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Robotic-assisted surgery for pediatric choledochal cyst: Case report and literature review

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World Journal of Clinical Cases 2018年第7期6卷 143-149页

作者： Xian-Qiang Wang Shu-Juan Xu Zheng Wang Yuan-Hong Xiao Jing Xu Zhen-Dong Wang Di-Xiang Chen Department of Pediatrics PLA General Hospital Center of Anesthesia and Operation PLA General Hospital

Our paper describes the key surgical points of pediatric choledochocystectomy performed completely by Da Vinci robotic system. A choledochocystectomy was safely carried out for a girl at our hospital, and without any complication. Then systematic literature review was done to discuss the methods of intestine surgery and intestinal anastomosis, the use of 3 rd robotic arm, the surgical safety and advantages comparing open and laparoscopic surgery. We systematically reviewed choledochocystectomy for children performed by robotic surgery. We included a total of eight domestic and foreign reports and included a total of 86 patients, whose average age was 6.3(0.3-15.9) years; the maleto-female ratio was 1:3.5(19:67). Seven patients experienced conversion to open surgery, and the surgery success rate was 91.9%(79/86). The average total operation time was 426(180-520) min, the operation time on the machine was 302(120-418) min, 11 cases used the number 3 arm, and the remaining mainly used the hitch-stitch technique to suspend the stomach wall and liver. Forty-seven patients underwent pull-through intestine and intestinal anastomosis, and 39 patients underwent complete robotic intestine surgery and intestinal anastomosis. The hospitalization time of roboticassisted choledochocystectomy was 8.8 d. Eight patientshad biliary fistula and were all cured by conservative treatment and continuous observation. One patient had anastomotic stenosis, and one patient had wound dehiscence, both cured by surgery. Choledochocystectomy for children performed by completely robotic surgery and Roux-en-Y hepaticojejunostomy is safe and feasible. The initial experience shows that this surgical approach has a clearer field than the traditional endoscopy, and its operation is more flexible, the surgery is more accurate, and the injury is smaller. With the advancement of technology and the accumulation of surgeons' experience, robotic surgery may become a new trend in this surgical procedure.

关键词： Choledochocystectomy Robotic surgery Pediatrics Congenital choledochal cysts

Endoscopic retrograde cholangiopancreatography in evaluation of choledochal dilatation in patients with obstructive jaundice

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Hepatobiliary & Pancreatic Diseases International 2002年第1期1卷 111-113页

作者： Chen W.-X. Zhang Y. Li Y.-M. Xu G.-Q. Fang Y. Cai S.-P. Department of Gastroenterology First Affiliated Hospital Zhejiang University School Medicine Hangzhou 310003 China

Objective: To determine the causes of choledochal di-latation in patients with obstructive ***: One hundred and sixty-four patients withobstructive jaundice were investigated by endoscopicretrograde cholangiopancreatography(ERCP), and pa-tients with choledochal dilatation (group Ⅰ, n=110)were compared with those without choledochal dilata-tion(group Ⅱ, n=54).Results: The causes of common bile duct dilatationwere choledocholith, juxtapapillary duodenal divertic-ula and congenital dilatation of the common bile *** distal common bile duct and its surroundings wereabnormal in 104(94.55%) of the 110 patients and in 13(24.08%) of the 54 patients (P<0.01). Juxtapapil-lary duodenal diverticulum accounted for 24.55% ingroup Ⅰ, and only in 9.26% in group Ⅱ (P<0.05).Post-cholecystectomy patients were 13.64% in groupⅠ, and only 5.56% in group Ⅱ.Conclusions: The abnormalities of the distal commonbile duct and its surroundings can usually be detectedas underlying causes of common bile duct *** is necessary before cholecystectomy, since it isconsidered the "gold standard" for the diagnosis ofdistal common bile duct abnormalities.

关键词： ERCP choledochal dilatation choledcholith juxtapapillary duodenal diverticula

The Extra-and Intra-Hepatic Ducts of Congenital choledochal Cyst in Infants and Children

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中国医科大学学报 1990年第S1期19卷 33-39页

作者：陈丽英潘恩源杭俊德靳家文李心元王慧贞李正 Department of Radiology The Third Affiliated Hospital China Medical University Shenyang China Department of Pediatric Surgery The Third Affiliated Hospital China Medical University Shenyang China

Congenital choledochal cyst is frequently seen ininfants and children in China. The extra-hepatic ductalchanges have been well described, but the changes in theintra-hepatic ducts in choledochal cyst are less well *** report is composed of 2 groups of patients: thirty-four cases who were operated upon between 1971 and1982 were followed post-operatively by plain abdominalfilm and barium meal examination and a group of 26cases receiving PTC between 1982 and 1984. In this lattergroup, both extra-and intra-hepatic ducts were shownsatisfactorily by PTC. In 23 cases (88.5%) besides thedilatation of the extra-hepatic duct, there were differentdegree and different forms of dilatation of the intra-hepatic ducts. In 10 cases(38.5%)the branches peripheralto the dilated main intra-hepatic ducts were found to benormal, in the other 10 cases (38.5%) the more peripheralbranches abruptly narrowed or were obliterated. In one case(3.8%) the entire intra-hepatic ductal system were dilatedwith a bead-like appearance. In only 3 cases were theintra-hepatic ducts normal (11.5%). Moreover the dilata-tion of the intra-hepatic ducts were found to persist longafter the obstruction was relieved in 28 cases (82.3%) ofthe 34 post-operative cases. Due to the frequent associationof intra-hepatic ductal dilatation with choledochal cyst,the various forms of dilatation and persistance of dilata-tion after relief of the obstruction, the term congenital biliary dilatation is suggested for this disease.

关键词： hepatic ducts choledochal cyst infants children

Role of magnetic resonance cholangiopancreatography in diagnosing choledochal cysts: Case series and review

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World Journal of Radiology 2013年第8期5卷 304-312页

作者： Vikas Y Sacher James S Davis Danny Sleeman Javier Casillas Department of Surgery University of Miami Department of Radiology University of Miami

AIM:To determine the merits of magnetic resonance cholangiopancreatography(MRCP) as the primary diagnostic test for choledochal cysts(CC’s).METHODS:Between 2009 and 2012,patients who underwent MRCP for perioperative diagnosis were *** information,clinical characteristics,and radiographic findings were *** results were compared with intraoperative findings.A PubMed search identified studies published between 1996-2012,employing MRCP as the primary preoperative imaging and comparing results with either endoscopic retrograde cholangiopancreatography(ERCP) or operative *** rates for CC’s and abnormal pancreaticobiliary junction(APBJ) were *** addition detection rates for clinically related biliary pathology like choledocholithiasis and cholangiocarcinomas in patients diagnosed with CC’s were also ***:Eight patients were identified with CC’*** patients out of them had typeⅣCC’s,1 had type I and 1 had a new variant of choledochal cyst with confluent dilatation of the common bile duct(CBD) and cystic *** patients had an APBJ and 3 of those had a long *** were found in 2 patients,1 had a CBD stone,and 1 pancreatic-duct stone was also *** all cases,MRCP successfully identified the type of CC’s,as well as APBJ with ductal *** analyzing the literature,we found that MRCP has 96%-100% detection rate for CC’***,we found that the range for sensitivity,specificity,and diagnostic accuracy was 53%-100%,90%-100% and 56%-100% in diagnosing ***’s detection rate was 100% for choledocholithiasis and 87% for cholangiocarcinomas with concurrent CC’***:After initial ultrasound and computed tomography scan,MRCP should be the next diagnostic test in both adult and pediatric *** should be reserved for patients where therapeutic intervention is needed.

关键词： Magnetic resonance cholangiopancreatography choledochal cyst Abnormal pancreaticobiliary junction Diagnostic test Choledocholithiasis Cholangiocarcinomas

Recent advances in choledochal cysts

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Open Journal of Gastroenterology 2012年第4期2卷 145-154页

作者： Hiroyuki Tadokoro Masaru Takase Department of Gastroenterology Kasukabe Chuo General Hospital Saitama Japan Division of Pathology Clinical Laboratory Koshigaya Municipal Hospital Saitama Japan

choledochal cysts are a congenital anomaly, and they show dilatation of the intra- or extrahepatic biliary tree. These cysts are uncommon in Western countries, but are not rare in Asian countries. choledochal cysts are classified into five groups based on location or shape of the cysts. Types I and IV-A cysts are the most common types, which are associated with anomalous pancreaticobiliary junction (APBJ), but other cysts are not associated with APBJ. Types I and IV-A cysts appear to belong to a different category from other cysts embryologically. Type I and IV-A cysts accompany anomalies of the pancreas. Type I and IV-A cysts might occur when left ventral anlage persists, and with disturbed recanalization of the common bile duct. Endoscopic retrograde cholangiopancreatography is the gold standard for detecting APBJ, but it is an invasive procedure. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive imaging tool for detecting pancreatic and biliary trees. MRCP is the first-choice modality for diagnosing choledochal cysts and APBJ in pediatric patients. Cystoenterostomy is been performed because of high complication and mortality rates. Complete excision of the cysts with Roux-en-Y hepatojejunostomy is a standard procedure for choledochal cysts to prevent postoperative complications, including development of cancer. In this study, we review classification, pathogenesis, diagnosis, and treatment of types I and IV-A choledochal cysts.

关键词： choledochal Cysts Anomalous Pancreaticobiliary Junction Pancreatic Polypeptide Ventral Pancreas Dorsal Pancreas

Type Ⅳ congenital choledochal cyst concurrent with acute pancreatitis: a case report

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Hepatobiliary & Pancreatic Diseases International 2005年第2期4卷 311-312页

作者： Jing-Tong Wang and Nan Wu Beijing, China Department of Gastroenterology, People’s Hospital, Beijing University, Beijing 100044, China

BACKGROUND: Congenital choledochal cyst is a rare kind of bile duct deformity, resulting from cystic or shuttle-like dilation of part of the choledochal duct congenitally. We present a 20-year-old girl with a congenital choledochal cyst complicated by acute pancreatitis. METHOD: The clinical data of the woman with a conge- nital choledochal cyst concurrent with acute pancreatitis were retrospectively analyzed. RESULT: The congenital choledochal cyst of the woman was type complicated by acute pancreatitis. CONCLUSIONS: The diagnosis of congenital choledochal cyst mainly depends on CT, MRCP, and ERCP. Total ex- cision of the choledochal cyst with Roux-en-Y hepaticoje- junostomy is recommended as the treatment. For patients with type cysts with frequently recurrent cholangitis re- sulting biliary liver cirrhosis, liver transplantation should be considered.

关键词： congenital choledochal cyst acute pancreatitis treatment

Traumatic rupture of a type Ⅳ a choledochal cyst in an adult male

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World Journal of Gastroenterology 2013年第24期19卷 3911-3914页

作者： Yun-Fei Duan Bo Yang Feng Zhu Department of Hepatobiliary Surgery the Third Affiliated Hospital of Soochow University

choledochal cyst (CC) is a rare, congenital anomaly of the bile ducts. We describe a 26-year-old male patient who was transferred to our hospital with a reported traumatic rupture of cystic liver lesions following a fall. At the time of injury, the patient experienced severe abdominal pain. He was found to have peritonitis and abdominal hemorrhage, which is quite rare. Laparot-omy revealed 3000 mL fluid consisting of a mixture of blood, bile and inflammatory effusion in the peritoneal cavity. The liver, gallbladder, spleen, stomach, duo-denum, small intestine, and colon appeared normal. A large cystic mass was discovered near the porta hepatis. This mass, which connected to the hepatic bifurcation and gallbladder had a 5 cm rupture in the right wall with active arterial bleeding. Abdominal com-puted tomography (CT) and emergency laparotomy revealed rupture of a huge type Ⅳa CC. The patient was successfully managed by primary cyst excision, cholecystectomy, and Roux-en-Y end-to-side hepatico-jejunostomy reconstruction. The postoperative course was uneventful and the patient was discharged on the 12 th day of hospitalization. Four weeks after surgery,abdominal CT scan showed pneumatosis in the intra-hepatic bile duct, and intrahepatic dilatation which decreased following adequate biliary drainage. The patient has remained well in the close follow-up period for 9 mo.

关键词： Biliary tract choledochal cyst Trauma Rupture Peritonitis Hemorrhage

75例先天性胆总管囊肿手术治疗的回顾及随访

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中华小儿外科杂志 1987年第3期9卷 152-153页

作者：房志勤丁家麟谷继卿贾胜琴韩茂棠天津市儿童医院外科

本文系自1968年以来我们对先天性胆总管囊肿75例手术治疗的回顾分析及随访结果.我们认为常规的囊肿切除肝管空肠Roux-y吻合仍不免有逆行感染发生,自应用囊肿切除、空肠间置、肝管十二指肠吻合及矩形瓣防返流术以采无重大合并症发生,近... 详细信息

本文系自1968年以来我们对先天性胆总管囊肿75例手术治疗的回顾分析及随访结果.我们认为常规的囊肿切除肝管空肠Roux-y吻合仍不免有逆行感染发生,自应用囊肿切除、空肠间置、肝管十二指肠吻合及矩形瓣防返流术以采无重大合并症发生,近期效果理想且合乎生理是最大优点.

关键词：先天性胆总管囊肿手术治疗 choledochal cyst children jejunal interposition operative mortality 囊肿切除 plus 矩形瓣防返流术 difficulties successful short Roux-y吻合随访结果空肠间置近期效果回顾分析肝管空肠 treated results

Gallbladder carcinoma associated with anomalous union of pancreatobiliary ductal system

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Open Journal of Gastroenterology 2013年第4期3卷 249-251页

作者： Sun Young Yi Division of Gastroenterology Internal Medicine School of Medicine Ewha Womans University Seoul South Korea

A 64-year-old woman was admitted with mild right upper quadrant abdominal pain. Her physical examination revealed a moderately nourished female with normal vital sign and no evidence of jaundice or anemia. Preoperative diagnosis was choledochal cyst with anomalous union of pancreaticobiliary duct (AUPBD), long Y-shaped type and gallbladder (GB) cancer. An extended cholecystectomy, excision of the common bile duct and biliary diversion via Roux-en Y hepaticojejunostomy was performed. The gallbladder cancer showed invasion to perimuscular connective tissue and no extension beyond serosa. Twelve months after curative resection, the patient had no evidence of tumor recurrence.

关键词： choledochal Cyst Gallbladder Cancer