Objective: To explore the factors influencing the occurrence of postoperative cholangitis in children with congenital choledochal cysts, and to provide a theoretical basis for preventing the occurrence of postoperative cholangitis. Methods: A retrospective analysis was conducted on the clinical data of 127 children with congenital choledochal cysts who underwent laparoscopic surgery in our hospital from September 2020 to September 2022. Based on whether the postoperative cholangitis occurred, the patients were divided into the cholangitis group(n=21) and the non-cholangitis group(n=106). Clinical data were compared between the two groups to identify independent factors influencing the occurrence of postoperative cholangitis, and the predictive efficacy of these independent factors was evaluated using the receiver operating characteristic(ROC) curve. Results: Univariate analysis indicated that cyst diameter, anemia, the presence of biliary sludge and stones, and albumin levels on postoperative day 3 were associated with the occurrence of postoperative cholangitis in children with congenital choledochal cysts(P<0.05). Multivariate analysis revealed that anemia and the presence of biliary sludge and stones were independent risk factors for postoperative cholangitis, while albumin levels on postoperative day 3 were an independent protective factor(P<0.05). ROC curve analysis demonstrated that the three independent factors had predictive value for postoperative cholangitis, with areas under the curve(AUC) of 0.715, 0.744, and 0.753, respectively. Conclusion: The occurrence of postoperative cholangitis in children with congenital choledochal cysts is closely related to anemia, the presence of biliary sludge and stones, and albumin levels on postoperative day 3. These factors have good predictive value for postoperative cholangitis and can guide targeted clinical interventions. |
[1] TAKAGI K,UMEDA Y,YOSHIDA R,et al.Robotic surgery for congenital biliary dilatation using the scope switch technique(with video)[J].Asian J Surg,2023,46(10):4399-4402.
[2] ZHANG M X,CHI S Q,CAO G Q,et al.Comparison of efficacy and safety of robotic surgery and laparoscopic surgery for choledochal cyst in children:a systematic review and proportional meta-analysis[J].Surg Endosc,2023,37(1):31-47.
[3] AMANO H,SHIROTA C,TAINAKA T,et al.Late postoperative complications of congenital biliary dilatation in pediatric patients:a single-center experience of managing complications for over 20 years[J].Surg Today,2021,51(9):1488-1495.
[4] 章开智,陈雨彤,郑泽兵,等.肝脏CD4+T细胞、IL-6、IL-8、IL-33的表达与术后胆管炎及黄疸清除的关系研究[J].中华小儿外科杂志,2022,43(12):1088-1094.
[5] BUXBAUM J L,BUITRAGO C,LEE A,et al.ASGE guideline on the management of cholangitis[J].Gastrointest Endosc,2021,94(2):207-221.
[6] ARAFA A,RAGAB M,ELTAGY G H.Laparoscopic hepaticoduodenostomy for choledochal cysts in children<1 year[J].Afr J Paediatr Surg,2022,19(1):36-39.
[7] YAN C,CAO J,ZHENG C,et al.Risk factors and impact on bile leakage in patients with choledochal cysts:a retrospective case-control analysis[J].Updates Surg,2021,73(6):2225-2229.
[8] FERSTL P G,QUECK A,BREMER K,et al.Comparison of short-course antibiotic therapy of 6 or less days with a longer treatment in patients with cholangitis after liver transplantation[J].Transpl Infect Dis,2022,24(4):e13868.
[9] 魏杰,王翔.经内镜逆行胰胆管造影术后并发胰腺炎及胆管炎的危险因素分析[J].中国普通外科杂志,2023,32(9):1415-1420.
[10] MIYATA T,MATSUI D,FUJIWARA Y,et al.Predictive factors for developing acute cholangitis and/or cholecystitis in patients undergoing delayed cholecystectomy:a retrospective study[J].Asian J Surg,2021,44(1):280-285.
[11] KAWAGUCHI Y,TERUI K,KOMATSU S,et al.Usefulness of hepatobiliary scintigraphy for predicting late complications in patients with choledochal cysts[J].Pediatr Surg Int,2022,38(12):1839-1845.
[12] 向强兴,周宇翔,唐湘莲,等.小儿先天性胆总管囊肿腹腔镜手术治疗后并发胆管炎的危险因素分析[J].肝脏,2023,28(7):845-848.
[13] HONDA M,SHIMOJIMA N,MAEDA Y,et al.Factors predicting surgical difficulties in congenital biliary dilatation in pediatric patients[J].Pediatr Surg Int,2023,39(1):79.
[14] 金明均,董亮,杨宏,等.腹腔镜下手术在儿童先天性胆总管扩张中的应用分析[J].河北医科大学学报,2021,42(9):1073-1077. |