Bonnel D H, Liguory C L, Lefebvre J F, Cornud F E
Centre Medico-Chirurgical De L'Alma, Paris, France.
AJR Am J Roentgenol. 1997 Dec;169(6):1517-22. doi: 10.2214/ajr.169.6.9393155.
This study was undertaken to evaluate the results of our 7-year experience with Gianturco-Rosch metallic stents, used for the management of postoperative biliary strictures.
From January 1989 to April 1995, self-expanding Gianturco-Rosch metallic stents were placed in 25 patients with postoperative bile duct stenosis. All patients had a history of bile duct injury during cholecystectomy. Twenty-four patients had a conventional open cholecystectomy and one patient had a laparoscopic cholecystectomy. Eight patients had stenosis at the level of the common bile duct. The other 17 patients, who had undergone surgical repair of the bile duct, had a stricture at the level of the hepaticojejunostomy. These anastomotic strictures recurred after simple cholangioplasty. Patients were monitored for 9-84 months (mean, 55 months). Treatment was considered successful if the initial stenosis did not recur. Treatment was considered a failure if the initial stenosis recurred within the stent.
Two patients had early complications: one had bile pleural effusion, treated with percutaneous drainage, and the other had arterial hemobilia, treated with embolization. Eighteen (72%) of 25 patients had no recurrence of the initial strictures. Among these patients, 11 had no further symptoms of biliary obstruction and seven, all with strictured hepaticojejunostomies, had recurrent episodes of cholangitis caused by secondary sclerosing cholangitis or intrahepatic stone formation. Seven (28%) of 25 patients had recurrence of the initial stenoses, causing repeated episodes of cholangitis. Among these seven patients, six had common bile duct stenoses and one had an anastomotic stricture. Recurrent biliary obstruction was treated surgically or with percutaneous methods, despite the presence of the metallic stent.
Gianturco-Rosch stent placement should be considered in patients with postoperative bile duct stenoses in whom another operation is not indicated and cholangioplasty has failed. The results are better in patients who have hepaticojejunostomy strictures rather than common bile duct strictures. Overall, a long-term recurrence rate of cholangitis of more than 50% of patients was seen because of recurrence of the original stenosis or intrahepatic bile duct obstruction.
本研究旨在评估我们使用Gianturco-Rosch金属支架治疗术后胆管狭窄7年的经验结果。
1989年1月至1995年4月，对25例术后胆管狭窄患者置入自膨式Gianturco-Rosch金属支架。所有患者在胆囊切除术中均有胆管损伤史。24例患者接受传统开放性胆囊切除术，1例患者接受腹腔镜胆囊切除术。8例患者胆总管水平出现狭窄。另外17例接受胆管手术修复的患者，肝空肠吻合口水平出现狭窄。这些吻合口狭窄在单纯胆管成形术后复发。对患者进行了9至84个月（平均55个月）的监测。如果初始狭窄未复发，则认为治疗成功。如果初始狭窄在支架内复发，则认为治疗失败。
2例患者出现早期并发症：1例出现胆汁性胸腔积液，经皮引流治疗；另1例出现动脉性胆道出血，行栓塞治疗。25例患者中有18例（72%）初始狭窄未复发。在这些患者中，11例无进一步胆道梗阻症状，7例均为肝空肠吻合口狭窄，因继发性硬化性胆管炎或肝内结石形成而反复发作胆管炎。25例患者中有7例（28%）初始狭窄复发，导致胆管炎反复发作。在这7例患者中，6例为胆总管狭窄，1例为吻合口狭窄。尽管有金属支架存在，但复发性胆道梗阻仍采用手术或经皮方法治疗。
对于术后胆管狭窄且不适合再次手术及胆管成形术失败的患者，应考虑置入Gianturco-Rosch支架。肝空肠吻合口狭窄患者的治疗效果优于胆总管狭窄患者。总体而言，由于原狭窄复发或肝内胆管梗阻，超过50%的患者出现胆管炎长期复发率。
