The Management of Prenatally Diagnosed Choledochal Cyst

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  • 胎児診断された先天性胆道拡張症7例の治療経験 : 臨床的特徴と早期一期的根治手術
  • タイジ シンダン サレタ センテンセイタンドウ カクチョウショウ 7レイ ノ チリョウ ケイケン リンショウテキ トクチョウ ト ソウキ イチゴテキ コンジ シュジュツ

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Abstract

Purpose: The number of cases of choledochal cyst diagnosed prenatally by ultrasonography has increased in recent years, but therapeutic strategy in such cases is still unclear. We reviewed the treatment of seven patients diagnosed at our institution with the aim of investigating the features of, and therapeutic strategy for prenatally diagnosed choledochal cyst. Methods: We reviewed the clinical features and treatment of seven patients prenatally diagnosed with choledochal cyst by ultrasonography from 1997 to 2006 at our department. Results: The figure of bile duct was categorized into large cystic type in all patients, with the diameter of the cyst being 33-80 mm (mean 46 mm). Only one case was type IV-A bile duct dilatation, with the other six being type Ia. Early surgery was carried out in six cases at the age of 8-68 days (mean 37 days), with the exception of one case who presented at our department at over one year old. The surgical procedure used in six cases was primary excision of the bile duct as well as the gall bladder and Roux-en-Y hepaticojejunostomy reconstruction. In the remaining case, which was complicated by a brain hemorrhage caused by vitamin K deficiency prior to surgery, cholecystostomy was initially performed. The level of pancreatic enzymes in the bile were elevated in four cases, indicating the reflux of pancreatic juice into the bile duct. Liver biopsy showed fibrosis in one case, and ballooning of hepatic cells with bile stasis in four cases. All patients are doing well following surgery, with no complications during two to eleven years of follow up. Conclusion: Since no patients suffered postoperative complications, and the flow of pancreatic juice into the bile duct or liver fibrosis was evident even in asymptomatic patients, we recommend that primary repair should be performed at an early stage for infants with prenatally diagnosed choledochal cyst.

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