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Objective:To discussed the diagnostic value of magnetic resonance cholangiopancreatography (MRCP), and the use of laparoscopic surgery in management of patients with choledochal cyst with extrahepatic bile duct anomaly.Methods:Of 330 consecutive patients who underwent laparoscopic choledochectomy at Guangzhou Women and Children's Medical Center from January 2010 to September 2018, there were 23 patients with extrahepatic bile duct anomaly. The data of these patients were retrospectively analyzed. There were 4 males and 19 females, with an average age of 3.2 (range 0.3~9.0) years. According to whether the extrahepatic bile duct anomaly was diagnosed by preoperative MRCP, these patients were divided into the preoperative MRCP diagnosis group and the preoperative MRCP undiagnosed group. The impact of MRCP in diagnosing bile duct anomaly to prevent bile duct injury, on operation time, hospital stay and the types of extrahepatic bile duct anomaly on outcomes of laparoscopic treatment were analyzed.Results:All the 23 patients with choledochal cysts complicated by extrahepatic bile duct anomaly were confirmed at surgery. The incidence of extrahepatic bile duct anomaly was 6.97% (23/330). There were 47.8% of type II AHD (11/23); 36.8% of type III AHD (7/23); 4.3% of type IV AHD (1/23); 17.4% (4/23) of the type with communication with accessory bile duct (CABD). The preoperative MRCP diagnosis group consisted of 14 patients, while the preoperative MRCP non-diagnosis group consisted of 9 patients, including 2 patients without MRCP. The diagnostic rate of MRCP in preoperative diagnosis of extrahepatic bile duct anomaly was 66.7%(14/21). The preoperative MRCP undiagnosed group, when compared with the preoperatives MRCP undiagnosed group, had a significantly higher bile duct injury rate [preoperative MRCP diagnosis group 7.1%(1/14), preoperative MRCP non-diagnosis group 55.6%(5/9)], and a significantly longer operation time [preoperative MRCP diagnosis group(232.6±10.0) min, preoperative MRCP undiagnosed group (278.9±22.45)min], (all P<0.05). Laparoscopic surgery was completed in 22 of 23 patients. One patient was converted to open surgery. AHD reconstruction was needed in 11 patients with type II AHD and 1 patient with type IV AHD. Seven patients with type III AHD did not require any surgical intervention for the anomaly. The 4 patients with CABD underwent simple ligation. Postoperative chyloperitoneum developed in 1 patient, who successfully responded to conservative treatment. Postoperative recovery was uneventful in the remaining patients. At a median follow-up of 2 years (range 1 to 5 years), no further complications, including intrahepatic bile duct dilatation and hepatic atrophy were detected. Conclusions:MRCP was effective in preoperative diagnosis of choledochal cysts with extrahepatic bile duct anomaly. It helped to decrease intraoperation injuries to bile duct anomalies. MRCP was also useful in classifying patients with extrahepatic bile duct anomaly to better preoperatively planning of surgical treatment strategies. Laparoscopic surgery could be completed in the majority of these patients with good postoperative results.
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Objective:To study the clinical outcomes of children with extrahepatic portal venous obstruction who underwent balloon venoplasties for anastomotic stenosis after Meso-Rex bypass.Methods:The data of 60 patients who underwent Meso-Rex bypass at Guangzhou Women and Children’s Medical Center between October 2014 and November 2018 were retrospectively analyzed. Four patients were shown by transhepatic portal venography to have graft stenosis in the left portal vein anastomosis. There were 2 males and 2 famales, the age of patients were 11 years, 5 years, 5 years and 8 years. Four patients underwent balloon dilation. The pressure, anastomotic diameter and blood flow velocity of the anterior portal vein were compared before and after balloon dilation. The patients were followed-up on the postoperative status.Results:Three of 4 patients who had anastomotic stenosis were successfully treated by balloon venoplasties. On postoperative follow-up for 6 months, the bridging vessels remained unobtrusive and there was no gastrointestinal bleeding. The pressures of the anterior hepatic portal vein before balloon dilation were 19, 15 and 25 mmHg (1 mmHg=0.133 kPa). They were 8, 11 and 20 mmHg after balloon dilation. The preoperative anastomotic diameters were 2.6, 3.0 and 3.0 cm. They were 6.0, 4.5 and 5.5 cm, respectively 6 months after surgery. The preoperative anastomotic blood flow velocities were 138, 107 and 94 cm/s. They were 96, 91 and 90 cm/s, respectively 6 months after surgery. The preoperative three-dimensional CT reconstruction of spleen volumes were 793.24, 192.25, and 318.05 cm 3, respectively. They were 681.84, 190.30, and 310.65 cm 3, respectively 6 months after surgery. In the remaining patient, balloon dilation failed because of the small diameter of the anastomotic stenosis segment. Conclusion:Balloon venoplasties is an optional procedure for patients with anastomotic stenosis after Meso-Rex bypass.
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Objective@#To study the diagnosis and management of choledochal cyst in children with accessory hepatic ducts (AHD).@*Methods@#From November 2013 to June 2018, 14 patients with choledochal cyst with AHD were treated in Guangzhou Women and Children's Medical Center. The patients included 2 males and 12 females, and age ranged from 4 months to 3 years (median 2 years). All patients underwent MRCP before operation, and 2 underwent operative cholangiography through the AHD.@*Results@#Seven patients with choledochal cyst and AHD were demonstrated by preoperative MRCP and intraoperative exploration. One patient was suspected by preoperative MRCP to have AHD which was confirmed by surgical exploration. Preoperative MRCP failed to diagnose, but operative exploration revealed AHD in 6 patients. Anastomosis of the AHD to jejunum was performed laparoscopically in 8 patients and by open surgery in 1 patient. Six patients had the common hepatic duct and the AHD joined together to create a common channel which was then implanted as a single duct into a Roux loop, Three patients had the common hepatic duct and the AHD anastomosed separately to a Roux loop. All the patients recovered well after operation and they were discharged home without any complication. A follow-up which ranged from 0.5 to 5 years showed no jaundice, liver atrophy or liver abscess.@*Conclusions@#MRCP was important in the preoperative diagnosis of choledochal cyst with accessory hepatic duct in children. MRCP was difficult in diagnosing type II accessory hepatic ducts. In suspected or undiagnosed cases of AHD, surgical exploration helped to improve the diagnostic accuracy, avoided injury and guided correct surgical decisions. Reconstruction of AHD required joining the AHD to the common hepatic duct, or as a separate duct to jejunal anastomosis to a Roux-y-loop.
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Objective To study the diagnosis and management of choledochal cyst in children with accessory hepatic ducts ( AHD) . Methods From November 2013 to June 2018, 14 patients with choledochal cyst with AHD were treated in Guangzhou Women and Children 's Medical Center. The patients included 2 males and 12 females, and age ranged from 4 months to 3 years (median 2 years). All patients underwent MRCP before operation, and 2 underwent operative cholangiography through the AHD. Results Seven patients with choledochal cyst and AHD were demonstrated by preoperative MRCP and intraoperative explora-tion. One patient was suspected by preoperative MRCP to have AHD which was confirmed by surgical explo-ration. Preoperative MRCP failed to diagnose, but operative exploration revealed AHD in 6 patients. Anasto-mosis of the AHD to jejunum was performed laparoscopically in 8 patients and by open surgery in 1 patient. Six patients had the common hepatic duct and the AHD joined together to create a common channel which was then implanted as a single duct into a Roux loop, Three patients had the common hepatic duct and the AHD anastomosed separately to a Roux loop. All the patients recovered well after operation and they were discharged home without any complication. A follow-up which ranged from 0. 5 to 5 years showed no jaundice, liver atrophy or liver abscess. Conclusions MRCP was important in the preoperative diagnosis of choledochal cyst with accessory hepatic duct in children. MRCP was difficult in diagnosing type Ⅱ accessory hepatic ducts. In suspected or undiagnosed cases of AHD, surgical exploration helped to improve the diagnostic accuracy, avoided injury and guided correct surgical decisions. Reconstruction of AHD required joining the AHD to the common hepatic duct, or as a separate duct to jejunal anastomosis to a Roux-y-loop.
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Objective To assess the mid-term result of laparoscopy in resection of choledoehal cyst,hepaticojejunostomy and discuss the technical improvement.Methods Retrospectively analyzed the data of 31 patients who had undergone laparoscopic choledochal cyst excision from November 2010 to November 2012.Under laparoscopic guidance,intraoperative cholangiogram was performed,Rorx-Y jejunojejunostomy was performed extracorporeally through umbilical incision,then the dilated bile duct were completely excised and a hepaticojejunostomy was carried out intracorporeally.Results Twenty-nine patients successfully underwent laparoscopic choledochal cyst resection,while 2 patients were converted to open surgery because of severe adhesion.The mean operation time was 260 minutes (range from 200 to 460 minutes).A follow-up of 3 to 27 months were achieved in all patients.Three patients developed early complications:one bile leakage,one incision port hemorrhage and one intestinal torsion.The laboratory tests were normal and no dilation of the bile duct was detected in all patients.Conclusions Laparoscopic total cyst excision with Roux-Y hepaticojejunostomy was effective and safe procedure with satisfied results.
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ObjectiveTo explore the importance and significance of classification diagnosis and treatment of chordee among hypospadias in children.MethodsA random sample review and controlled study was made in patients with hypospadias and chordee from 1989 to 2011 in First Affiliated Hospital of Sun Yat-Sen University,and the patients were divided into 2 groups.There were 232 cases in group A,who were all diagnosed as chordee only on the basis of clinical symptoms or an erection induced by artificial stimulation before operation.All the 232 cases were corrected empirically without objective assessment by degloving the penis,dissecting superficial and deep fascia,and cutting off the urethral plate,and so on during operation.There were 25 cases in group B,who were all strictly implemented on classification diagnosis and treatment of chordee,in sponge saline injection test during operation and correction effect evaluation after operation.Chordee was classified according to different etiology and pathology:skin type,fascia-type,urethra type,sponge type and the glans of penis type.There were different operating methods in different ways of folding tunica albuginea.ResultsIn group A,86 patients (37％) had postoperative recurrence of chordee,25 patients ( 11％ ) had pain during erection after surgery,183 patients were satisfied with correction of chordee (79％).In group A,25 patients were in their adulthood when followed up,and 7 patients had IIEF-5 score ＜21 points.In group B,the single type of chordee among hypospadias were 7/25 (28％),merged type were 18/25 (72％).All patients were followed up without chordee recurrence or painless erection,and 100％ patients or families were satisfied with correction of chordee.The efficacy difference were statistically significant between the two groups in chordee correction.In folding tunica albuginea group in group B,the penile erection length was (4.58 ± 1.59) cm before the correction,and (6.16 ±2.54) cm after correction.In non-folding tunica albuginea group,penile erection length was (4.O1 ± 1.18 ) cm before correction,and (5.82 ± 1.51 ) cm after correction.The difference was not significant between the 2 groups in penile erection length (P ＞ 0.05 ).ConclusionsSurgeon should pay more attention to the correction,effect evaluated,classified etiology and pathological diagnosis of hypospadias and chordee.And the targeted selection of the correct treatment of chordee can further improve the therapeutic effect.Chordee of hypospadias can exist in single or merged according to the pathological classification.Chordee correction surgery can increase length of penis,and dorsal tunica albuginea plication had no significantly different effect on the length of the penis compared to other chordee corrective surgery.
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Objective To investigate the indications and results of long channel technique with pedicle inner preputial flap urethroplasty for middle hypospadias repair. Methods During September 2007 to April 2010,28 cases of middle hypospadias were include in this study.The average age was 2.0 years (1.5 -6.0 years).The orifice of urethra was opened in the shaft of penis,and the distance between the urethral meatus and the center of glans was 25 mm ( 16 - 37 mm).A pars-meatus skin incision was made,which was dissected deep to the urethral plate.The urethral plate was transected,and a long channel between the urethral plate and the corpora cavernosa was created.The neourethra was made from the inner prepuce,and transposed to the ventral tunnel through a tunnel between buck's fascia and albuginea of ventrolateral corpora cavernosa.The neourethra was anastomosed with the proximal urethra.The buck's and dartos fascia along the skin incision were brought together and sutured individually,covering the proximal neo-urethra and the anastomosis.Induced penile erection confirmed that 13 cases were with mild penile curvature,and the other 15 case were without penile curvature.The average length of the defected urethra and tunnel was 38 mm (30 -42 mm) and 33 mm (26 -38 mm). ResultsSuccess was achieved in all cases without fistula or urethral stricture formation with the average follow-up of 20 months (6 -31 months),and penile curvature was completely corrected.The urethra was opened in the apex of the glans with normal-looking circumcised penis. ConclusionsLong channel technique with pedicle inner preputial flap urethroplasty can provide another option for repairing middle hypospadias without penile curvature or with mild penile curvature,especially for young children and those with small penis.This technique is simple,and the result is satisfied.