Clinical Analysis Of Prenatal Diagnosed Choledochal Cyst In Children

Objective:Analysis of the clinical data,imaging examination,surgical methods,postoperative complications and clinicopathology of children with congenital choledochal cyst diagnosed in prenatal,to discuss the postnatal diagnosis and operation time selection of those children.Methods:82 children with congenital choledochal cyst found in antenatal examination were selected from January 2012 to May 2019.The clinical data of diagnosis gestational age,clinical manifestation,imaging examination,pathological type,operation time and operation prognosis were analyzed retrospectively.Results:The average prenatal gestational age of 82 patients was 27.92±6.21 weeks,including 20 males and 62 females,with 71 cyst types and 11 spindle types.The group were divided into < 1 month age group(8 cases),1-3 month age group(26 cases)and > 3 month age group(48 cases)according to the operation age.Twenty one cases were symptomatic after birth,with 17 cases of obstructive jaundice,five cases with clay-colored stools.Five cases of jaundice were observed in <1 month group(5/8),and significant differences were obtained as compared with 1-3month(6/26)and >3 month group.Biochemical test demonstrated 53 cases with various degrees of abnormal liver function,16 cases of elevated ALT,53 cases of increased AST level,43 cases of increased GGT and 27 cases of increased bilirubin.There are no statistically significant difference between the three groups of elevated ALT,and the difference of elevated AST between 1-3month group(22/26)and >3 month group 2(27/48)was statistically significant(χ2=6.066,P=0.014).Eleven cases of increased GGT were examined in >3 month group(11/48),and significant differences were obtained as compared with 0-1month(7/8)and 1-3 month group(25/26)(all P <0.05).All children underwent laparoscopic choledochal cyst resection.Postoperative pathological results demonstrated 10 cases of cholestasis,4 cases of degeneration and necrosis of liver cells,and 1 case of liver fibrosis.The postoperative pathological in 1-3month(6/26)and > 3 month group compared with >3month group was statistically significant.(P= 0.043 and <0.001,respectively).There was no statistically significant difference between the three groups in postoperative pathology of children without clinical symptoms(χ2=8.708,P=0.146).There were 14 cases of postoperative complications,,which were treated conservely in 10 case,and 4 cases were reoperated,including 2 cases of anastomotic leakage,1 case of anastomotic stenosis and 1 case of intestinal obstruction,no significant difference were observed between there groups statistically(χ2=0.209,P=901).All children were discharged successfully.Forty nine cases of intrahepatic bile duct dilatation preoperative were gradually retracted within a period of 2 and 3 month follow up postoperative.The patients were followed up for 6months to 3 years,and no intermediate and long-term complications occurred.Conclusion:Congenital choledochal cysts of prenatal diagnosis should be followed up closely after birth,routine hepatobiliary ultrasonography and liver function test are mandatory.Once sever jaundice,infection,liver function abnormalities or progressively enlargement of the cyct were present,prompt surgical treatment are necessary.Asymptomatic congenital choledochal cyst can also be followed up regularly in the outpatient department,and selective operation is allowed.Laparoscopic choledochal cyst resection and biliary reconstruction can also be tolerated in the neonatal period.