Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Hepatobiliary Pancreat Dis Int. 2017 Aug 15;16(4):412-417. doi: 10.1016/S1499-3872(17)60033-X.
Stricture formation at the bilioenteric anastomosis is a rare but important postoperative complication. However, information on this complication is lacking in the literature. In the present study, we aimed to assess its prevalence and predictive factors, and report our experience in managing bilioenteric anastomotic strictures over a ten-year period.
A total of 420 patients who had undergone bilioenteric anastomosis due to benign or malignant tumors between February 2001 and December 2011 were retrospectively reviewed. Univariate and multivariate modalities were used to identify predictive factors for anastomotic stricture occurrence. Furthermore, the treatment of anastomotic stricture was analyzed.
Twenty-one patients (5.0%) were diagnosed with bilioenteric anastomotic stricture. There were 12 males and 9 females with a mean age of 61.6 years. The median time after operation to anastomotic stricture was 13.6 months (range, 1 month to 5 years). Multivariate analysis identified that surgeon volume (≤30 cases) (odds ratio: -1.860; P=0.044) was associated with the anastomotic stricture while bile duct size (>6 mm) (odds ratio: 2.871; P=0.0002) had a negative association. Balloon dilation was performed in 18 patients, biliary stenting in 6 patients, and reoperation in 4 patients. Five patients died of tumor recurrence, and one of heart disease.
Bilioenteric anastomotic stricture is an uncommon complication that can be treated primarily by interventional procedures. Bilioenteric anastomosis may be performed by a surgeon in his earlier training period under the guidance of an experienced surgeon. Bile duct size >6 mm may play a protective role.
胆肠吻合口狭窄是一种罕见但重要的术后并发症。然而，文献中对此并发症的信息较少。在本研究中，我们旨在评估其发生率和预测因素，并报告我们在十年期间处理胆肠吻合口狭窄的经验。
回顾性分析了 2001 年 2 月至 2011 年 12 月期间因良性或恶性肿瘤行胆肠吻合术的 420 例患者。采用单因素和多因素方法确定吻合口狭窄发生的预测因素。此外，还分析了吻合口狭窄的治疗方法。
21 例（5.0%）患者诊断为胆肠吻合口狭窄。男 12 例，女 9 例，平均年龄 61.6 岁。术后至吻合口狭窄的中位时间为 13.6 个月（1 个月至 5 年）。多因素分析发现，手术医师的手术量（≤30 例）（比值比：-1.860；P=0.044）与吻合口狭窄有关，而胆管直径（>6mm）（比值比：2.871；P=0.0002）与吻合口狭窄呈负相关。18 例患者行球囊扩张，6 例患者行胆道支架置入，4 例患者行再次手术。5 例患者死于肿瘤复发，1 例死于心脏病。
胆肠吻合口狭窄是一种少见的并发症，可以通过介入治疗为主的方法进行治疗。胆管直径>6mm 可能起到保护作用。胆肠吻合术可由经验丰富的医师指导处于早期培训阶段的医师进行操作。
