Objective To explore surgery strategy of reoperation for type Ⅳa congenital choledochal cyst. Methods The patient was a 20-year-old female with repeated right upper abdominal pain and fever for more than 1 year and aggravation for more than 1 month, and the choledochal cyst excison was performed 15 years ago. The MRI revealed that a huge cyst located in the left lobe of liver, with multiple intrahepatic calculus. The patient was diagnosed with a type Ⅳa congenital choledochal cyst and choledochojejunostomy later and the intrahepatic dilated bile duct was untreated. Results The cystic dilatation of the intrahepatic bile duct was confirmed during the reoperation, and the multiple stones with pus formation were seen, the color of the right liver was normal and the anatomical left hemihepatectomy was performed. The original anastomosis had no stenosis then was preserved. An about 1.5 cm length of extrahepatic bile duct was dissociated from the upper of anastomosis, and the extrahepatic bile duct was cut open and explored with a choledochoscope. The T-tube drainage was performed following removing the stone. The patient recovered well and was discharged smoothly following the surgery. The cholangiography 6 weeks later revealed that the biliary tract was patency and there was no residual stone. There was no jaundice or fever afterwards. Conclusion Complete excision of choledochal cyst and hepaticoduodenostomy is widely accepted as a standard surgery for type Ⅳa congenital choledochal cyst.
Objective To investigate the risk factors of infection after radiofrequency ablation in patients with liver metastases after choledochojejunostomy. Methods The clinical data of patients with liver metastases treated by radiofrequency ablation in our hospital from January 2010 to April 2022 were collected retrospectively and analyzed by univariate and multivariate logistic regression analysis. Results A total of 57 patients were included in the study, and the total number of postoperative infections was 19 (33.33%). Univariate logistic regression analysis showed that the tumor location, maximum tumor diameter, number of tumors, ablation times, and ablation duration were related to the occurrence of infection after radiofrequency ablation (P<0.01). The results of multivariate logistic regression analysis showed that the tumor location [OR=6.45, 95%CI (1.11, 37.35), P=0.037] and ablation duration [OR=1.49, 95%CI (1.16, 1.91), P=0.002] were independent risk factors for infection after radiofrequency ablation in patients with choledocho-jejunostomy. Conclusions For patients with metastatic liver cancer with a history of choledochojejunostomy, the tumor location and the duration of ablation are closely related to postoperative infection. We should strengthen the indivi-dualized management of such patients during and after operation should be strengthened to promote disease recovery.