Pitt H A, Miyamoto T, Parapatis S K, Tompkins R K, Longmire W P
Am J Surg. 1982 Jul;144(1):14-21. doi: 10.1016/0002-9610(82)90595-5.
We reviewed our experience from 1955 to 1979 with benign postoperative biliary strictures to determine which factors were associated with a favorable outcome. Patients operated on from 1970 to 1979 were significantly more likely (p less than 0.01) to achieve a good result (86 percent) than were patients undergoing surgery between 1955 and 1969 (68 percent). An inverse correlation (r = -0.96, p less than 0.05) was present between the number of previous repairs and the percentage of good results. Patients referred without a previous repair were most likely to achieve a good result (86 percent). Roux-Y jejunal reconstructions were associated with the best results (p less than 0.01). In recent years Silastic transhepatic stents were used in 20 patients with hilar strictures; 18 (90 percent) achieved good results. Patients stented for the shortest period (less than 1 month) were less likely to achieve a good outcome than those stented for longer periods (p less than 0.025). Patients with difficult hilar strictures who were stented for more than 9 months were more likely to have a good result if a changeable Silastic transhepatic stent was employed (p less than 0.01). This analysis suggests that early referral, Roux-Y jejunal reconstruction, judicious use of Silastic transhepatic stents, and prolonged stenting of hilar strictures will improve the outlook in patients with postoperative biliary strictures.U
我们回顾了1955年至1979年期间处理良性术后胆管狭窄的经验，以确定哪些因素与良好预后相关。1970年至1979年接受手术的患者取得良好结果的可能性（86%）显著高于1955年至1969年接受手术的患者（68%）（p<0.01）。既往修复次数与良好结果百分比之间存在负相关（r = -0.96，p<0.05）。未进行过既往修复的转诊患者最有可能取得良好结果（86%）。Roux-Y空肠重建的效果最佳（p<0.01）。近年来，20例肝门部狭窄患者使用了硅橡胶经肝支架；18例（90%）取得了良好结果。支架置入时间最短（少于1个月）的患者比支架置入时间较长的患者取得良好预后的可能性小（p<0.025）。对于肝门部狭窄困难的患者，如果使用可更换的硅橡胶经肝支架，支架置入超过9个月更有可能取得良好结果（p<0.01）。该分析表明，早期转诊、Roux-Y空肠重建、合理使用硅橡胶经肝支架以及延长肝门部狭窄的支架置入时间将改善术后胆管狭窄患者的预后。
