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肝十二指肠吻合术用于肝外胆管中段癌手术后胆道重建的安全性和有效性。

Safety and efficacy of hepaticoduodenostomy for biliary reconstruction after extrahepatic mid-bile duct cancer surgery.

作者信息

Lee Okjoo, Lee Cheolgu, Yoon So Kyung, Jeong Jaehong, Kim Hyung Chul, Chung Jun Chul

机构信息

Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea.

Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.

出版信息

Gland Surg. 2024 Aug 31;13(8):1418-1427. doi: 10.21037/gs-24-155. Epub 2024 Aug 22.

DOI:10.21037/gs-24-155
PMID:39282036
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11398998/
Abstract

BACKGROUND

Bile duct resection and reconstruction for bile duct cancer (BDC) is a complex surgical and oncologic procedure that requires extensive resection and reconstruction of the biliary tract. Hepaticojejunostomy is commonly performed for biliary reconstruction after extrahepatic mid-bile duct resection, while hepaticoduodenostomy (HD) is performed only rarely due to the risk of ascending cholangitis. However, the efficacy of HD has not been well-established in extrahepatic mid-BDC surgery. In this study, we aimed to analyze the outcomes of HD in patients who underwent bile duct resection for extrahepatic mid-BDC.

METHODS

We retrospectively analyzed 38 extrahepatic mid-BDC patients who underwent bile duct resection in our center between January 2018 and June 2023. We compared postoperative outcomes, cancer recurrence, and patient survival between hepaticojejunostomy (n=20) and HD (n=18) groups.

RESULTS

Operation time for the HD group was significantly shorter than that of the hepaticojejunostomy group (188 206 min, P=0.044) with no significant differences in postoperative outcomes. Regression analysis showed that a HD was not associated with a significantly high risk of cancer recurrence or decrease in patient survival.

CONCLUSIONS

HD appears to have comparable operative benefits, postoperative complications, and oncologic outcomes to hepaticojejunostomy in extrahepatic mid-BDC patients.

摘要

背景

胆管癌（BDC）的胆管切除和重建是一项复杂的外科手术和肿瘤学手术，需要对胆道进行广泛的切除和重建。肝空肠吻合术常用于肝外中段胆管切除术后的胆道重建，而肝十二指肠吻合术（HD）由于存在上行性胆管炎的风险，很少进行。然而，HD在肝外中段BDC手术中的疗效尚未得到充分证实。在本研究中，我们旨在分析接受肝外中段BDC胆管切除的患者行HD的结局。

方法

我们回顾性分析了2018年1月至2023年6月在我们中心接受胆管切除的38例肝外中段BDC患者。我们比较了肝空肠吻合术组（n = 20）和HD组（n = 18）的术后结局、癌症复发和患者生存率。

结果

HD组的手术时间明显短于肝空肠吻合术组（188±206分钟，P = 0.044），术后结局无显著差异。回归分析表明，HD与癌症复发的高风险或患者生存率的降低无显著相关性。

结论

在肝外中段BDC患者中，HD似乎与肝空肠吻合术具有相当的手术益处、术后并发症和肿瘤学结局。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6f1f/11398998/fbaa2f28d8b8/gs-13-08-1418-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6f1f/11398998/ac56ca3aab4e/gs-13-08-1418-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6f1f/11398998/fbaa2f28d8b8/gs-13-08-1418-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6f1f/11398998/ac56ca3aab4e/gs-13-08-1418-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6f1f/11398998/fbaa2f28d8b8/gs-13-08-1418-f2.jpg

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本文引用的文献

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Ann Hepatobiliary Pancreat Surg. 2023 May 31;27(2):151-157. doi: 10.14701/ahbps.22-090. Epub 2023 Jan 2.
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Incidence, mortality and survival of gallbladder, extrahepatic bile duct, and pancreatic cancer using Korea central cancer registry database: 1999-2019.利用韩国中央癌症登记数据库分析1999 - 2019年胆囊癌、肝外胆管癌和胰腺癌的发病率、死亡率及生存率
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Economics and safety of continuous and interrupted suture hepaticojejunostomy: An audit of 556 surgeries.
连续缝合与间断缝合肝空肠吻合术的经济学与安全性：556例手术的审计
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Indication and surgical techniques of bypass choledochojejunostomy for intractable choledocholithiasis.难治性胆总管结石的胆肠吻合术指征及手术技巧
Ann Hepatobiliary Pancreat Surg. 2021 May 31;25(2):259-264. doi: 10.14701/ahbps.2021.25.2.259.
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Choledochoduodenostomy versus hepaticojejunostomy - a matched case-control analysis.胆总管十二指肠吻合术与胆肠吻合术的对比——一项匹配病例对照分析。
HPB (Oxford). 2021 Apr;23(4):560-565. doi: 10.1016/j.hpb.2020.08.014. Epub 2020 Sep 13.
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Diagnosis and treatment of the afferent loop syndrome.输入的英文文本是：诊断和治疗输入袢综合征。
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