Clinicalanalysis Of Congenital Choledochal Cyst Perforation Of 38 Cases

Objective:Summary clinical data of 38 patients of congenital choledochal cyst perforation, raise awareness of the disease, optimize diagnosis and treatment.Methods:The retrospective analysis was performed on 38 patients of choledochal cyst perforation admitted in the Children’s Hospital of Chongqing Medical University from March 2008 to August2015.Retrospective analysis of symptoms, age, gender distribution,laboratory examinations,and surgery plan.Results:1.All 38 cases of children has choledochal cyst perforation,perforation rate was 4.5% in total, of which 7 cases were boys, 31 cases were girls, male to female ratio is about 1: 4.4. Age range from 7 days to 6years and 2 months, with a median of 14 months, 15 cases ≤1 year old,accounting for 39.5%, 33 cases ≤3 yeasr old, accounting for 86.8%.2.Main symptoms of children with biliary tract perforation :abdominal pain(47.4%), abdominal distention(42.1%), fever(44.7%),vomiting(73.7%), jaundice(23.7%),white clay-like stool(13.2%),abdominal mass(15.8%),dark urine(21.1%), diarrhea(7.9%).3.Auxiliary examination like abdominal paracentesis, abdominal ultrasound, and MRCP have high diagnostic accuracy.4.Early misdiagnosis rate was 34.2%(13/38), 7 cases occurred in ≤1year old infant, accounting for 46.7%(7/15) of the age group, 6 cases occurred in>1 year old children,accounting for 26.1%(6/23) of the age group. Misdiagnosis mainly are other abdominal diseases and bronchial pneumonia complicated by pleural effusion.5.38 children bear on choledochal cyst perforation,and about 81.6% of them the ascites amylase have increased.Biliary perforated portion occurs most often in the common bile duct and cystic duct junction.Different cyst forms has different incidence, cystic dilatation to fusiform dilatation is about 2.2:1,and the preoperative bilirubin level is higher in cystic dilatation group than fusiform dilatation group.6.38 cases of biliary perforation underwent two stage surgery.Firstly take the drainage operation, after 1-4 months complete cystectomy and biliary reconstruction with Roux-en-Y hepatojejunostomy.(1)After drainage operation,none of 38 patents suffer from drainage tube retrograde infection,lung infection,bleeding or other complications.On the average,discharge time was 11 days after surgery,Male children need longer recovery time than the time of female patients.Adopting cyst external drainage. T tube drainage or T tube drainage+peritoneal drainageneed less time for patients’ body temperature returned to normal than a simple peritoneal drainage.At a follow-up, 3 patients occur biliary tract infectionin within 2 months after drainage.After infection get control, these3 patients underwent stage-Ⅱ surgery 1month later.(2)All 38 patents underwent stage-Ⅱ surgery recovered well.None of them suffered bleeding,infection or other complications. Discharge time was 10 days after surgery at average. At a 3 months follow-up none of them occur biliary fistula or jaundice.7.38 choledochal cyst perforation cases used the third generation cephalosporin + ornidazole or metronidazole as anti-infective therapy, of which 16 cases add one kind of β- lactamase stable antibiotic. The body temperature mostly back to normal after 1-3 days of drug using. Using Atomolan, Compound Glycyrrhizin or Atomolan + Compound Glycyrrhizin as hepatoprotive therapy, transaminases have returned to normal after about 1-3 days.Conclusion:1.The influence of age on perforation occurred in infants was higher than in older children.2.Choledochal cyst perforation main symptoms are abdominal pain,abdominal distention, fever, vomiting,but classical triad of jaundice,abdominal pain, fever appears at low rate.3.Younger(≤1 year old) children are more reliable to earlymisdiagnosis.Abdominal ultrasound and bile-like liquid extract from abdominal paracentesis are convenient and reliable way to diagnosis.4. Pancreaticobiliary maljunction, choledochal cyst or distal common bile duct obstruction, neuromuscular dysplasia of distal common bile duct,common bile duct ischemia,etc. are etiology of choledochal cyst perforation.5.Choledochal cyst perforation adopted two stage surgery is safe and effective. In the Stage-Ⅰsurgery,peritoneal drainage used as an auxiliary drainage way which is not suitable for single using.6.It is very important for postoperative recovery by the using of anti-antibiotics,hepatoprotive medicine, nutrition and vitamin support After the surgery.