胆管囊肿再次手术的安全性及疗效分析

Analysis of safety and outcomes of reoperation for bile duct cyst

目的探讨胆管囊肿再次手术的安全性及疗效。方法回顾性分析2013年1月至2018年12月北京协和医院收治的116例胆管囊肿患者的临床资料,采用倾向值匹配法,对再次手术和首次手术病例的一般情况和并发症进行比较。结果共纳入80例患者,32例获得匹配,均为女性,平均年龄(43.7±15.7)岁。腹痛是最常见的症状,发生于29例患者(90.6%)。吻合口狭窄、肝内胆管结石、囊肿残余均是常见的再次手术原因,分别为8、6、6例。随访时间7~73个月,平均(36.7±22.5)个月。胆道感染是最常见的并发症,术后近期发生胆道感染6例,远期胆道感染10例。再次手术和首次手术病例在一般情况、近期及远期并发症等方面的差异均无统计学意义(P>0.05)。结论胆管囊肿再次手术病例并不少见,吻合口狭窄是最常见的再次手术原因,再次手术和首次手术的安全性和疗效相近。

Objective To analyze the safety and outcomes of reoperation for bile duct cyst.Methods The data of the patients with bile duct cyst admitted in Peking Union Medical College Hospital between January 2013 and December 2018 were analyzed retrospectively.By using the method of propensity score matching,the clinical features and complications of the patients who underwent reoperation or first operation were compared.Results Eighty cases were selected and 32 of them were matched.Thirty-two patients were female,and the mean age was(43.7±15.7)years.Abdominal pain was the most common symptom which occurred in 29 patients(90.6%).Anastomotic stenosis,hepatolith,and residual cyst were common reasons for reoperation which were found in 8,6,and 6 patients,respectively.Thirty-two cases were followed up from 7 to 73 months,mean(36.7±22.5)months.Bile duct infection was the most common complication which occurred within 30 days after operation in six patients and 10 patients occurred after 30 days.There was no significant difference between reoperation and first operation patients in clinical features,recent and long-term complications(P>0.05).Conclusions Reoperation for bile duct cyst is not unusual.Anastomotic stenosis is the most common reoperation reason.If the treatment is appropriate,reoperation could have similar safety and outcomes with first operation.