Diagnosis and management of choledochal cyst with accessory hepatic ducts in children
10.3760/cma.j.issn.1007-8118.2019.10.005
- VernacularTitle: 儿童胆总管囊肿合并副肝管的诊治
- Author:
Qifeng LIANG
1
;
Zhe WEN
1
;
Jiankun LIANG
1
;
Tao LIU
1
;
Binbin ZHANG
1
;
Weiyan CHEN
2
Author Information
1. Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou 510623, China
2. Operating Room of Guangzhou Women and Children's Medical Center, Guangzhou 510623, China
- Publication Type:Journal Article
- Keywords:
Choledochal cyst;
Accessory hepatic duct;
Diagnosis and management;
Children
- From:
Chinese Journal of Hepatobiliary Surgery
2019;25(10):737-740
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the diagnosis and management of choledochal cyst in children with accessory hepatic ducts (AHD).
Methods:From November 2013 to June 2018, 14 patients with choledochal cyst with AHD were treated in Guangzhou Women and Children's Medical Center. The patients included 2 males and 12 females, and age ranged from 4 months to 3 years (median 2 years). All patients underwent MRCP before operation, and 2 underwent operative cholangiography through the AHD.
Results:Seven patients with choledochal cyst and AHD were demonstrated by preoperative MRCP and intraoperative exploration. One patient was suspected by preoperative MRCP to have AHD which was confirmed by surgical exploration. Preoperative MRCP failed to diagnose, but operative exploration revealed AHD in 6 patients. Anastomosis of the AHD to jejunum was performed laparoscopically in 8 patients and by open surgery in 1 patient. Six patients had the common hepatic duct and the AHD joined together to create a common channel which was then implanted as a single duct into a Roux loop, Three patients had the common hepatic duct and the AHD anastomosed separately to a Roux loop. All the patients recovered well after operation and they were discharged home without any complication. A follow-up which ranged from 0.5 to 5 years showed no jaundice, liver atrophy or liver abscess.
Conclusions:MRCP was important in the preoperative diagnosis of choledochal cyst with accessory hepatic duct in children. MRCP was difficult in diagnosing type II accessory hepatic ducts. In suspected or undiagnosed cases of AHD, surgical exploration helped to improve the diagnostic accuracy, avoided injury and guided correct surgical decisions. Reconstruction of AHD required joining the AHD to the common hepatic duct, or as a separate duct to jejunal anastomosis to a Roux-y-loop.
