To Analyze The Diagnosis,treatment And Prognostic Factors Of Pancreaticobiliary Maljunction

Objective Through the analysis of clinical data of children with pancreaticobiliary maljunction(PBM).To understand the possible factors that affect the prognosis of abnormal pancreaticobile duct,so as to achieve early diagnosis,early treatment,reduce the occurrence of complications,improve the quality of clinical treatment and prognosis of children.Methods One multicenter study was conducted to analyze the clinical data of 141 children diagnosed as PBM with complete cystectomy and hepatic duct jejunal Roux-en-Y anastomosis.Clinical data include clinical manifestations,laboratory examinations,Imaging examination,surgical procedures,etc.SPSS 20 was used for statistical analysis.Results Of the 120 children diagnosed with ultrasonography,104 were diagnosed with congenital bile duct dilatation.Of the 40 children diagnosed with CT,38 were diagnosed with congenital bile duct dilatation and 9 with PBM.Of the 112 Patients examined by MRCP,109 were diagnosed with congenital bile duct dilatation and 79 with PBM.Of the 106 children diagnosed with intraoperative cholangiography,86 were diagnosed with PBM.The significant differences between MRCP and CT(P <0.001),MRCP and US(P < 0.001),IOC and CT(P <0.001),IOC and US(P <0.001),CT and US(P< 0.001)were shown in the diagnostic rates;There is no significant difference between IOC and MRCP(P = 0.068).All 141 children underwent operation successfully,and 54(38.3 %)received laparoscopic surgery.Results: The operative time of laparoscopic surgery was significantly higher than that of traditional operation group(P < 0.05),but the mean blood loss,postoperative hospital time and postoperative exhaust time were lower than those of traditional operation group(P < 0.05).In addition,there was no significant difference between complications of the two groups(P > 0.05).Univariate analysis showed that laparoscopic surgery,preoperative total bilirubin,preoperative direct bilirubin,vomiting and jaundice were significantly associated with the duration of hospital stay(P < 0.05).The multivariate analysis confirmed that laparoscopic surgery,preoperative direct bilirubin,and vomiting were independently associated with hospital stay of PBM patients.ROC curves indicated that laparoscopic surgery,preoperative direct bilirubin,and vomiting were predictive of the duration of hospital stay(AUC = 0.633?0.661,and0.642,respectively).Conclusions1.MRCP is a noninvasive and feasible method for the diagnosis of pancreaticobiliary maljunction,which can be used as the first choice for the diagnosis of PBM.2.Laparoscopic cyst excision and hepatic duct jejunum Roux-en-Y anastomosis have the characteristics of small trauma and quick recovery in children.It is worth popularizing in children.3.Laparoscopic surgery,preoperative serum bilirubin level and vomiting are independent factors that affect the hospitalization time of PBM in children.These findings may play a role in improving the quality of PBM treatment in children.