Nakamura Kazuki, Ishii Yasutaka, Tatsukawa Yumiko, Nakamura Shinya, Ikemoto Juri, Miyamoto Sayaka, Furukawa Masaru, Iijima Noriaki, Hanada Keiji, Oka Shiro
Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Department of Gastroenterology, Onomichi General Hospital, Hiroshima, Japan.
Surg Endosc. 2025 Feb;39(2):1160-1168. doi: 10.1007/s00464-024-11479-2. Epub 2024 Dec 23.
The treatment of hepatolithiasis in patients who underwent hepaticojejunostomy (HJS) is challenging. In this study, we aimed to clarify the therapeutic outcomes of double balloon enteroscopy (DBE) and percutaneous transhepatic biliary drainage (PTBD) for hepatolithiasis after HJS.
Patients who underwent DBE or PTBD for hepatolithiasis after HJS at Hiroshima University Hospital were enrolled, and treatment outcomes and recurrence were compared.
Forty-eight of the 84 eligible patients underwent DBE, with the HJS site reached in 42 patients (87.5%; DBE group). Forty-one patients underwent PTBD (PTBD group). There were no differences in the clinical characteristics and stone-related factors, including localization, maximum diameter, and quantity, between both groups. The complete stone removal rates in the DBE and PTBD groups were 85.7% and 90.2%, respectively. The DBE group had a significantly shorter median length of hospital stay than the PTBD group (6 vs. 21 days, P < 0.001). During a median follow-up of 45 months, stone recurrence was observed in 22 (32.8%) patients. The cumulative recurrence rates at 1, 3, 5, and 10 years were 13.1%, 31.8%, 34.9%, and 52.7%, respectively. The stone recurrence rates of the DBE and PTBD groups were not significantly different (28.6% vs. 37.5%). Multivariate analysis revealed a stone diameter > 8 mm (hazard ratio, 2.602; P = 0.026) and age ≥ 70 years (hazard ratio, 3.077; P = 0.017) as independent risk factors for stone recurrence.
DBE showed outcomes comparable to those of PTBD in the treatment of hepatolithiasis in patients who underwent HJS. Although reaching the HJS site is difficult in some cases, treatment can be completed within a short period with DBE; therefore, it could be the first choice of treatment for hepatolithiasis after HJS.
对接受肝空肠吻合术（HJS）的患者进行肝内胆管结石的治疗具有挑战性。在本研究中，我们旨在阐明双气囊小肠镜检查（DBE）和经皮经肝胆道引流（PTBD）对HJS术后肝内胆管结石的治疗效果。
纳入在广岛大学医院接受DBE或PTBD治疗HJS术后肝内胆管结石的患者，并比较治疗效果和复发情况。
84例符合条件的患者中有48例接受了DBE，其中42例（87.5%）到达了HJS部位（DBE组）。41例患者接受了PTBD（PTBD组）。两组在临床特征和结石相关因素（包括结石位置、最大直径和数量）方面无差异。DBE组和PTBD组的结石完全清除率分别为85.7%和90.2%。DBE组的中位住院时间明显短于PTBD组（6天对21天，P<0.001）。在中位随访45个月期间，22例（32.8%）患者出现结石复发。1年、3年、5年和10年的累积复发率分别为13.1%、31.8%、34.9%和52.7%。DBE组和PTBD组的结石复发率无显著差异（28.6%对37.5%）。多因素分析显示结石直径>8mm（风险比，2.602；P=0.026）和年龄≥70岁（风险比，3.077；P=0.017）是结石复发的独立危险因素。
在治疗接受HJS的患者的肝内胆管结石方面，DBE显示出与PTBD相当的效果。尽管在某些情况下到达HJS部位困难，但DBE可在短时间内完成治疗；因此，它可能是HJS术后肝内胆管结石的首选治疗方法。
