Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy.
Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy; Gastroenterology Department, Garcia de Orta Hospital, E.P.E, Almada, Portugal.
Gastrointest Endosc. 2020 Mar;91(3):584-592. doi: 10.1016/j.gie.2019.09.043. Epub 2019 Oct 17.
Right aberrant hepatic ducts are an anatomic variant with clinical relevance because of the risk of injury during cholecystectomy. Treatment options for aberrant hepatic duct injuries are not standardized. This study aims to analyze the long-term results of endoscopic treatment of aberrant hepatic duct lesions.
Patients who underwent ERCP for aberrant hepatic duct lesions were retrospectively identified. Demographic data, type of aberrant duct lesion according to the Strasberg classification, type of treatment (number of plastic stents inserted, treatment duration, and number of ERCPs), and adverse events were recorded. Follow-up was obtained by telephone contact or medical examinations.
Between January 1996 and March 2019, 32 patients (78% women, mean age 51.7 years) with aberrant hepatic duct injuries underwent ERCP at our Endoscopy Unit. Six patients had Strasberg type B lesions, 11 patients had type C, and 8 patients had type E5, and 7 patients had a stenosis of the aberrant duct. A mean of 3.7 biliary plastic stents per patient were used; mean treatment duration was 6.3 months. All patients with isolated aberrant duct stenosis and 1 of 6 patients (17%) with type B Strasberg lesions achieved patency. Ten of 11 patients (91%) with type C Strasberg lesions achieved duct recanalization. After a mean follow-up of 109.3 ± 61.2 months, 29 of 32 patients (91%) were asymptomatic; 1 underwent surgery for recurrent cholangitis, 1 received a new endoscopic procedure because of cholangitis, and 1 reported episodic biliary colic without an increase in liver function test values and was successfully managed with a low-fat diet.
An endoscopic approach to aberrant hepatic duct lesions after cholecystectomy can be considered an effective first-line therapy.
右肝管异常是一种具有临床相关性的解剖变异，因为在胆囊切除术中存在损伤的风险。异常肝管损伤的治疗选择尚未标准化。本研究旨在分析内镜治疗异常肝管病变的长期结果。
回顾性确定因异常肝管病变而行 ERCP 的患者。记录人口统计学数据、根据 Strasberg 分类的异常胆管病变类型、治疗类型（插入的塑料支架数量、治疗持续时间和 ERCP 次数）以及不良事件。通过电话联系或体格检查获得随访。
1996 年 1 月至 2019 年 3 月期间，我院内镜科对 32 例（78%为女性，平均年龄 51.7 岁）异常肝管损伤患者进行了 ERCP。6 例患者存在 Strasberg 类型 B 病变，11 例患者存在类型 C，8 例患者存在类型 E5，7 例患者存在异常胆管狭窄。每位患者平均使用 3.7 个胆道塑料支架；平均治疗时间为 6.3 个月。所有孤立性异常胆管狭窄患者和 6 例 Strasberg 类型 B 病变患者中的 1 例均实现了通畅。11 例 Strasberg 类型 C 病变患者中有 10 例实现了胆管再通。平均随访 109.3±61.2 个月后，32 例患者中有 29 例（91%）无症状；1 例因复发性胆管炎接受手术，1 例因胆管炎接受新的内镜治疗，1 例报告间歇性胆绞痛，但肝功能检查值无增加，通过低脂饮食成功治疗。
胆囊切除术后异常肝管病变的内镜治疗可以作为一种有效的一线治疗方法。
