Zielsdorf Shannon M, Klein John J, Fleetwood Vidya A, Hertl Martin, Chan Edie Y
From the *Department of Surgery, Rush University Medical Center, Chicago, Illinois.
†Department of Surgery, University of Wisconsin, Madison, Wisconsin; and.
Am Surg. 2019 Dec 1;85(12):1350-1353.
The objective of the study was to determine the long-term stricture rate of hepaticojejunostiomy (HJ) performed for benign disease, to compare stricture rates for transplant patients and nontransplant patients, and to compare the success rates of procedural and surgical treatment options. Hospital charts of 135 consecutive patients undergoing HJ between 1998 and 2016 were analyzed retrospectively. The primary outcome was stricture formation. Secondary outcomes were time to stricture diagnosis and success rates of various interventions. The anastomotic stricture rate was 13.3 per cent (18). The mean follow-up period was 4.3 years. The mean time to stricture diagnosis was 2.3 years. Stricture rates were similar between the transplant (19.2%) and nontransplant, non-Whipple group (13%). Strictures were treated with radiological intervention with a 44.4 per cent success rate; each required multiple interventions. Mortality from liver disease after failure of nonoperative management of HJ strictures reached 30 per cent (3). Five of ten patients who failed radiological intervention underwent HJ revision; the success rate was 80 per cent. Anastomotic strictures of HJ performed for benign disease occur in 13 per cent of patients and typically develop within 2.5 years postoperatively. Yet, given the dangerous sequelae of chronic biliary obstruction and potential delay in presentation, a follow-up is recommended for up to 10 years. When strictures occur, HJ revision should be considered early, after two failed radiological interventions.
本研究的目的是确定因良性疾病行肝空肠吻合术（HJ）的长期狭窄发生率，比较移植患者和非移植患者的狭窄发生率，并比较介入治疗和手术治疗方案的成功率。对1998年至2016年间连续135例行HJ手术患者的医院病历进行回顾性分析。主要结局是狭窄形成。次要结局是狭窄诊断时间和各种干预措施的成功率。吻合口狭窄发生率为13.3%（18例）。平均随访时间为4.3年。狭窄诊断的平均时间为2.3年。移植组（19.2%）和非移植、非惠普尔手术组（13%）的狭窄发生率相似。狭窄采用放射介入治疗，成功率为44.4%；每次均需多次介入治疗。HJ狭窄非手术治疗失败后，肝病死亡率达30%（3例）。10例放射介入治疗失败的患者中有5例行HJ修复术；成功率为80%。因良性疾病行HJ手术的吻合口狭窄发生率为13%，通常在术后2.5年内发生。然而，鉴于慢性胆道梗阻的危险后果和可能的就诊延迟，建议随访长达10年。当发生狭窄时，在两次放射介入治疗失败后应尽早考虑行HJ修复术。
