Mie Takafumi, Sasaki Takashi, Kobayashi Kosuke, Takeda Tsuyoshi, Okamoto Takeshi, Kasuga Akiyoshi, Inoue Yosuke, Takahashi Yu, Saiura Akio, Sasahira Naoki
Department of Hepato-Biliary-Pancreatic Medicine Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan.
Division of Hepatobiliary and Pancreatic Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan.
DEN Open. 2023 Oct 28;4(1):e307. doi: 10.1002/deo2.307. eCollection 2024 Apr.
Hepaticojejunostomy anastomotic stricture (HJAS) is a serious adverse event of pancreaticoduodenectomy. Preoperative biliary drainage with a self-expandable metal stent (SEMS) is often performed before pancreaticoduodenectomy. The purpose of this study is to evaluate the risk factors and impact of preoperative SEMS placement on developing benign HJAS after pancreaticoduodenectomy.
We retrospectively analyzed consecutive patients who underwent pancreatoduodenectomy at our institution between July 2014 and June 2020. Risk factors for benign HJAS were identified using univariate and multivariate logistic regression analysis. We also compared outcomes of preoperative biliary drainage using SEMS and non-SEMS.
Of the 626 included patients, benign HJAS occurred in 36 patients (5.8%). The median follow-up time was 36.7 months (interquartile range, 25.4-57.4 months). Multivariate logistic regression analysis revealed that lack of preoperative biliary drainage, preoperative bile duct diameter <5 mm, and former or current smoking were independent predictors of benign HJAS. In the preoperative biliary drainage group, the rate of preoperative bile duct diameter <5 mm was significantly lower in the SEMS group than in the non-SEMS group (2.0% vs. 12.8%, = 0.04).
Preoperative biliary drainage with SEMS may be useful to maintain bile duct diameter ≥5 mm and to reduce benign HJAS as a result.
肝空肠吻合口狭窄（HJAS）是胰十二指肠切除术的一种严重不良事件。胰十二指肠切除术前行自膨式金属支架（SEMS）胆道引流较为常见。本研究旨在评估术前放置SEMS的危险因素及其对胰十二指肠切除术后发生良性HJAS的影响。
我们回顾性分析了2014年7月至2020年6月在本机构接受胰十二指肠切除术的连续患者。采用单因素和多因素逻辑回归分析确定良性HJAS的危险因素。我们还比较了使用SEMS和未使用SEMS进行术前胆道引流的结果。
在纳入的626例患者中，36例（5.8%）发生了良性HJAS。中位随访时间为36.7个月（四分位间距，25.4 - 57.4个月）。多因素逻辑回归分析显示，术前未进行胆道引流、术前胆管直径<5 mm以及既往或当前吸烟是良性HJAS的独立预测因素。在术前胆道引流组中，SEMS组术前胆管直径<5 mm的发生率显著低于未使用SEMS组（2.0%对12.8%，P = 0.04）。
术前使用SEMS进行胆道引流可能有助于维持胆管直径≥5 mm，从而减少良性HJAS的发生。
