Value Of Endoscopic Retrograde Cholangiopancreatography In Diagnosis Of Congenital Choledochal Cyst

Objective: Analysis of congenital choledochal cyst in the performance of endoscopic retrograde cholangiopancreatography in order to explore retrograde cholangiopancreatography as a congenital choledochal cyst diagnosed with non-surgical pathology clinical value.Methods: In our hospital from March 1990 to December 2009 have been 22 cases of pathologically confirmed cases of congenital choledochal cyst in the preoperative endoscopic retrograde cholangiopancreatography imaging performance analysis, retrograde cholangiopancreatography image learning results with surgery and pathology results were compared. The data obtained using the x~2 test was used for statistical analysis.Results: By ERCP diagnosis and surgical pathologic diagnosis consistent with the situation, obtained through the analysis of ERCP and surgical pathology diagnostic methods CCC rates are very high, respectively 95.45% and 100%, we can see through the x~2 test, x~2 = 1.02, P>0.05, These two methods for the diagnosis of CCC was no significant difference between the difference was not statistically significant, preoperative ERCP and surgical pathology diagnostic accuracy of the CCC fairly. Congenital choledochal cyst, also known as congenital cystic dilatation of common bile duct, cysts can be found in any part of the extrahepatic bile duct, some cases of cysts seen in the stones, or cancer occurrence. Since this disease is autosomal recessive, and therefore clinically very rare in this disease, but with the continuous advancement of diagnostic tools, disease-positive diagnostic data continues to grow, information is displayed as 51%. It is reported that Asian countries, the incidence of congenital choledochal cyst was significantly higher than the Western countries, Asian countries to Japan-prone, Japanese scholars Kimura reported that the incidence in Japan compared to 0.1%, an American scholar Hugs reported incidence of this disease compared to 0 .001%, in our country has not yet seen a clear incidence of reporting. Proportion of the difference in incidence may be related to living environment, as well as genetic and gene mutation and other factors. Clinical CCC is divided into five categories: I type as cystic expansion;â…¡type of diverticulum-like expansion;â…¢type of cystic bile duct orifice valve prolapse; IV type for extrahepatic biliary dilatation; V type for the intrahepatic bile duct cyst (Caroli disease). The clinical manifestations of this disease more obvious, often accompanied by other symptoms, infants and young children is a congenital choledochal cyst with multiple groups and the patients age, more in early childhood to 10 years ago, adult patients in about 5% to 8%. Another report showed that about 20% to 25% of the patients are in the adult after the onset. This may be obvious early symptoms of the individual organism to withstand the disease come to medical treatment when the different levels of development of the disease have a close relationship. Cause of congenital choledochal cyst study is not yet very clear, at present there are three theories, Babbit made with anomalous pancreaticobiliary junction (AJPBD) is the main cause of congenital choledochal cyst, pancreatic juice back into the bile duct, causing bile duct epithelium the damage caused by Caroli, triggering the disease. There are theories that the common bile duct distal nerve, muscle dysplasia of the main reasons leading to cystic dilatation of common bile duct, cyst wall of a lack of ganglion cells, some scholars believe is due to a lack of ganglion cells induced by common bile duct cyst. Yotuyanagi make embryonic bile duct epithelial cells proliferated actively.Cause of common bile duct obstruction caused by cystic dilatation of common bile duct. At present, Babbit's theory accepted by most, and clinical data have repeatedly proved this theory. Extrahepatic bile duct system of the fetus form a majority in the first 5 weeks and 7 weeks, 5mm in the fetal stage, the duodenum, the ventral membrane buds and proximal extrahepatic bile duct rotation, the surface of common bile duct into the duodenum left and the Department of lining epithelial hyperplasia in the bile duct system to form a substantial cell Faso, after integration into the cavity shape and cavity shape and in the vacuole fusion occurs during cavity abnormalities, congenital choledochal cyst can form. In addition, adults suffering from the symptoms of choledochal cyst due to inter -Breaking and non-specific, causing disease is difficult to be an early and therefore have inflammation of weight, easy to concurrent cholangitis, common bile duct stones, biliary atresia, acute pancreatitis, bile duct and so on. Thus, for such congenital to achieve early diagnosis, early treatment, ERCP technology is perfectly suited to the requirements of this disease, early diagnosis of disease can be oriented to provide a reliable basis for early treatment in order to provide direction, to prevent cancer and to enhance quality of life. For patients with congenital choledochal cyst, ERCP, when the majority of the line exist in varying degrees of difficult intubation, the current maturity of the technology of the medical unit for biliary and pancreatic diseases is still as high as 5 to 20% of the selectivity of pure bile duct cannulation the failure rate. ERCP caused by repeated intubation is an important factor in postoperative complications, so to choose a variety of ways to achieve selective bile duct cannulation effect, and not recommended repeatedly intubation. In order to overcome this problem, some scholars have proposed a dual-guide wire method, and after pancreatic sphincterotomy pre-cut method, the clinical use of these two methods is more extensive.Pairs of guide wire method can solve a considerable number of cases of difficult intubation ERCP problems, there is a small part of the pairs of guide wire method can not be solved, it is necessary in some patients with pancreatic sphincterotomy by law, some scholars have suggested that common bile duct and pancreatic Pipe a layer between the thin film, and sometimes difficult intubation is a selective membranes of this layer is caused by pancreatic sphincterotomy when using pre-cut law, this layer of film was cut, which makes intubation changes smoothly, it was reported that this law is effective up to 100%. ERCP line, we find that the appropriate adjustment can be a better posture in patients with duodenal major papilla exposed position, and can use this method to remove the X-ray gas in the interference factors, but also can be adjusted common bile duct stones position. In 22 routine ERCP examination in patients with congenital choledochal cyst in deaths does not appear, examination, were placed in naso-biliary drainage, and anti-inflammatory treatment, are consistent with the line status of pre-ERCP in some patients into the nose as after the common bile duct drainage unobstructed, jaundice symptoms were relieved or disapp- eared.Many cases of congenital choledochal cyst associated with anoma- lous pancreaticobiliary junction, some patients with congenital choled- ochal cyst associated with bile duct stones. With pancreatic duct confluence of typing methods, (1) B-P type, that is, to import the main pancreatic duct common bile duct to form a common channel; (2) P-B type, that is, to import the main pancreatic duct common bile duct. At the same time see if accompanied by common bile duct stones. Through data analysis, application x~2 test we can see them in the ERCP and surgical pathologic classification for the diagnosis of CCC in comparison x~2= 0, P>0.05, no difference between the two diagnostic methods; ERCP and surgical pathology of the CCC approach classification of pancreatic duct confluence diagnosisComparative aspects of x~2 = 0.0024, P>0.05, no difference in the two diagnostic methods; ERCP and surgical pathology of the CCC with the diagnosis of common bile duct stones in comparison x~2= 0.23, P>0.05, no difference in the two diagnostic methods.Conclusion: Preoperative ERCP is not only able to observe the existence of CCC, the CCC to conduct clinical classification, but also can determine whether the CCC associated with anomalous pancreaticobiliary junction, anomalous junction of pancreaticobiliary duct clinical classification, and can be observed that CCC is associated with common bile duct stone. We can see the vast majority of congenital choledochal cyst associated with anomalous pancrea- ticobiliary junction, and close relationship with anomalous pancreaticobiliary junction; some cases of congenital choledochal cyst accompanied by common bile duct stones; ERCP observations of congenital choledochal cyst is very precise, and can simultaneously display the shape of biliary and pancreatic system, and whether or Office for common bile duct stones,be able to provide clear guidance for the operation; ERCP for preoperative diagnosis of choledochal cyst is indeed very high degree of potential, and safety, can be used as confirmed to replace the standard of surgical pathology.