Li Teng-Fei, Fu Pei-Ji, Han Xin-Wei, Ma Ji, Zhu Ming, Li Zhen, Ren Jian-Zhuang
Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University.
Interventional Institute of Zhengzhou University, Zhengzhou, China.
Medicine (Baltimore). 2020 Oct 30;99(44):e22741. doi: 10.1097/MD.0000000000022741.
Percutaneous balloon dilatation for benign biliary-enteric anastomosis stricture has been the most widely used alternative to endoscopic treatment. However, patency results from the precedent literature are inconsistent.The objective of this study was to evaluate the safety and feasibility of repeated balloon dilatation with long-term biliary drainage for the treatment of benign biliary-enteric anastomosis strictures.Data from patients with benign biliary-enteric anastomosis strictures who underwent percutaneous transhepatic cholangiography (PTC), repeated balloon dilatation with long-term biliary drainage (repeated-dilatation group; n = 23), or PTC and single balloon dilatation with long-term biliary drainage (single-dilatation group; n = 26) were reviewed. Postoperative complications, jaundice remission, and sustained anastomosis patency were compared between the groups.All procedures were successful. No severe intraoperative complications, such as biliary bleeding and perforation, were observed. The jaundice remission rate in the first week was similar in the 2 groups. During the 26-month follow-up period, 3 patients in the repeated-dilatation group had recurrences (mean time to recurrence: 22.84 ± 0.67 months, range: 18-26 months). In the single-dilatation group, 15 patients had recurrences (mean time to recurrence = 15.28 ± 1.63 months, range: 3-18 months). The duration of patency after dilatation was significantly better in the repeated-dilatation group (P = .01). All patients with recurrence underwent repeat PTC followed by balloon dilatation and biliary drainage.Repeated balloon dilatation and biliary drainage is an effective, minimally invasive, and safe procedure for treating benign biliary-enteric anastomosis strictures, and provides significantly higher patency rates than single dilatation.
经皮球囊扩张术治疗良性胆肠吻合口狭窄是内镜治疗最广泛应用的替代方法。然而,以往文献报道的通畅率结果并不一致。本研究旨在评估长期胆道引流下重复球囊扩张术治疗良性胆肠吻合口狭窄的安全性和可行性。回顾了接受经皮肝穿刺胆管造影术(PTC)、长期胆道引流下重复球囊扩张术(重复扩张组;n = 23)或PTC及长期胆道引流下单次球囊扩张术(单次扩张组;n = 26)的良性胆肠吻合口狭窄患者的数据。比较两组术后并发症、黄疸消退情况及吻合口持续通畅情况。所有手术均成功。未观察到严重的术中并发症,如胆道出血和穿孔。两组第一周黄疸消退率相似。在26个月的随访期内,重复扩张组有3例患者复发(平均复发时间:22.84±0.67个月,范围:18 - 26个月)。单次扩张组有15例患者复发(平均复发时间 = 15.28±1.63个月,范围:3 - 18个月)。重复扩张组扩张后通畅持续时间明显更好(P = 0.01)。所有复发患者均接受了重复PTC,随后进行球囊扩张和胆道引流。重复球囊扩张和胆道引流是治疗良性胆肠吻合口狭窄的有效、微创且安全的方法,其通畅率明显高于单次扩张。