■胰胆管连接异常(PBM)通常与胆总管囊肿(CC)有关。根据欧洲的一项多中心研究,在CC病例中,PBM的患病率为72.2%,然而,没有印度的研究描述了印度CC儿童中PBM的患病率,是CC发病的主要假定因素之一。在这项研究中,我们尝试前瞻性观察CC患儿中PBM的患病率,并将其与形态学和生化指标相关联.PBM的存在与组织病理学发现之间的关联,例如CC粘膜的上皮变化,炎症,化生或发育不良,肝脏的组织病理学也得到了评估。
■我们进行了一个中心,单臂研究组的前瞻性观察性研究。我们前瞻性选择了2018年11月至2020年10月接受手术的所有CC患者。生化数据,放射学,收集并分析组织病理学参数。
■我们共纳入20名患者。参与者的平均年龄为6.22±4.32岁。其中,男性11人(55.0%),女性9人(45%)。腹痛是我们患者中最常见的主诉(75.0%),并且与PBM的存在显着相关(P=0.001)。在有症状的儿童中,黄疸症状的平均持续时间为4.50±2.26个月,腹胀4.50±1.98个月,腹痛5.07±2.02个月。在3名患有胆管炎的儿童中,平均发作次数为3.33±2.08,中位数为4次.14名(70.0%)儿童患有Ⅰ型CC,Ib型各1名(5.0%)参与者,IC,其中II和IVa和2(10.0%)患有IVb型囊肿。囊肿的平均大小(cm)为7.41±3.03,中位数为6.85cm。在孩子中,9(45%)在磁共振胰胆管造影(MRCP)上显示存在PBM,其中7(77.8%)显示科米的C-P类型,2(22.2%)显示科米的PC类型。MRCP上的平均公共通道长度(mm)为8.11±2.47,中位长度为8.00mm。胆汁液淀粉酶和脂肪酶的生化分析是PBM存在的功能指标。组织病理学检查显示,在10个(50.0%)的标本中,CC壁中存在溃疡。在CC的粘膜中存在PBM和溃疡的存在显著关联(P≤0.001),在PBM存在的组中,中位数水平最高。
■腹痛是CC患儿最常见的主诉,当存在时,它与PBM的存在显著相关。MRCP是检测CC并找出PBM形态的金标准工具。CC儿童中PBM的患病率为45%,平均公共通道长度为8.11mm。胆汁淀粉酶和脂肪酶的生化分析是PBM存在的功能指标,它们的较高水平与PBM的存在存在显着关联。慢性炎症和微观溃疡的存在是描述PBM存在的重要组织学参数。
UNASSIGNED: Pancreatico-biliary maljunction (PBM) is often found to be associated with choledochal cysts (CCs). According to a European multicenter
study, the prevalence of PBM in cases of CC is found to be 72.2%, however, there is no Indian
study depicting the prevalence of PBM in Indian children with CCs, which is one of the main postulated factors in the etiopathogenesis of CC. In this
study, we have attempted to observe prospectively the prevalence of PBM in children with CC and correlate this to its morphological and biochemical parameters. The association between the presence of PBM and histopathological findings such as epithelial changes of the mucosa of the CC, inflammation, metaplasia or dysplasia, and histopathology of the liver has also been evaluated.
UNASSIGNED: We carried out a single center, prospective observational study with a single arm
study group. We prospectively selected all patients of CC admitted for surgery from November 2018 to October 2020. Data on biochemical, radiological, and histopathological parameters were collected and analyzed.
UNASSIGNED: We included a total of 20 patients in our
study. The mean age of the participants was 6.22 ± 4.32 years. Among them, 11 (55.0%) were male and 9 (45%) were female. Abdominal pain was the most common presenting complaint among our patients (75.0%) and had a significant association with the presence of a PBM (P = 0.001). In symptomatic children, the mean duration of symptoms was 4.50 ± 2.26 months for jaundice, 4.50 ± 1.98 months for abdominal distension, and 5.07 ± 2.02 months for abdominal pain. Among the 3 children with cholangitis, the mean number of episodes was 3.33 ± 2.08, with a median of four episodes. Fourteen (70.0%) of the children had type I a CC, 1 (5.0%) participant each for types I b, I c, II and IV a and 2 (10.0%) of them had type IV b cyst. The mean size of the cyst (cm) was 7.41 ± 3.03 with a median of 6.85 cm. Among the children, 9 (45%) showed the presence of PBM on magnetic resonance cholangiopancreatography (MRCP), with 7 (77.8%) showing Komi\'s C-P type and 2 (22.2%) showing Komi\'s PC type. The mean common channel length (mm) on MRCP was 8.11 ± 2.47 with a median length of 8.00 mm. The biochemical analysis of a bile fluid amylase and lipase is the functional indicator of the presence of a PBM. Histopathological examination showed the presence of ulceration in the walls of the CC in 10 (50.0%) of the specimens. There was a significant association of the presence of PBM and ulceration in the mucosa of the CC (P ≤ 0.001), with the median levels being the highest in the PBM present group.
UNASSIGNED: Abdominal pain is the most common complaint in a child with CC, and when present, it is significantly associated with the presence of a PBM. MRCP is the gold standard tool to detect CCs and find out the morphology of PBM. The prevalence of PBM in children with CC of 45% with a mean common channel length of 8.11 mm. The biochemical analysis of a bile amylase and lipase is the functional indicator of the presence of a PBM and there is a significant association of their higher levels and presence of PBM. The presence of chronic inflammation and microscopic ulcers is significant histologic parameters depicting the presence of a PBM.