Bednarsch Jan, Czigany Zoltan, Heise Daniel, Lang Sven Arke, Olde Damink Steven W M, Luedde Tom, Bruners Philipp, Ulmer Tom Florian, Neumann Ulf Peter
Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany.
Department of Surgery, Maastricht University Medical Centre (MUMC), 6229 Maastricht, The Netherlands.
J Clin Med. 2020 May 8;9(5):1392. doi: 10.3390/jcm9051392.
This study aims to provide a deep insight into the incidence and clinical significance of postoperative anastomotic leakage (AL) and anastomotic stenosis (AS) of the hepaticojejunostomy (HJ) after curative-intent liver resection for perihilar cholangiocarcinoma (pCCA). Between 2011 and mid-2019, 114 patients with pCCA underwent surgery in curative intent at our institution and were analyzed regarding the postoperative incidence of AL and AS. Further, associations between AL and AS and clinical characteristics were assessed using multiple univariate logistic regression analyses. AL was diagnosed in 11.4% (13/114) of the patients resulting in postoperative mortality in the minority of patients (23.0%, 3/13). AS occurred in 11.0% (11/100) of the individuals eligible for follow-up with local tumor recurrence being the underlying pathology in 72.7% (8/11) of the cases. None of the investigated clinical factors including surgical difficulty of the HJ showed a meaningful association with AL or AS. AL and AS are frequent complications and can be treated by conservative, interventional or surgical therapy with a high success rate. Also, technical difficulty of the HJ appears not to be not associated with the occurrence of AL or AS. Moreover, AS is associated with tumor recurrence in the majority of cases.
本研究旨在深入了解肝门部胆管癌（pCCA）根治性肝切除术后肝管空肠吻合术（HJ）的术后吻合口漏（AL）和吻合口狭窄（AS）的发生率及临床意义。2011年至2019年年中，114例pCCA患者在本机构接受了根治性手术，并对其术后AL和AS的发生率进行了分析。此外，使用多个单因素逻辑回归分析评估了AL和AS与临床特征之间的关联。11.4%（13/114）的患者被诊断为AL，少数患者（23.0%，3/13）术后死亡。11.0%（11/100）符合随访条件的个体发生了AS，72.7%（8/11）的病例其潜在病理为局部肿瘤复发。包括HJ手术难度在内的所有研究临床因素均未显示与AL或AS有有意义的关联。AL和AS是常见的并发症，可通过保守、介入或手术治疗，成功率较高。此外，HJ的技术难度似乎与AL或AS的发生无关。而且，在大多数病例中，AS与肿瘤复发有关。
