Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France.
Inserm UMR 1312 - Team 3 "Liver Cancers and Tumoral Invasion", Bordeaux Institute of Oncology, University of Bordeaux, Bordeaux, France.
Langenbecks Arch Surg. 2023 Oct 18;408(1):409. doi: 10.1007/s00423-023-03139-1.
Hepaticojejunostomy (HJ) is the gold standard procedure for repairing major bile duct injury (BDI). Dilation status of the BD before repair has not been assessed as a risk factor for anastomotic stricture.
This retrospective single-centre study was performed on a population of 87 patients with BDI repaired by HJ between 2007 and 2021. Dilation status was assessed preoperatively, and dilation was defined as the presence of visible peripheral intrahepatic BDs with remaining BD diameter > 8 mm. The short- and long-term outcomes of HJ were assessed according to preoperative dilation status.
Before final repair, the BDs were dilated (dBD) in 56.3% of patients and not dilated (ND) in 43.7%. Patients with ND at the time of repair had more severe BDI injury than those with dBD (94.7% vs. 77.6%, p = 0.026). The rate of preoperative cholangitis was lower in patients with ND than in those with dBD (10.5% vs. 44.9%, p = 0.001). The rate of short-term morbidity after HJ was 33.3% (ND vs. dBD: 38.8% vs. 26.3%, p = 0.32). Long-term anastomotic stricture rate was 5.7% with a mean follow-up period of 61.3 months. There were no differences in long-term biliary complications according to dilation status (ND vs. dBD: 12.2% vs. 10.5%, p = 1).
Dilation status of the BD before HJ for BDI seemed to have no impact on short- or long-term outcomes. Both surgical and radiological external biliary drainages after BDI appear to be acceptable options to reduce cholangitis before repair without increasing risk for long-term anastomotic stricture.
肝肠吻合术（HJ）是修复大胆管损伤（BDI）的金标准。BD 在修复前的扩张状态尚未被评估为吻合口狭窄的危险因素。
本研究回顾性分析了 2007 年至 2021 年间 87 例接受 HJ 修复的 BDI 患者。术前评估 BD 的扩张情况，扩张定义为存在可见的肝内周围胆管，且剩余 BD 直径>8mm。根据术前扩张状态评估 HJ 的短期和长期结果。
在最终修复前，56.3%的患者 BD 扩张（dBD），43.7%的患者 BD 不扩张（ND）。与 dBD 患者相比，修复时 ND 患者的 BDI 损伤更严重（94.7%比 77.6%，p=0.026）。ND 患者术前胆管炎的发生率低于 dBD 患者（10.5%比 44.9%，p=0.001）。HJ 后短期发病率为 33.3%（ND 比 dBD：38.8%比 26.3%，p=0.32）。平均随访 61.3 个月后，吻合口狭窄的长期发生率为 5.7%。根据扩张状态，长期胆道并发症无差异（ND 比 dBD：12.2%比 10.5%，p=1）。
BDI 行 HJ 前 BD 的扩张状态似乎对短期或长期结果没有影响。BDI 修复前，外科和放射学外部胆管引流似乎是减少胆管炎的可接受选择，而不会增加长期吻合口狭窄的风险。
