Department of Pediatric Surgery, Japanese Red Cross Society Himeji Hospital, Himeji, Japan.
Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.
Kobe J Med Sci. 2024 Nov 21;70(3):E100-E105. doi: 10.24546/0100492148.
Liver fibrosis is not thought to occur in patients with no adverse events after surgery for congenital biliary dilatation (CBD). However, this speculation is not supported by any reports. Real-time shear wave elastography (SWE) is a noninvasive, ultrasound-based technique to evaluate liver stiffness. We aimed to clarify the presence of liver fibrosis using SWE in patients who had undergone surgery for CBD.
We included patients who underwent radical surgery for CBD, who were followed up until March 2022, and have been performed with SWE at our institution from April 2021 to March 2022. Liver stiffness was evaluated using SWE, and liver fibrosis stages (F0-F4; METAVIR scoring) were determined based on the previously reported associations between liver stiffness and liver fibrosis. We assessed the general condition of each patient and performed routine blood investigations on the same day as SWE.
Two out of 20 patients had long-term complications (intrahepatic stones without symptoms [n = 1], recurrent cholangitis [n = 1]). The median hepatic shear wave propagation velocity was 1.26 (range, 1.12-1.60) m/s in all cases. The estimated liver fibrosis stage was ≤F1 in patients without long-term complications. In patient with recurrent cholangitis, the hepatic shear wave propagation velocity was 1.60 m/s, and the estimated liver fibrosis stage was F3.
Liver fibrosis tended not to occur in patients with no complications after surgery for CBD. However, patients with long-term postoperative complications, such as cholangitis, should be examined using SWE so as not to overlook liver cirrhosis.
先天性胆管扩张症（CBD）手术后无不良事件的患者，据推测不会发生肝纤维化。但目前尚无相关报告对此进行证实。实时剪切波弹性成像（SWE）是一种非侵入性的超声技术，可用于评估肝脏硬度。本研究旨在通过 SWE 明确 CBD 手术后患者是否存在肝纤维化。
我们纳入了在我院于 2021 年 4 月至 2022 年 3 月期间接受 CBD 根治性手术且随访至 2022 年 3 月的患者，同时这些患者在我院进行了 SWE 检查。使用 SWE 评估肝脏硬度，并根据之前报道的肝脏硬度与肝纤维化之间的相关性，确定肝纤维化分期（F0-F4；METAVIR 评分）。我们评估了每位患者的一般情况，并在同一天与 SWE 检查同时进行了常规血液检查。
20 例患者中有 2 例出现长期并发症（无症状性肝内胆管结石 1 例，复发性胆管炎 1 例）。所有患者的肝脏剪切波传播速度中位数为 1.26（范围，1.12-1.60）m/s。无长期并发症患者的估计肝纤维化分期均为≤F1。复发性胆管炎患者的肝脏剪切波传播速度为 1.60 m/s，估计肝纤维化分期为 F3。
CBD 手术后无并发症的患者肝脏纤维化倾向于不发生。但是，对于复发性胆管炎等长期术后并发症的患者，应使用 SWE 进行检查，以免漏诊肝硬化。
