Shirota Chiyoe, Hinoki Akinari, Tainaka Takahisa, Sumida Wataru, Makita Satoshi, Amano Hizuru, Takimoto Aitaro, Yasui Akihiro, Nakagawa Yoichi, Liu Jiahui, Guo Yaohui, Kato Daiki, Goda Yousuke, Maeda Takuya, Uchida Hiroo
Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Pediatr Surg. 2024 Mar;59(3):385-388. doi: 10.1016/j.jpedsurg.2023.10.045. Epub 2023 Oct 20.
This study aimed to develop a postnatal treatment strategy for infants with prenatally diagnosed congenital biliary dilatation.
We performed a retrospective study of patients with prenatal diagnosed congenital biliary dilatation (CBD), aged <1 year who underwent surgery at our hospital between 2013 and 2023. We classified the patients into two groups, the "early group," consisting of patients who could not wait for growth, and required early surgery, and the "scheduled group," consisting of patients who were asymptomatic and could undergo scheduled surgery, and compared them. The parameters for early surgical prediction were AST, ALT, TB, DB, and CRP levels at birth, 1 week, 2 weeks, 1 month, 2 months, and 3 months after birth, and immediately before surgery, as well as the cyst diameter, presence of intrahepatic bile duct dilation, and presence of debris in the common bile duct.
During the study period, 15 patients were diagnosed prenatally. The cyst diameter was significantly larger at all points in the early group. Patients with a cyst diameter of >30 mm at birth, intrahepatic bile duct dilatation at birth, and postnatal enlargement of the common bile duct to >30 mm are more likely to develop symptoms early. Blood biochemistry tests showed no significant differences between the two groups.
Patients with a cyst diameter >30 mm in the early postnatal period require careful postnatal management and parents should be counseled regarding the high likelihood of their child needing surgery within the first 3 months of life.
Level IV.
本研究旨在为产前诊断为先天性胆管扩张的婴儿制定出生后治疗策略。
我们对2013年至2023年期间在我院接受手术的年龄小于1岁的产前诊断为先天性胆管扩张（CBD）的患者进行了回顾性研究。我们将患者分为两组，“早期组”，包括那些不能等待生长而需要早期手术的患者，以及“计划组”，包括那些无症状且可接受计划手术的患者，并对两组进行比较。早期手术预测参数包括出生时、出生后1周、2周、1个月、2个月和3个月以及手术前即刻的AST、ALT、TB、DB和CRP水平，以及囊肿直径、肝内胆管扩张情况和胆总管内有无碎屑。
在研究期间，15例患者在产前被诊断。早期组在所有时间点的囊肿直径均显著更大。出生时囊肿直径>30 mm、出生时肝内胆管扩张以及出生后胆总管增大至>30 mm的患者更有可能早期出现症状。血液生化检查显示两组之间无显著差异。
出生后早期囊肿直径>30 mm的患者需要仔细的出生后管理，并且应向家长告知其孩子在出生后前3个月内需要手术的可能性很高。
四级。
