Shirai Takeshi, Hamada Yoshinori, Hamada Hiroshi, Doi Takashi
Department of Pediatric Surgery, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka, Japan.
Pediatr Surg Int. 2025 Apr 9;41(1):109. doi: 10.1007/s00383-025-06016-8.
This study aims to assess the long-term postoperative changes in the preoperative dilated intrahepatic bile duct (IHBD) in pediatric patients with congenital biliary dilatation (CBD).
The postoperative serial changes in the preoperative dilated left IHBD in pediatric patients who underwent appropriate excision surgery were evaluated using magnetic resonance cholangiopancreatography (MRCP).
The IHBD dilation significantly decreased at a median of 1.5 years and was maintained up to 15 years postop in the 24 CBD patients, regardless of the methods of biliary reconstruction. In the 16 patients with apparent preoperative IHBD dilation (5 mm or more), a significant rapid decrease was also observed and maintained up to 15 years postop, regardless of age at surgery. However, a patient with failed rapid reduction at 1.5 years postop and sustained IHBD dilatation of more than 5 mm developed cholangitis 15 years postop with suspected residual congenital stenosis at the hepatic hilum.
Performing the appropriate excision surgery resulted in a rapid reduction of the preoperative IHBD dilation and maintained long-term reduced IHBD dilation. Patients with failed rapid reduction and sustained dilatation of the IHBD would have residual stenosis and should be carefully followed up for possible late cholangitis.
本研究旨在评估先天性胆管扩张症（CBD）患儿术前扩张的肝内胆管（IHBD）术后的长期变化。
使用磁共振胰胆管造影（MRCP）评估接受适当切除手术的患儿术前扩张的左肝内胆管术后的系列变化。
24例CBD患儿的肝内胆管扩张在术后中位时间1.5年时显著减轻，并在术后长达15年保持稳定，无论胆管重建方法如何。16例术前肝内胆管明显扩张（5mm或以上）的患儿，无论手术时年龄大小，术后也观察到显著快速减轻，并在术后长达15年保持稳定。然而，1例术后1.5年肝内胆管扩张快速减轻失败且持续扩张超过5mm的患儿，术后15年发生胆管炎，怀疑肝门处存在先天性狭窄残留。
进行适当的切除手术可使术前肝内胆管扩张快速减轻，并长期维持肝内胆管扩张减轻状态。肝内胆管扩张快速减轻失败且持续扩张的患儿可能存在残留狭窄，应密切随访以防可能发生的迟发性胆管炎。
