Abstract：
OBJECTIVE: To compare the clinical and radiologic findings between perforated and non-perforated choledochal cysts in children.
METHODS: Fourteen patients (mean age ± standard deviation, 1.7 ± 1.2 years) with perforated choledochal cysts (perforated group) and 204 patients (3.6 ± 3.8 years) with non-perforated choledochal cysts (non-perforated group) were included between 2000 and 2019. All patients underwent choledochal cyst excision after ultrasound, CT, or MR cholangiopancreatography. Relevant data including demographics, clinical symptoms, laboratory findings, imaging findings, and outcomes were analyzed. Statistical differences were compared using the Mann-Whitney U test and Fisher\'s exact test.
RESULTS: Choledochal cyst perforation occurred only in children under the age of 4 years. Acute symptoms, including fever (p < 0.001), were more common in the perforated group than in the non-perforated group. High levels of white blood cells (p = 0.004), C-reactive protein (p < 0.001), and serum amylase (p = 0.002), and low levels of albumin (p < 0.001) were significantly associated with the perforated group. All 14 patients with perforated choledochal cysts had ascites, whereas only 16% (33/204) of patients in the non-perforated group had ascites (p < 0.001). In the subgroup of patients who had ascites, a large amount of ascites (p = 0.001), increase in the amount of ascites in a short time (p < 0.001), complex ascites (p < 0.001), and perihepatic pseudocysts (p < 0.001) were more common in the perforated group than in the non-perforated group.
CONCLUSIONS: Children with perforated choledochal cysts have characteristic clinical and radiologic findings compared to those with non-perforated choledochal cysts. In young children with choledochal cysts, perforation should be differentiated in cases with acute symptoms, laboratory abnormalities, and characteristic ascites findings.
METHODS: Fourteen patients (mean age ± standard deviation, 1.7 ± 1.2 years) with perforated choledochal cysts (perforated group) and 204 patients (3.6 ± 3.8 years) with non-perforated choledochal cysts (non-perforated group) were included between 2000 and 2019. All patients underwent choledochal cyst excision after ultrasound, CT, or MR cholangiopancreatography. Relevant data including demographics, clinical symptoms, laboratory findings, imaging findings, and outcomes were analyzed. Statistical differences were compared using the Mann-Whitney U test and Fisher\'s exact test.
RESULTS: Choledochal cyst perforation occurred only in children under the age of 4 years. Acute symptoms, including fever (p < 0.001), were more common in the perforated group than in the non-perforated group. High levels of white blood cells (p = 0.004), C-reactive protein (p < 0.001), and serum amylase (p = 0.002), and low levels of albumin (p < 0.001) were significantly associated with the perforated group. All 14 patients with perforated choledochal cysts had ascites, whereas only 16% (33/204) of patients in the non-perforated group had ascites (p < 0.001). In the subgroup of patients who had ascites, a large amount of ascites (p = 0.001), increase in the amount of ascites in a short time (p < 0.001), complex ascites (p < 0.001), and perihepatic pseudocysts (p < 0.001) were more common in the perforated group than in the non-perforated group.
CONCLUSIONS: Children with perforated choledochal cysts have characteristic clinical and radiologic findings compared to those with non-perforated choledochal cysts. In young children with choledochal cysts, perforation should be differentiated in cases with acute symptoms, laboratory abnormalities, and characteristic ascites findings.
摘要：
目的：比较儿童胆总管囊肿穿孔和未穿孔的临床和影像学表现。
方法：14名患者(平均年龄±标准差，在2000年至2019年之间，包括1.7±1.2年）穿孔的胆总管囊肿（穿孔组）和204例（3.6±3.8年）未穿孔的胆总管囊肿（未穿孔组）。所有患者经超声检查后行胆总管囊肿切除术,CT,或者MR胰胆管造影术.相关数据，包括人口统计，临床症状,实验室发现,影像学发现，并对结果进行了分析。使用Mann-WhitneyU检验和Fisher精确检验比较统计学差异。
结果：胆总管囊肿穿孔仅发生在4岁以下的儿童中。急性症状,包括发烧（p<0.001），穿孔组比非穿孔组更常见。高水平的白细胞（p=0.004），C反应蛋白（p<0.001），和血清淀粉酶（p=0.002），和低水平的白蛋白(p<0.001)与穿孔组显著相关。所有14例胆总管囊肿穿孔患者均有腹水，而非穿孔组只有16%(33/204)的患者有腹水(p<0.001).在腹水患者亚组中，大量腹水（p=0.001），短时间内腹水增加（p<0.001），复杂的腹水（p<0.001），和肝周假性囊肿(p<0.001)在穿孔组比非穿孔组更常见。
结论：与未穿孔的胆总管囊肿相比，穿孔的胆总管囊肿患儿具有特征性的临床和影像学表现。在胆总管囊肿的幼儿中，穿孔应在有急性症状的情况下进行鉴别，实验室异常，和特征性腹水发现。
方法：14名患者(平均年龄±标准差，在2000年至2019年之间，包括1.7±1.2年）穿孔的胆总管囊肿（穿孔组）和204例（3.6±3.8年）未穿孔的胆总管囊肿（未穿孔组）。所有患者经超声检查后行胆总管囊肿切除术,CT,或者MR胰胆管造影术.相关数据，包括人口统计，临床症状,实验室发现,影像学发现，并对结果进行了分析。使用Mann-WhitneyU检验和Fisher精确检验比较统计学差异。
结果：胆总管囊肿穿孔仅发生在4岁以下的儿童中。急性症状,包括发烧（p<0.001），穿孔组比非穿孔组更常见。高水平的白细胞（p=0.004），C反应蛋白（p<0.001），和血清淀粉酶（p=0.002），和低水平的白蛋白(p<0.001)与穿孔组显著相关。所有14例胆总管囊肿穿孔患者均有腹水，而非穿孔组只有16%(33/204)的患者有腹水(p<0.001).在腹水患者亚组中，大量腹水（p=0.001），短时间内腹水增加（p<0.001），复杂的腹水（p<0.001），和肝周假性囊肿(p<0.001)在穿孔组比非穿孔组更常见。
结论：与未穿孔的胆总管囊肿相比，穿孔的胆总管囊肿患儿具有特征性的临床和影像学表现。在胆总管囊肿的幼儿中，穿孔应在有急性症状的情况下进行鉴别，实验室异常，和特征性腹水发现。
