Jang Sung Ill, Do Min Young, Lee See Young, Cho Jae Hee, Joo Seung-Moon, Lee Kwang-Hun, Chung Moon Jae, Lee Dong Ki
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Department of Medicine, Graduate School of Yonsei University College of Medicine, Seoul, South Korea.
Gastrointest Endosc. 2024 Dec;100(6):1053-1060.e4. doi: 10.1016/j.gie.2024.05.009. Epub 2024 May 16.
Post-cholecystectomy biliary strictures can be treated surgically or nonsurgically. Although endoscopic or percutaneous treatments are the preferred approaches, these methods are not feasible in cases in which complete stricture occlusion prevents the successful passage of a guidewire. The utility of magnetic compression anastomosis (MCA) in patients with post-cholecystectomy complete biliary obstruction that cannot be treated conventionally was evaluated.
MCA was performed in 10 patients with post-cholecystectomy biliary strictures that did not resolve with conventional endoscopic or percutaneous treatment. One magnet was delivered through the percutaneous transhepatic biliary drainage tract, and another was advanced via ERCP of the common bile duct. After magnet approximation and recanalization, a fully covered self-expandable metal stent (FCSEMS) was placed for 3 months and then replaced for an additional 3 months. Stricture resolution was evaluated after FCSEMS removal.
Among the 10 patients who underwent MCA for post-cholecystectomy biliary stricture, the biliary injury was Strasberg type B in 2, type C in 3, and type E in 5. Recanalization was successful in all patients (technical success rate, 100%). The mean follow-up period after recanalization was 50.2 months (range, 13.2-116.8 months). Partial restenosis after MCA occurred in 2 patients at 24.1 and 1.6 months after stent removal. ERCP with FCSEMS placement resolved the recurrent stenosis in both patients.
MCA is a useful nonsurgical alternative treatment for complete biliary obstruction after cholecystectomy that cannot be resolved by use of conventional methods.
胆囊切除术后胆管狭窄可采用手术或非手术治疗。虽然内镜或经皮治疗是首选方法，但在完全性狭窄阻塞导致导丝无法成功通过的情况下，这些方法不可行。本研究评估了磁压缩吻合术（MCA）在无法采用传统方法治疗的胆囊切除术后完全性胆管梗阻患者中的应用价值。
对10例经传统内镜或经皮治疗未缓解的胆囊切除术后胆管狭窄患者实施MCA。一枚磁体经皮经肝胆道引流途径置入，另一枚通过胆总管内镜逆行胰胆管造影（ERCP）推进。磁体靠近并再通后，置入全覆膜自膨式金属支架（FCSEMS）3个月，然后再更换3个月。在取出FCSEMS后评估狭窄缓解情况。
在10例行MCA治疗胆囊切除术后胆管狭窄的患者中，胆管损伤Strasberg分型为B型2例、C型3例、E型5例。所有患者再通均成功（技术成功率100%）。再通后的平均随访期为50.2个月（范围13.2 - 116.8个月）。2例患者在取出支架后24.1个月和1.6个月发生MCA后部分再狭窄。通过再次置入FCSEMS的ERCP解决了这2例患者的复发性狭窄。
对于胆囊切除术后无法通过传统方法解决的完全性胆管梗阻，MCA是一种有用的非手术替代治疗方法。
