背景:胆总管囊肿是罕见的先天性胆道畸形,可能导致梗阻,慢性炎症,感染,和恶性肿瘤。切除的时间差异很大,手术入路,和重建技术。结果很少在国家一级进行比较。
方法:我们查询了儿科国家手术质量改善计划(NSQIP),以确定2015年至2020年接受胆总管囊肿切除术的患者。患者通过肝十二指肠吻合术(HD)和Roux-en-Y肝空肠吻合术(RNYHJ)进行分层,使用微创手术(MIS),和手术年龄。我们收集了几个结果,包括停留时间(LOS),再操作,并发症,输血,和再入院率。我们使用非参数检验和多元回归比较了队列之间的结果。
结果:总之,407名患者符合研究标准,150人(36.8%)接受了RNYHJ重建,100人(24.6%)只接受了管理信息系统,而不足一岁的有111人(27.3%)。接受开放手术的患者年龄较小(中位年龄2.31vs.4.25年,p=0.002),更有可能接受RNYHJ重建(42.7%vs.19%,p=0.001)。在调整后的分析中,LOS的结果,再操作,输血,重建类型之间的并发症相似,手术入路,和年龄。接受RNYHJ的患者再入院率低于接受HD的患者(4.0%vs.10.5%,或0.34,CI[0.12,0.79],p=0.02)。
结论:胆总管囊肿患儿,重建技术之间的大多数短期结果是相似的,手术入路,切除时的年龄,尽管在这项研究中HD重建与较高的再入院率相关。临床决策应由长期和胆道特异性结果驱动。
Choledochal cysts are rare congenital anomalies of the biliary tree that may lead to obstruction, chronic inflammation, infection, and malignancy. There is wide variation in the timing of resection, operative approach, and reconstructive techniques. Outcomes have rarely been compared on a national level.
We queried the Pediatric National Surgical Quality Improvement Program (NSQIP) to identify patients who underwent choledochal cyst excision from 2015 to 2020. Patients were stratified by hepaticoduodenostomy (HD) versus Roux-en-Y hepaticojejunostomy (RNYHJ), use of minimally invasive surgery (MIS), and age at surgery. We collected several outcomes, including length of stay (LOS), reoperation, complications, blood transfusions, and readmission rate. We compared outcomes between cohorts using nonparametric tests and multivariate regression.
Altogether, 407 patients met the study criteria, 150 (36.8%) underwent RNYHJ reconstruction, 100 (24.6%) underwent MIS only, and 111 (27.3%) were less than one year old. Patients who underwent open surgery were younger (median age 2.31 vs. 4.25 years, p = 0.002) and more likely underwent RNYHJ reconstruction (42.7% vs. 19%, p = 0.001). On adjusted analysis, the outcomes of LOS, reoperation, transfusion, and complications were similar between the type of reconstruction, operative approach, and age. Patients undergoing RNYHJ had lower rates of readmission than patients undergoing HD (4.0% vs. 10.5%, OR 0.34, CI [0.12, 0.79], p = 0.02).
In children with choledochal cysts, most short-term outcomes were similar between reconstructive techniques, operative approach, and age at resection, although HD reconstruction was associated with a higher readmission rate in this study. Clinical decision-making should be driven by long-term and biliary-specific outcomes.