AST、ALT、AMY和胆管吻合口直径与手术时间呈正相关。多因素分析确定最大囊肿直径、术前AST和胆管吻合口直径是影响手术时间的重要因素。术后，SOT组有1例患者出现胰内结石和麻痹性肠梗阻，LOT组有1例患者出现轻度胆漏。
最大囊肿直径、术前AST和胆管吻合口直径有可能预测小儿CBD剖腹手术的难度。
