Yang Chang-Zhen, Zhu Cheng-Zhan, Chen Zhi-Yu, Jiang Nan, Wang Si-Yuan, Wang Yu-Jie, Liu Zhi-Peng, Lv Guo-Yue, Wang Guang-Yi, Fan Zhong-Qi, Sun Xiao-Dong, Zhao Zhi-Hao, Hu Xu-Tao, Lu Hong-Wei, Shang Hao, Lu Yu-Xuan, Lin Yu-Jia, Zhou Hu, Zhang Tao, Shan Si-Qiao, Lin Ming-Yu, Yang Dong-Liang, Sun Kai, Xiang Can-Hong, Zeng Jian-Ping, Jin Shuo, Dong Jia-Hong
Hepato-Pancreato-Biliary Center, Beijing Tsinghua Changgung Hospital, Key Laboratory of Digital Intelligence Hepatology, Ministry of Education, School of Clinical Medicine, Tsinghua University, Beijing, China.
Research Unit of Precision Hepatobiliary Surgery Paradigm, Chinese Academy of Medical Sciences, Beijing, China.
Ann Surg. 2025 Aug 12. doi: 10.1097/SLA.0000000000006898.
To compare the efficacy and safety of radical extrahepatic cyst excision including the intrapancreatic bile duct (REC) and subtotal extrahepatic cyst excision preserving the intrapancreatic bile duct (SEC) in treating Todani type I congenital bile duct dilation (CBD) with intrapancreatic bile duct involvement (I-IPBD).
The application of REC and SEC in I-IPBD remains debated.
The multicenter study recruited I-IPBDs who underwent REC or SEC from 5 centers between 2006 and 2024. The primary endpoint was occurrence of long-term complications, including recurrent cholangitis, pancreatitis, and intrapancreatic bile duct stones. The secondary outcomes included readmission, reoperation, life quality assessed by Mayo score, carcinogenesis, and perioperative complications categorized as overall, severe, pancreas-related, and severe pancreas-related.
355 I-IPBDs were included and divided into the REC group (175 cases) and SEC (180 cases) from 722 type I CBDs. The REC group demonstrated better long-term complication-free survival compared to SEC group (log-rank P <0.001; HR=0.08, 95%CI: 0.04-0.15, P <0.001). The REC group had lower rates of readmission, reoperation, and carcinogenesis, and achieved a superior Mayo score (P <0.05). No significant differences were observed between the REC and SEC groups in overall perioperative complications, severe perioperative complications, and severe pancreas-related perioperative complications (P >0.05). Furthermore, subgroup analysis by age demonstrated similar trends in primary and secondary outcomes compared to the overall analysis.
REC was an effective and safe surgical approach for I-IPBD compared with SEC, thus it should be recommended routinely for these patients.
比较根治性肝外囊肿切除术（包括胰内胆管，REC）和保留胰内胆管的次全肝外囊肿切除术（SEC）治疗合并胰内胆管受累的Todani I型先天性胆管扩张症（CBD）的疗效和安全性。
REC和SEC在I-IPBD中的应用仍存在争议。
这项多中心研究纳入了2006年至2024年间在5个中心接受REC或SEC治疗的I-IPBD患者。主要终点是长期并发症的发生，包括复发性胆管炎、胰腺炎和胰内胆管结石。次要结局包括再次入院、再次手术、通过梅奥评分评估的生活质量、癌变以及分为总体、严重、胰腺相关和严重胰腺相关的围手术期并发症。
共纳入355例I-IPBD患者，从722例I型CBD患者中分为REC组（175例）和SEC组（180例）。与SEC组相比，REC组显示出更好的长期无并发症生存率（对数秩检验P<0.001；HR=0.08，95%CI：0.04-0.15，P<0.001）。REC组的再次入院、再次手术和癌变发生率较低，且梅奥评分更高（P<0.05）。REC组和SEC组在总体围手术期并发症、严重围手术期并发症和严重胰腺相关围手术期并发症方面未观察到显著差异（P>0.05）。此外，按年龄进行的亚组分析显示，与总体分析相比，主要和次要结局的趋势相似。
与SEC相比，REC是治疗I-IPBD的一种有效且安全的手术方法，因此应常规推荐给这些患者。
