Weber A, Rosca B, Neu B, Rösch T, Frimberger E, Born P, Schmid R M, Prinz C
Department of Internal Medicine II, Technical University of Munich, Germany.
Endoscopy. 2009 Apr;41(4):323-8. doi: 10.1055/s-0029-1214507. Epub 2009 Apr 1.
Anastomotic strictures are well-known complications after bilioenterostomy. Endoscopic procedures are usually not possible in patients with a bilioenterostomy. Hence, percutaneous transhepatic biliary drainage (PTBD) has become the treatment of choice for the management of these patients. The main goal of the present study was to analyze the long-term follow-up of PTBD in such patients.
Between January 1996 and December 2006, 44 patients with benign anastomotic stricture after bilioenterostomy were identified by an analysis of the PTBD database, hospital charts, and cholangiograms.
In 27/44 patients the percutaneous transhepatic biliary drain was successfully removed after 19.9 +/- 16.1 months (treatment success in 61.4 %). During a mean follow-up of 53.7 +/- 28.4 months after removal of the drain, no evidence was found of recurrent strictures in these patients. Ten out of 44 patients carry permanent drains (22.6 % of patients with ongoing treatment, mean follow-up 46.4 +/- 54.7 months) without the option for further surgery owing to concomitant disease (n = 2) or because they refused further surgery (n = 8). In 7 out of 44 patients (16 %) PTBD treatment was deemed to have failed and the patients underwent repeat operation.
PTBD should be considered the treatment of choice in patients with benign anastomotic stricture after bilioenterostomy, especially after stricturing of a hepatojejunostomy.
吻合口狭窄是胆肠吻合术后常见的并发症。对于接受胆肠吻合术的患者，通常无法进行内镜治疗。因此，经皮经肝胆道引流术（PTBD）已成为这类患者的首选治疗方法。本研究的主要目的是分析此类患者PTBD的长期随访情况。
通过分析PTBD数据库、医院病历和胆管造影，在1996年1月至2006年12月期间，确定了44例胆肠吻合术后良性吻合口狭窄的患者。
44例患者中有27例在19.9±16.1个月后成功拔除经皮经肝胆道引流管（治疗成功率为61.4%）。在拔除引流管后的平均53.7±28.4个月的随访中，未发现这些患者有复发性狭窄的迹象。44例患者中有10例留置永久性引流管（占持续治疗患者的22.6%，平均随访46.4±54.7个月），由于合并疾病（n = 2）或拒绝进一步手术（n = 8）而无法进行进一步手术。44例患者中有7例（16%）PTBD治疗被认为失败，患者接受了再次手术。
对于胆肠吻合术后良性吻合口狭窄的患者，尤其是肝空肠吻合口狭窄的患者，PTBD应被视为首选治疗方法。
