Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kanagawa, 216-8511, Japan.
Department of Gastroenterology, School of Medicine, St. Marianna University, Kawasaki, Japan.
BMC Gastroenterol. 2024 Aug 28;24(1):293. doi: 10.1186/s12876-024-03388-4.
To determine the causes of benign hepaticojejunostomy strictures (BHSs) after pancreaticoduodenectomy (PD) and the outcome of endoscopic retrograde cholangiography (ERC) treatment for BHSs.
A total of 175 patients who underwent PD between January 2013 and December 2020 and who were followed up for at least 1 year were included. Preoperative data, operative outcomes, and postoperative courses were compared between the BHS group and the group of patients who did not develop stenosis during follow-up (non-BHS group). The course of treatment in the BHS group was also examined.
BHS occurred in 13 of 175 patients (7.4%). Multivariate analysis of the BHS and non-BHS groups revealed that male sex (OR; 3.753, 95% CI; 1.029-18.003, P = 0.0448) and a preoperative bile duct diameter less than 8.8 mm (OR; 7.51, 95% CI; 1.75-52.40, P = 0.0053) were independent risk factors for the development of BHS. In the BHS group, all patients underwent ERC using enteroscopy. The success rate of the ERC approach to the bile duct was 92.3%. Plastic stents were inserted in 6 patients, and metallic stents were inserted in 3 patients. The median observation period since the last ERC was 17.9 months, and there was no recurrence of stenosis in any of the 13 patients.
Patients with narrow bile ducts are at greater risk of BHS after PD. Recently, BHS after PD has been treated with ERC-related procedures, which may reduce the burden on patients.
确定胰十二指肠切除术后良性胆肠吻合口狭窄（BHS）的原因，以及内镜逆行胆管造影（ERC）治疗 BHS 的结果。
纳入 2013 年 1 月至 2020 年 12 月期间接受胰十二指肠切除术且随访时间至少 1 年的 175 例患者。比较 BHS 组和随访期间未发生狭窄的患者组（非 BHS 组）的术前资料、手术结果和术后过程。还检查了 BHS 组的治疗过程。
175 例患者中有 13 例（7.4%）发生 BHS。BHS 组和非 BHS 组的多变量分析显示，男性（OR；3.753，95%CI；1.029-18.003，P=0.0448）和术前胆管直径小于 8.8mm（OR；7.51，95%CI；1.75-52.40，P=0.0053）是 BHS 发生的独立危险因素。在 BHS 组，所有患者均采用经内镜逆行胰胆管造影术进行 ERC。胆管 ERC 成功率为 92.3%。6 例患者插入塑料支架，3 例患者插入金属支架。末次 ERC 后中位观察时间为 17.9 个月，13 例患者均无狭窄复发。
PD 后胆管狭窄的患者发生 BHS 的风险更高。最近，PD 后 BHS 已采用 ERC 相关治疗，这可能减轻患者的负担。
