The Evaluation Of Modified Roux-Y Hepaticojejunostomy To Treat Congenital Biliary Dilation

Researching background and Objective Congenital Biliary Dilation (CBD) is one of the most commonly biliary tract diseases. Because the drainage of the bile is hindered, the cyst should be excised and the biliary tract should be reconstructed as early as possible once the disease is diagnosed, the viewpoint was accepted by people. In spite of internal drainage procedure is common, the complications occure frequently especially the reflux of the intestinal contents. We still have no a better operation procedure to eliminate cholangitis even though many experts have designed some modified procedure to intense the the effectiveness and effected at some extent. Cholangitis after hepaticojejunostomy is still a formidable problem. To evaluate the efficacy of the modified hepaticojejunostomy performed during the treatment of CBD,we have made a retrospective analysis in children who have accepted the treatment and followed up them. So that we can improve clinical techniques.Methods We reviewed and followed up 137 children with CBD who were admitted into Provincial Hospital Affiliated to Shandong University from 1993 to 2009, it contains 53 males and 84 females, the age ranged from 21 days to 13.2 years (3.22±2.90). There were 117 cases among those children have underwent the modified hepaticojejunostomy. 60 cases were evaluated on the state of health, the information was recorded in the standard questionnaires with different postoperative time. The state of heath preoperation and long-term clinical manifestations postoperation, the state of growth, physiological function, mental status were investigated. Some auxiliary examinations (Hepatic function test, Biochemistry, Hemocytes examinations, B-mode ultrasoundscanning, CT, MRI and Gastroenterograph) were made on the children.Results Clinical symptoms included: abdominal pain 82/137, jaundice in 75/137, fever 35/137, mass of the abdomen 49/137, vomiting66/137, trilogyl 6/137. 7cases perforated during the 117cases underwent the modified hepaticojejunostomy when they were admitted into hospital, the age range from 1.4 years to 3.3 years.2 cases with ankylenteron,1 case with cutting infection,3 cases with cutting splitting after the operation, the age range from 21 days to 2 months years. All the cases followed up were diagnosed by B-mode ultrasound scanning and CT, during them 12cases are scanned by MRI and been diagnosed. During our following-up,60 cases are classified into 3 groups, according to the standard clinical scoring systems. 40(66.7%) cases have no stomachache and they don't need to control food.17(28.3%) cases have stomachache some times, they have no fever and jaundice, they have no need of especial treatment.3(5%) cases have stomachache frequently, they need outpatient treatment or hospitalization sometimes. B-mode ultrasoundscanning were made in all cases,11(18.3%)cases have reflux, 1case(1.7%)with calculus of bile duct; Gastroenterograph were performed in 2lcases,5 cases with gastritis, others are normal. During the 60cases, 6cases(10%) with introversional character because of the abdominal scar; The result of hepatic function test, biochemistry and hemocytes examinations were normal. Growth and development were normal in the children who were followed up.60 cases are classified into 3 groups according to the ages:babies (below 12 months), infants (13 months-3 years), children (3 years-14 years). Because complications after operation are different, we classify children into two groups:babies (≤1 Y)和children (> 1Y).The data were analyzed by SPSS software. Statistical significance was evaluated using SPSS software, and a P value of less than 0.05 was regarded as a significant difference.Conclusion (1) The children who with perforation of choledochus are usually very serious and has a high mortality. All followed patients were performed by internal drainage with a "T" tube, then were treated with the modified hepaticojejunostomy, they all obtained good effectivness.(2) Although the children with CBD were fairly rare below 3 months, their pathology and physiology state changed obviously. Also their hepatic function and nutritional state were bad. those patients can easily occur some complications, for example, ankylenteron, intestinal obstruction, cutting splitting and so on, so these patients should be diagnosed and treated as soon as possible. Long-term effectiveness are content.(3) Hepatispneumatosis has no direct relation with clinical manifestations according to following results; Not all the patients with calculus of bile duct have obvious clinical manifestations, the manifestations still request further observation.(4)Babies'main Clinical symptoms of CBD are jaundice, other children main present abdominal pain or vomiting, typical trilogy is seldom. B-mode ultrasoundscannings, CT scanning and MRI should be the first choice in the diagnosis of CBD, so we can avoid delaying treatment.(5) Daily life, character, growth and development were normal in the children who were followed up.(6) This modified anti-reflux set is similar to physiological function. Clinical manifestations of 3 groups according to the ages have some differences. The more early the procedures were performed, the less long-term complications occurred.Quality of life, growth and development are most normal mostly. Incidence rates of Calculus of bile duct and stomastenosis are very low. But we should take attention of the infants and the severe patients.We should diagnose the disease early and take suitable measures. We should pay attention to recent and long-term complications. The modified Roux-Y hepaticojejunostomy is a feasible method to treat Congenital Biliary Dilation (CBD) in children.