Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands; Department of Surgery, Radboud University, Nijmegen, The Netherlands.
Surgery. 2018 May;163(5):1121-1127. doi: 10.1016/j.surg.2018.01.003. Epub 2018 Feb 21.
Hepaticojejunostomy is commonly indicated for major bile duct injury after cholecystectomy. The debate about the timing of hepaticojejunostomy for bile duct injury persists since data on postoperative outcomes, including postoperative strictures, are lacking. The aim of this study was to analyze short- and long-term outcomes of hepaticojejunostomy for bile duct injury, including risk factors for strictures.
Analysis of outcome of hepaticojejunostomy in bile duct injury patients referred to a multidisciplinary team.
Between the years1991 and 2016, 281 patients underwent hepaticojejunostomy for bile duct injury. Clavien-Dindo grade III complications occurred in 31 patients (11%) and 90-day mortality occurred in 2 patients (0.7%). After a median follow-up of 10.5 years (interquartile range 6.7-14.8 years), clinically relevant strictures were found in 37 patients (13.2%). Strictures were treated with percutaneous dilatation in 33 patients (89.2%), and 4 patients (1.4%) were reoperated. The stricture rate in patients undergoing hepaticojejunostomy <14 days, between 14-90 days, and >90 days after bile duct injury was 15.8%, 18.7%, and 9.9%, respectively. The stricture rate for early versus intermediate and late repair did not differ (P = 0.766 and 0.431, respectively). The stricture rate for repair after 14-90 days, however, was higher compared with repair >90 days after bile duct injury (P = 0.045). In multivariable analysis male gender was the only independent variable associated with stricture formation (OR 6.7, 95% CI 1.8-25.4, P = 0.005).
Hepaticojejunostomy is a relatively safe treatment of bile duct injury. Timing of surgery and intermediate repair affect long-term stricture rate; most anastomotic strictures can be treated successfully with percutaneous dilation.
胆肠吻合术常用于胆囊切除术后的主要胆管损伤。由于缺乏术后结果（包括术后狭窄）的数据，因此对于胆管损伤行胆肠吻合术的时机仍存在争议。本研究旨在分析胆管损伤行胆肠吻合术的短期和长期结果，包括狭窄的危险因素。
对多学科团队转诊的胆管损伤患者胆肠吻合术的结果进行分析。
1991 年至 2016 年间，281 例患者因胆管损伤行胆肠吻合术。31 例（11%）发生 Clavien-Dindo 分级Ⅲ级并发症，2 例（0.7%）患者术后 90 天内死亡。中位随访 10.5 年（四分位距 6.7-14.8 年）后，37 例（13.2%）患者发现临床相关狭窄。33 例（89.2%）患者采用经皮扩张治疗狭窄，4 例（1.4%）患者再次手术。胆管损伤后 14 天内、14-90 天内和>90 天内行胆肠吻合术的狭窄发生率分别为 15.8%、18.7%和 9.9%。早期修复与中期和晚期修复的狭窄发生率无差异（P=0.766 和 0.431）。然而，与胆管损伤后>90 天修复相比，14-90 天修复的狭窄发生率更高（P=0.045）。多变量分析显示，男性是唯一与狭窄形成相关的独立变量（OR 6.7，95%CI 1.8-25.4，P=0.005）。
胆肠吻合术是一种相对安全的胆管损伤治疗方法。手术时机和中期修复会影响长期狭窄发生率；大多数吻合口狭窄都可以通过经皮扩张成功治疗。
