Department of Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Surgery. 2024 Oct;176(4):1207-1214. doi: 10.1016/j.surg.2024.06.044. Epub 2024 Jul 25.
Postoperative cholangitis is a common complication after pancreatoduodenectomy that can occur with or without anatomical biliary obstruction. This study aimed to investigate the incidence, diagnosis, treatment, and risk factors of cholangitis after pancreatoduodenectomy.
We performed a retrospective cohort study of consecutive patients who underwent pancreatoduodenectomy in 2 Dutch tertiary pancreatic centers (2010-2019). Primary outcome was postoperative cholangitis, defined as systemic inflammation with abnormal liver tests without another focus of infection, at least 1 month after resection. Diagnostic and therapeutic strategies were evaluated. Two types of postoperative cholangitis were distinguished; obstructive cholangitis (benign stenosis of the hepaticojejunostomy) and nonobstructive cholangitis. Potential risk factors were identified using logistic regression analysis.
Postoperative cholangitis occurred in 93 of 900 patients (10.3%). Median time to first episode of cholangitis was 8 months (interquartile range 4-16) after pancreatoduodenectomy. Multiple episodes of cholangitis occurred in 44 patients (47.3%) and readmission was necessary in 83 patients (89.2%). No cholangitis-related mortality was observed. Obstructive cholangitis was seen in 37 patients (39.8%) and nonobstructive cholangitis in 56 patients (60.2%). Surgery was performed for cholangitis in 7 patients (7.5%) and consisted of revision of the hepaticojejunostomy or elongation of the biliary limb. Postoperative biliary leakage (odds ratio 2.56; 95% confidence interval 1.42-4.62; P = .0018) was independently associated with postoperative cholangitis.
Postoperative cholangitis unrelated to cancer recurrence was seen in 10% of patients after pancreatoduodenectomy. Nonobstructive cholangitis was more common than obstructive cholangitis. Postoperative biliary leakage was an independent risk factor.
胆系感染是胰十二指肠切除术后常见的并发症，可能伴有或不伴有解剖性胆道梗阻。本研究旨在探讨胰十二指肠切除术后胆系感染的发生率、诊断、治疗和危险因素。
我们对荷兰 2 家三级胰腺中心（2010-2019 年）连续接受胰十二指肠切除术的患者进行了回顾性队列研究。主要结局为术后胆系感染，定义为术后至少 1 个月发生的全身性炎症，伴有肝功能异常，无其他感染灶。评估了诊断和治疗策略。区分了两种类型的术后胆系感染；梗阻性胆系感染（胆肠吻合口良性狭窄）和非梗阻性胆系感染。使用逻辑回归分析确定潜在的危险因素。
900 例患者中有 93 例（10.3%）发生术后胆系感染。胆系感染的中位时间为胰十二指肠切除术后 8 个月（四分位间距 4-16）。44 例患者发生多次胆系感染（47.3%），83 例患者需要再次入院（89.2%）。未观察到与胆系感染相关的死亡。37 例（39.8%）为梗阻性胆系感染，56 例（60.2%）为非梗阻性胆系感染。7 例（7.5%）因胆系感染行手术治疗，包括胆肠吻合口重建或胆肠吻合口延长。术后胆漏（比值比 2.56；95%置信区间 1.42-4.62；P =.0018）是术后胆系感染的独立相关因素。
胰十二指肠切除术后，与癌症复发无关的胆系感染发生率为 10%。非梗阻性胆系感染比梗阻性胆系感染更为常见。术后胆漏是独立的危险因素。
