In order to observe the absorption of the fat solube vitamine afer operative treatment of the congenital biliary dilation(CBD),the plasma fat soluble vitamin A,D and E were determined in 57 cases of CBD at the postoperative stage and 51 cases of normal children as control.The normal values of vitamin A,D and E was 576.25±170.93ng/ml,13.21±2.20ng/ml and 7.34±1.96ng/ml respectively in control group versus 501.59±120.64ng/ml, 11.66±1.81ng/ml and 6.16±1.18ng/ml respectively in the postoperative group of CBD.The differences were significant for a long period of about 10 years,and gradually disappear after that to approach or near the normal level.Therefor,the radical operation of CBD may affect the absorption of the fat soluble vitamins.
Twenty five children with congenital biliary dilatation were treated with hepatico-jejuno-duodenostomy following excision of choledochal cysts between 1983 and 1985. The age ranged from two months to eleven years. The last follow-up ranged from 6-9 years (mean 7.5 years). All patients were free of jaundice with normal growth and development and none had peptic ulcer. The results from the last follow-up was better than that of the first one. This procedure was safe, effective and physiologically appealing.
ObjectiveTo explore the clinical efficacy and share the experience of Da Vinci robot assisted choledochal cyst resection in children. MethodThe data of children including preoperative, intraoperative, and postoperative details who underwent Da Vinci robot assisted choledochal cyst resection in the Department of Pediatric Surgery, West China Hospital of Sichuan University from April 2018 to June 2022 were collected and analyzed. ResultsA total of 200 patients were collected in this study, 54 of whom were males and 146 were females. The male to female was 1∶2.70. The age was (46±33) months and the body weight was (15.77±7.10) kg. The main symptoms were abdominal pain (136 cases, 68.0%), jaundice (62 cases, 31.0%), abdominal distension (20 cases, 10.0%), and abdominal mass (23 cases, 11.5%). The diameter of cyst was (3.46±2.01) cm. There were 153 cases of type Ⅰa, 35 cases of type Ⅰc, 1 case of type Ⅱ, and 11 cases of type Ⅳ. The operation time was (179.9±10.3) min, the intraoperative fluid infusion was (397.4±26.4) mL, the intraoperative blood loss was (21.5±10.9) mL, the liquid intake time was (3.01±0.35) d, the solid intake time was (3.80±0.27) d, and the postoperative hospitalization time was (7.44±0.94) d. The intraoperative blood transfusion was performed in 4 cases (2.0%). There were 7 cases (3.5%) of postoperative complications, including 2 cases of biliary leakage, 2 cases of incomplete intestinal obstruction, and 1 case of anastomotic bleeding, which were improved by conservative treatment. Anastomotic stenosis occurred in 1 case, and the Roux-en-Y anastomosis was performed again. Biliary loop torsion obstruction occured in 1 case, which received reoperation restoring the biliary loop and closing the mesangial fissure. ConclusionsFrom the results of this study, Da Vinci robotic surgical system can obviously reduce the difficulty of choledochal cyst resection in children. It has the advantages of safe, beautiful incision, clear exposure, rapid recovery, and less complications.
ObjectiveTo intend to propose a new clinical classification of congenital biliary dilatation (CBD) which is more concise and suitable for diagnosis and treatment, and explore feasibility and reliability of the new classification. MethodsBased on the preoperative imaging data of patients with CBD admitted to the Department of Pediatric Surgery of West China Hospital of Sichuan University, from January 2015 to December 2018, a new classification of CBD was accomplished according to the site of bile duct dilatation lesions, which was named HUAXI CBD classification. The CBD was classified into 4 types: type Ⅰ (distal extra-hepatic bile duct dilatation), type Ⅱ (distal extra-hepatic combined with right and left primary hepatic bile duct dilatation), type Ⅲ (extra-hepatic combined with secondary and above hepatic bile duct dilatation), and type Ⅳ (intra-hepatic bile duct dilatation). Meanwhile, the feasibility and reliability of the HUAXI CBD classification were analyzed. ResultsA total of 300 patients with CBD were included in this study. According to the HUAXI CBD classification method, 240 cases were type Ⅰ, 48 cases were type Ⅱ, 10 cases were type Ⅲ, and 2 cases were type Ⅳ. For type Ⅰ, 236 patients underwent cholecystectomy and Roux-en-Y hepaticojejunostomy and 4 cases were treated non-operatively; For type Ⅱ, 48 patients underwent cholecystectomy, central hepatic duct reconstruction and Roux-en-Y hepaticojejunostomy; For type Ⅲ, 9 patients underwent cholecystectomy and Roux-en-Y hepaticojejunostomy, 5 of which had intrahepatic dilatation confined to part of the liver lobe and underwent partial hepatectomy with intra-hepaticojejunostomy. One case was treated with percutaneous transhepatic cholangial drainage (PTCD) only; two type Ⅳ patients were treated with PTCD only. Patients with type Ⅰ had a normal hepatobiliary function after surgery and a good prognosis; patients with type Ⅱ had good recovery of liver function in 37 cases (77.1%), but 11 cases (22.9%) had postoperative complications during follow-up; patients with type Ⅲ and Ⅳ had high incidence of cholangitis (6/10, 2/2, respectively) and choledocholithiasis (5/10, 2/2, respectively) after surgery, especially those with diffuse intrahepatic dilatation having a poor prognosis, eventually developing cirrhosis and necessitating liver transplantation. ConclusionThe HUAXI CBD classification is consistent with treatment principles, concise and easy to remember, and more suitable for pediatric clinical application, which can effectively assist in the selection of clinical treatment strategies for children with BD.
A complex mechanism of reduced number of bile duct innervating ganglion cells, smooth muscle distribution, foregut duplications, and abnormal pancreaticobiliary duct junction, which occurs during embryonic development and after birth in a genetic context, can lead to pathological congenital biliary dilatation. As a precancerous lesion of the biliary system, irrational treatment of congenital biliary dilatation will further increase the risk of malignancy in patients. By understanding the causes, pathological features, and limitations of early detection techniques of malignant tumor secondary to congenital biliary dilatation is helpful to clarify the key points in the management of congenital biliary dilatation, reduce the incidence of postoperative adverse treatment events and avoid the medical risk of secondary malignancy.