内镜治疗胆肠吻合术后狭窄的有效性和安全性

Efficacy and safety of endoscopic treatment for biliary‑enteric anastomotic stricture

摘要:

目的 评估内镜治疗胆肠吻合术后狭窄的有效性和安全性。方法 回顾性纳入2016年1月至2024年1月在海军军医大学第一附属医院因良性胆肠吻合口狭窄接受内镜治疗的53例患者。主要观察指标为内镜治疗方式、治疗次数、技术成功率、胆肠吻合口狭窄复发时间、狭窄缓解率以及并发症发生情况。结果 53例患者共接受103例次内镜治疗，技术成功率98.1%（101/103）。48例次（47.5%）选择支架置入联合扩张治疗，40例次（39.6%）选择仅支架置入治疗，13例次（12.9%）选择仅扩张治疗。6例患者因随访时间过短被排除后续分析，余47例患者随访31.0（13.5，50.3）个月。37例（78.7%）胆肠吻合口狭窄缓解，10例（21.3%）胆肠吻合口狭窄复发。37例达到胆肠吻合口狭窄缓解患者内镜下治疗1（1，2）次。对于需要多次内镜治疗才能达到胆肠吻合口狭窄缓解的患者，约6.2（3.5，7.9）个月再次进行内镜干预治疗。并发症发生率为12.9%（13/101），其中手术相关并发症发生率为7.9%（8/101），支架相关性并发症发生率为5.0%（5/101）。结论 内镜治疗作为良性胆肠吻合术后狭窄的保守治疗方法，具有较高的狭窄缓解率和可控的并发症风险。

Abstract:

Objective To evaluate the efficacy and safety of endoscopic treatment for biliary‑enteric anastomotic stricture. Methods A total of 53 patients who received endoscopic treatment for benign biliary‑enteric anastomotic stricture in the First Affiliated Hospital of Naval Medical University from January 2016 to January 2024 were retrospectively included. The main outcomes included the endoscopic treatment methods, session number, the technical success rate, recurrence, the remission rate and complications. Results A total of 103 endoscopic procedures were performed on 53 patients, with a technical success rate of 98.1% (101/103). Treatments included stent placement combined with dilation (48 cases,47.5%), stenting alone (40 cases,39.6%), and dilation alone (13 cases,12.9%). After excluding 6 patients with insufficient follow‑up, 47 patients with 31.0‑month (13.5, 50.3) follow‑up showed stricture remission in 78.7% (37/47) and recurrence in 21.3% (10/47). A median of 1 (1, 2) endoscopic treatment sessions were needed for 37 patients who achieved stricture remission. For patients who required several treatment sessions, the treatment interval was approximately 6.2 (3.5, 7.9) months. The overall complications occurred in 12.9% (13/101), comprising procedure‑related (7.9%,8/101) and stent‑related (5.0%,5/101) events. Conclusion As a conservative treatment method for biliary‑enteric anastomotic stricture, endoscopic treatment demonstrates high rate of stricture remission and manageable complication risks.