Trifonov Sergei, Kovalenko Yury, Gurmikov Beslan, Varava Aleksey, Vodeiko Valeria, Pakhtushkin Evgeniy, Vishnevsky Vladimir, Zharikov Yury
Department of Surgical Oncology, A.V. Vishnevsky National Medical Research Center of Surgery, Moscow 115093, Russia.
Department of Human Anatomy and Histology, FSAEI HE I.M. Sechenov First MSMU of MOH of Russia (Sechenovskiy University), Moscow 125009, Russia.
World J Hepatol. 2025 May 27;17(5):104646. doi: 10.4254/wjh.v17.i5.104646.
It is well known that in case of high initial strictures of bile ducts surgical treatment is associated with a high risk of damage to the hepatoduodenal ligament elements, often involved in rough scarring, and with a significant risk of stricture recurrence.
To compare the long-term outcomes of different surgical treatment options for patients with high-grade benign biliary strictures.
From 2012 to 2022, 193 patients were treated at the A.V. Vishnevsky Surgical Center. All of them had different levels of strictures according to Bismuth-Strasberg classification: Type E1-2 in 32 patients, type E3 - 99, type E4 - 62.123 patients underwent open reconstructive interventions, 70 percutaneous endobiliary interventions.
Long-term results were available for 192 (99%) patients with a follow-up of 4.7 ± 1.6 years after reconstructive surgery; 3.0 ± 1.4 years after percutaneous interventions. Excellent and good results (according to Terblanche classification) were achieved in 35% (42/122) of patients after open reconstructive surgery and in 13% (9/70) of patients after percutaneous transhepatic interventions (-value < 0.05).
Technically, the most difficult bile duct strictures for reconstructive and percutaneous transhepatic interventions with a high recurrence rate are Bismuth-Strasberg type E4 and E5. The comparative analysis of long-term results of percutaneous and open procedures showed a statistically significant advantage of percutaneous procedures compared to open reconstructive procedures.
众所周知，对于胆管初始高度狭窄的情况，手术治疗与肝十二指肠韧带结构受损的高风险相关，这些结构常伴有严重瘢痕形成，且狭窄复发风险显著。
比较不同手术治疗方案对高度良性胆管狭窄患者的长期疗效。
2012年至2022年，193例患者在A.V.维什涅夫斯基外科中心接受治疗。根据比绍特-斯特拉斯伯格分类，所有患者均有不同程度的狭窄：E1-2型32例，E3型99例，E4型62例。123例患者接受了开放重建手术，70例接受了经皮经肝胆道介入治疗。
192例（99%）患者有长期随访结果，开放重建手术后随访4.7±1.6年；经皮介入治疗后随访3.0±1.4年。开放重建手术后35%（42/122）的患者和经皮经肝介入治疗后13%（9/70）的患者取得了优良结果（根据特尔布兰奇分类）（P值<0.05）。
从技术上讲，重建和经皮经肝介入治疗中最难处理且复发率高的胆管狭窄是比绍特-斯特拉斯伯格E4型和E5型。经皮和开放手术长期结果的比较分析显示，与开放重建手术相比，经皮手术具有统计学上的显著优势。
