Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
HPB (Oxford). 2024 Apr;26(4):558-564. doi: 10.1016/j.hpb.2024.01.003. Epub 2024 Jan 7.
Cholangitis is a well-known complication after hepaticojejunostomy (HJ), which is mainly caused by a stenotic anastomosis. However, the rate of cholangitis in patients with a non-stenotic (i.e. patent) HJ is unknown. We aimed to evaluate the incidence and risk factors of recurrent cholangitis in patients with a non-stenotic HJ.
This single-center retrospective cohort study included all consecutive patients who had undergone hepatobiliary or pancreatic (HPB) surgery requiring HJ (2015-2022). Primary outcome was recurrent non-stenotic cholangitis, risk factors for recurrent non-stenotic cholangitis were identified using logistic regression.
Overall, 835 patients with a HJ were included of whom 31/698 (4.4%) patients developed recurrent cholangitis with a non-stenotic HJ during a median follow-up of 34 months (IQR 22-50) and 98/796 (12.3%) patients developed a symptomatic HJ stenosis. These 31 patients experienced 205 cholangitis episodes, median 7.0 (IQR 3.8-8.8) per patient, and 71/205 (34.6%) cholangitis episodes required hospitalization. Male sex (aOR 3.17 (95% CI: 1.34-7.49)) and benign disease (aOR 2.97, 95% CI 1.40-6.33) were identified as risk factors for recurrent cholangitis in non-stenotic HJ in both univariate and multivariable analysis.
This study shows that 4% of patients developed recurrent cholangitis without an underlying HJ stenosis.
胆管炎是胆肠吻合术后（HJ）的一种常见并发症，主要由吻合口狭窄引起。然而，非狭窄（即通畅）HJ 患者胆管炎的发生率尚不清楚。我们旨在评估非狭窄 HJ 患者复发性胆管炎的发生率和危险因素。
这项单中心回顾性队列研究纳入了所有因肝胆胰（HPB）手术需要进行 HJ 的连续患者（2015-2022 年）。主要结局是复发性非狭窄性胆管炎，使用逻辑回归确定复发性非狭窄性胆管炎的危险因素。
总体而言，835 例患者行 HJ，其中 31/698（4.4%）例患者在中位随访 34 个月（IQR 22-50）期间出现非狭窄性 HJ 复发性胆管炎，98/796（12.3%）例患者出现症状性 HJ 狭窄。这 31 例患者共发生 205 次胆管炎发作，中位数为 7.0（IQR 3.8-8.8）次/例，71/205（34.6%）次胆管炎发作需要住院治疗。男性（aOR 3.17（95%CI：1.34-7.49））和良性疾病（aOR 2.97，95%CI 1.40-6.33）在单因素和多因素分析中均被确定为非狭窄性 HJ 复发性胆管炎的危险因素。
本研究表明，4%的患者在没有潜在 HJ 狭窄的情况下发生复发性胆管炎。
