Biliary Stricture After Necrotizing Pancreatitis: An Underappreciated Challenge.
Biliary Stricture After Necrotizing Pancreatitis: An Underappreciated Challenge.
复制标题
坏死性胰腺炎后胆道狭窄：一个未被充分认识的挑战。
DOI：
10.1097/sla.0000000000004470
复制
发表时间：
2022-07-01
影响因子：
9
通讯作者：
中科院分区：
文献类型：
--
作者：
坏死性胰腺炎 (NP) 中的胆道狭窄尚未进行系统分类；因此，我们试图确定 NP 引起的胆道狭窄的发病率和自然史。良性胆道狭窄继发于胆管损伤、吻合口狭窄或慢性炎症和纤维化。 NP 的严重局部炎症反应会造成具有挑战性的胆道狭窄。对 2005 年至 2019 年期间接受治疗的 NP 患者进行了回顾。胆道狭窄通过胆管造影确定为肝外胆管树狭窄至<未受影响胆管直径的 75%。评估了胆道狭窄的危险因素和结果。 743例NP患者中，死亡64例，失访13例；因此，最终队列中共有 666 名患者。 108 名 (16%) 患者出现胆道狭窄。平均随访时间为 3.5±3.3 年。从 NP 发病到胆道狭窄诊断的中位时间为 4.2 个月（IQR，1.8-10.9）。通常表现为临床或生化黄疸，各 n = 30 (28%)。狭窄发展的危险因素是内脏静脉血栓形成和胰头实质坏死。狭窄缓解的中位时间为发病后 6.0 个月 (2.8-9.8)。平均执行 3.3±2.3 次手术。 22 名 (20%) 患者需要手术干预。 17% (17/99) 的患者内镜治疗失败，且与狭窄长度无关。感染性坏死或 NP 病程≥6 个月的患者更有可能进行胆道狭窄的手术治疗。坏死性胰腺炎后经常发生胆道狭窄，并与内脏静脉血栓形成和胰头坏死有关。 20%进行了手术矫正。坏死性胰腺炎的胆道狭窄治疗起来很困难，并且尚未进行系统分类。 16% 的患者出现这种并发症，并与胰头坏死和内脏静脉血栓形成相关。内窥镜治疗对大多数患者有效；然而，20%的患者接受了手术矫正。
Biliary stricture in necrotizing pancreatitis (NP) has not been systematically categorized; therefore, we sought to define the incidence and natural history of biliary stricture caused by NP. Benign biliary stricture occurs secondary to bile duct injury, anastomotic narrowing, or chronic inflammation and fibrosis. The profound loco-regional inflammatory response of NP creates challenging biliary strictures. NP patients treated between 2005-2019 were reviewed. Biliary stricture was identified on cholangiography as narrowing of the extrahepatic biliary tree to <75% of the diameter of the unaffected duct. Biliary stricture risk factors and outcomes were evaluated. Among 743 NP patients, 64 died, 13 were lost to follow up; therefore, a total of 666 patients were included in the final cohort. Biliary stricture developed in 108 (16%) patients. Mean follow up was 3.5±3.3 years. Median time from NP onset to biliary stricture diagnosis was 4.2 months (IQR, 1.8-10.9). Presentation was commonly clinical or biochemical jaundice, n = 30 (28%) each. Risk factors for stricture development were splanchnic vein thrombosis and pancreatic head parenchymal necrosis. Median time to stricture resolution was 6.0 months after onset (2.8-9.8). A mean of 3.3±2.3 procedures were performed. Surgical intervention was required in 22 (20%) patients. Endoscopic treatment failed in 17% (17/99) of patients and was not associated with stricture length. Operative treatment of biliary stricture was more likely in patients with infected necrosis or NP disease duration ≥6 months. Biliary stricture occurs frequently after necrotizing pancreatitis and is associated with splanchnic vein thrombosis and pancreatic head necrosis. Surgical correction was performed in 20%. Biliary strictures in necrotizing pancreatitis are challenging to treat and have not been systematically categorized. This complication developed in 16% of patients and was associated with pancreatic head necrosis and splanchnic vein thrombosis. Endoscopic treatment is effective in most; however, 20% of patients underwent operative correction.