1.What is choledochal cyst?
A: It is a dilatation of the common bile duct connected to the liver, which usually appears as a cystic mass called choledochal cyst (bile duct dilatation).
2.Why does choledochal cyst occur in fetus?
A: Because choledochal cyst is an embryonic disease, the common bile duct starts to excrete bile when the fetus is 18-20 weeks old, and if the common bile duct is narrowed or blocked, the common bile duct will dilate and form a cyst.
3.When can fetal common bile duct cysts be detected at the earliest?
A: The fetal bile ducts start to develop at 4 weeks of embryonic life and are formed at 5 weeks. The intrahepatic bile ducts are formed at about 8 weeks of gestation, but the bile ducts do not connect with the intestinal ducts until 13-16 weeks, when bile begins to be secreted and excreted into the intestine. If there is a stricture or blockage in the common bile duct and the duct dilates to form a cyst, then a common bile duct cyst can be detected as early as 15-20 weeks of fetal life.
4.How to determine the fetal common bile duct cyst?
A: At present, prenatal 3D ultrasound of the fetus during pregnancy can be initially determined. Other abdominal cystic masses: mesenteric cyst, renal cyst, cystic teratoma, etc. need to be identified, but mainly with choledochal atresia type biliary atresia, because the ultrasound performance of the latter is almost the same as that of choledochal cyst, and the prognosis is extremely poor.
5.How to distinguish fetal common bile duct cyst from biliary atresia (choledochal atresia type)?
A: The gallbladder of common bile duct cyst can be clearly shown under ultrasound, while the gallbladder of biliary atresia is not clearly shown or not seen; the common bile duct cyst can gradually increase in size, while biliary atresia has no significant increase in size; most postnatal jaundice of common bile duct cyst is not obvious, and the jaundice is fluctuating and sometimes light; jaundice of biliary atresia occurs early, progressively worsens, and liver function is heavily impaired.
6.What is the prognosis of common bile duct cyst and biliary atresia?
A: Choledochal cysts are caused by distal stenosis of the common bile duct or abnormal merging of the pancreaticobiliary duct, and can be completely cured by reconstruction of the bile duct. In contrast, biliary atresia is caused by malformation or atresia of the intrahepatic bile ducts and interruption of bile excretion in the intra- and extrahepatic bile ducts, so biliary reconstruction can only drain very little bile and slow down the process of cirrhosis.
7.How many treatment methods are there for choledochal cyst?
A: At present, the treatment of common bile duct cyst can only be cured by surgery, and there are two types of surgery: first, traditional open cyst excision and bile duct reconstruction; second, complete laparoscopic cyst excision and bile duct reconstruction (i.e. minimally invasive surgery).
8.What are the advantages of minimally invasive surgery for common bile duct cyst?
A: Minimally invasive laparoscopic surgery has the advantages of fine and accurate anatomy, small surgical trauma, less bleeding, fast postoperative recovery, minimal complications, and concealed and beautiful wounds.
9.What is the best age for baby to have surgery?
A: Minimally invasive surgery can be performed 2-3 months after birth if the baby is asymptomatic and generally well; if the baby has frequent abdominal pain, jaundice, light-colored stools and liver function impairment, surgery should be performed as early as possible.
10.Can I have surgery later?
A: At present, surgery for common bile duct cyst is a very mature technology, with very good results and complete recovery after surgery. Late surgery may cause recurrent abdominal pain, pancreatitis, cholecystitis, cholelithiasis, jaundice, irreversible liver function damage, and the gradual increase of cyst may lead to rupture and perforation causing cholestatic peritonitis, which is life-threatening in serious cases, and even cancer in a few patients.
11.Which hospitals can do the screening?
A: Any hospital that carries out 3D color ultrasound and prenatal diagnosis can do screening, and it is better if the medical unit carries out pediatric surgery. This is conducive to accurate diagnosis and treatment of the disease.