Gang Sujin, Kim Pyeong Hwa, Kwon Hyunhee, Yoon Hee Mang, Namgoong Jung-Man
Department of Pediatric Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea.
Department of Radiology and Research Institute of Radiology, Asan Medical Center, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea.
Sci Rep. 2025 Mar 18;15(1):9235. doi: 10.1038/s41598-025-94308-3.
Postoperative bile duct stones, including intrahepatic bile duct (IHD) stones and remnant distal common bile duct (remnant intrapancreatic common bile duct, RIPD) or common channel duct (CCD) stones, are long-term complications following choledochal cyst (CC) excision. We aimed to retrospectively review occurrence, associated factors, and treatment of postoperative bile duct stones. Records of 457 pediatric patients who underwent CC excision at Asan Medical Center (1992-2021) were retrospectively reviewed. Data on cholelithiasis, operation, and outcomes were analyzed. Overall, 457 pediatric patients underwent CC excision, with 21 developing intrahepatic duct (IHD) stones, primarily associated with Todani type IVa cysts, especially Tsuchida types 2 or 3, which are often linked to IHD dilation and upstream stenosis. Patients with RIPD/CCD stones were all identified with complicated Komi types, and the impact of pancreas divisum itself was unclear. Early surgery even before 6 months of age is associated with improved prognosis regarding the occurrence of IHD stones, but not related with RIPD/CCD stones. This is the largest retrospective study to date, comprising 21 IHD and 18 RIPD/CCD stones from 457 pediatric patients with CCs and their clinical outcomes. We found that the structural characteristics of the bile duct influence stone formation. In addition, our findings indicate the need for more systematic and long-term follow-up of patients with CCs after surgery.
术后胆管结石，包括肝内胆管（IHD）结石以及残余远端胆总管（残余胰内段胆总管，RIPD）或共同通道胆管（CCD）结石，是胆总管囊肿（CC）切除术后的长期并发症。我们旨在回顾性分析术后胆管结石的发生率、相关因素及治疗情况。对457例在峨山医学中心接受胆总管囊肿切除术的儿科患者（1992 - 2021年）的记录进行了回顾性分析。分析了胆石症、手术及预后的数据。总体而言，457例儿科患者接受了胆总管囊肿切除术，其中21例发生肝内胆管（IHD）结石，主要与Todani IVa型囊肿相关，尤其是土田2型或3型，这些类型常与肝内胆管扩张及上游狭窄有关。RIPD/CCD结石患者均为复杂小宫型，胰腺分裂本身的影响尚不清楚。甚至在6个月龄前进行早期手术与改善肝内胆管结石发生的预后相关，但与RIPD/CCD结石无关。这是迄今为止最大的回顾性研究，纳入了457例患有胆总管囊肿的儿科患者中的21例肝内胆管结石和18例RIPD/CCD结石及其临床结局。我们发现胆管的结构特征会影响结石形成。此外，我们的研究结果表明，对胆总管囊肿患者术后需要进行更系统和长期的随访。
