An increasing proportion of congenital choledochal malformation (CCM) are being detected on antenatal ultrasound. However, the actual timing of its surgical correction remains controversial with some series showing an excess of complications the earlier the operation. The aim of this study was to characterize the pathophysiological aspects of this cohort from the perspective of age at surgery in order to inform a more rational basis for clinical decision-making. We analysed a prospective database of CCM acquired over a 26-year period (Jan. 1997 to Dec. 2022) for patient demography; details of pre- and post-natal imaging; age at surgical intervention; operative complications (Clavien-Dindo classification) and outcome. Data are quoted as median (IQR). All comparisons are non-parametric. A P value of 0.05 was accepted as significant. There were 58 (72% female) children with an antenatally-detected CCM from a total of 265 (21.8%) in the series. These were classified as Type 1C (n = 47; 81%), type 4C (n = 3; 5%) and Type 5 (n = 8; 14%). There were no Type 1F lesions in this cohort. Median age at surgery was 113 (IQR 57–198) days. This is one of the largest series documenting the outcomes of antenatally-detected CCMs, certainly in Europe and North America. Such lesions are invariably cystic in nature, and either Types 1C, 4C or 5. The absence of complications using a policy of early intervention (where possible) in experienced hepatobiliary units was shown. II.

中文翻译：

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产前检测出胆总管畸形：我们还在等什么？

通过产前超声检查发现的先天性胆总管畸形 (CCM) 的比例越来越大。然而，其手术矫正的实际时机仍然存在争议，一些系列显示手术越早并发症越多。本研究的目的是从手术年龄的角度描述该队列的病理生理学特征，以便为临床决策提供更合理的基础。我们分析了 26 年期间（1997 年 1 月至 2022 年 12 月）获取的 CCM 前瞻性数据库，以进行患者人口统计；产前和产后影像的详细信息；接受手术时的年龄；手术并发症（Clavien-Dindo 分类）和结果。数据以中位数 (IQR) 表示。所有比较都是非参数的。 AP 值为 0.05 被认为是显着的。该系列共有 265 名儿童（21.8%），其中 58 名（72% 为女性）患有产前检测出的 CCM。这些被分为 1C 型（n = 47；81%）、4C 型（n = 3；5%）和 5 型（n = 8；14%）。该队列中没有 1F 型病变。手术时的中位年龄为 113 (IQR 57–198) 天。这是记录产前检测的 CCM 结果的最大系列之一，尤其是在欧洲和北美。此类病变本质上总是囊性的，并且为 1C、4C 或 5 型。在经验丰富的肝胆科采用早期干预政策（如果可能），没有出现并发症。二.