The Comparative Clinical Study Of Choledochal Cysts In Children And Adults

Objective: Congenital common bile duct cyst,a developmental malformation of the biliary tract,has been reported in cases in both children and adults.The purpose of this article is to analyze the clinical characteristics of pediatric and adult patients with common bile duct cysts and to improve clinical management.Methods:All cases of patients accepted RYHJ surgery from January 2016 to December2021 at the Department of Pediatric General Surgery and Adult General Surgery of Shengjing Hospital of China Medical University were retrospectively collected.All patients were divided into pediatric and adult groups based on the age of 14 years.Symptoms,imaging manifestations,changes in liver enzyme indices,postoperative complications,and bile duct pathological changes were collected from all patients.The Mann-Whitney U test and the Chi-square test were used for comparison.P < 0.05 was considered statistically significant.Results: A total of 197 patients were included in the study.Of the 197 patients,148 were children(75%)and 49 were adults(25%).The sex ratio was 1:3.8 in the children group;1:3.9 in the adult group.The most common symptom in both groups was abdominal pain(74.3% in the children group and 77.6% in the adult group,P>0.05).Jaundice(26.4%;12.2% P < 0.05)and vomiting(34.5%,4.1%,P<0.01)were more likely to occur in pediatric patients than in adult patients.Pediatric patients were more likely to have combined pancreatitis than adult patients(23.1%;8.2%,P<0.05).The type of cyst in both groups was predominantly type Ⅰ choledochal cyst(75.0%;65.3%,P > 0.05),followed by type Ⅳ choledochal cyst(24.3%;30.6%,P > 0.05).The prevalence of preoperative ALT elevation was higher in the pediatric group than in adult patients(61.5%;28.6%,P<0.001),with higher values of ALT(U/L)elevation than in adult patients(203(120;353);122(63;255),P<0.001).The decrease in ALT(U/L)was more significant in pediatric patients after surgical treatment(164(87;327);65(29;226.25),P<0.05).The incidence of preoperative AST elevation was also higher in the pediatric group than in the adult group(59.5%;18.4%,P<0.001),and there was no significant difference in the rate of postoperative reduction between the two groups.The incidence of preoperative γ-GGT elevation was higher in the pediatric group than in the adult group(68.9%;53.1%,P < 0.05),and the postoperative γ-GGT(U/L)reduction was more significant in adult patients(220(99;414);86(47.5;293),P<0.05).In 197 patients,the incidence of postoperative complications was less in pediatric patients than in adult patients(3.4%;14.3%,P < 0.05).Pathological examination in pediatric patients suggested a lower probability of bile duct atypical epithelium than in adults(3.4%;14.2%,P<0.05).Conclusion:Compared to adult patients,pediatric patients with choledochal cysts are more likely to present with jaundice and vomiting,and have a higher incidence of combined pancreatitis.Preoperative liver injury was more frequent and severe in pediatric patients,while postoperative improvement in liver enzyme parameters was more significant.Postoperative complications and atypical epithelium were less common in pediatric patients.This indicates that patients with choledochal cysts who receive early diagnosis and surgical treatment in childhood can reduce the incidence of postoperative complications,improve liver function,and reduce the risk of distant cancer.