Sciumè Carmelo, Geraci Girolamo, Pisello Franco, Facella Tiziana, Li Volsi Francesco, Modica Giuseppe
Unità Operativa di Chirurgia ad Indirizzo Toracico, Dipartimento di Chirurgia Generale d'Urgenza e dei Trapianti d'Organo, Policlinico P. Giaccone, Università degli Studi di Palermo.
Ann Ital Chir. 2006 Jan-Feb;77(1):19-24; discussion 25.
To describe the management and outcome after endoscopic treatment of 23 patients with post-operative benign bile duct stricture (BBDS) managed in Authors' Department from 1991 to 2000.
The management of the postoperative bile duct strictures remains a challenge for even the most skilled biliary tract surgeon and endoscopist. The 1990s saw a dramatic increase in the incidence of bile duct strictures from the introduction and widespread use of laparoscopic cholecystectomy. The management of these injuries, short-term outcome and follow-up have been reported.
Data were collected retrospectively on 23 patients treated in the Service of Diagnostic and Operative Endoscopy of the Operative Unit of General and Thoracic Surgery (Policlinico Paolo Giaccone, Palermo, Italy) with BBDS between 1991 and 2000. All patients underwent ERCP (endoscopic retrograde cholangiopancreatography). Follow-up and pharmacological therapy post-ERCP were conducted by scheduled medical audit.
Of the 23 initial patients, 20 undergoing endoscopic stenting (3 with complete transaction were invited to surgery), 16 had completed treatment with symptoms resolution (mean follow-up of 70 months). One patient died of reason unrelated to biliary tract disease before the completion of treatment. Seven had not completed treatment. Of 16 patient who had completed treatment, 13 were considered to have a successful outcome without the need of follow-up invasive, diagnostic or therapeutic interventional procedures. Overall, a successful outcome, was obtained in 65% of patients, including those requiring a secondary procedure for recurrent strictures.
Postoperative bile duct strictures remain a considerable surgical challenge. Management with endoscopic cholangiography to delineate the postoperative anatomy and to place biliary stents, to solve the symptoms, is associated with a successful outcome in up of 65% of patients, in well experienced team. Endoscopic treatment should be the initial management of choice for postoperative bile duct stenosis, as a real alternative to surgical reconstruction: because his failure will not compromised the following surgical treatment prior endoscopic treatment does not preclude surgery), whereas endoscopic treatment is impossible one a Roux-en-Y loop has been constructed
描述1991年至2000年在作者所在科室接受内镜治疗的23例术后良性胆管狭窄（BBDS）患者的治疗情况及结果。
即使是最熟练的胆道外科医生和内镜医生，术后胆管狭窄的治疗仍然是一项挑战。20世纪90年代，随着腹腔镜胆囊切除术的引入和广泛应用，胆管狭窄的发生率急剧上升。这些损伤的治疗、短期结果及随访情况已有报道。
回顾性收集1991年至2000年在普通胸外科手术单元（意大利巴勒莫 Paolo Giaccone综合医院）诊断性和手术性内镜服务部接受治疗的23例BBDS患者的数据。所有患者均接受了内镜逆行胰胆管造影（ERCP）。ERCP术后的随访及药物治疗通过定期医疗审核进行。
23例初始患者中，20例行内镜支架置入术（3例完全离断者被邀请接受手术），16例完成治疗且症状缓解（平均随访70个月）。1例患者在治疗完成前死于与胆道疾病无关的原因。7例未完成治疗。在16例完成治疗的患者中，13例被认为治疗成功，无需后续侵入性诊断或治疗干预程序。总体而言，65%的患者获得了成功的治疗结果，包括那些因复发性狭窄需要二次手术的患者。
术后胆管狭窄仍然是一项相当大的外科挑战。在内镜胆管造影的帮助下明确术后解剖结构并放置胆道支架以解决症状，在经验丰富的团队中，约65%的患者可获得成功治疗结果。内镜治疗应作为术后胆管狭窄的首选初始治疗方法，是手术重建的真正替代方案：因为其失败不会影响后续手术治疗（内镜治疗前不会排除手术），而一旦构建了Roux-en-Y袢则无法进行内镜治疗
