术后胆管炎是胰十二指肠切除术后常见的并发症，可能伴有或不伴有解剖性胆道梗阻。本研究旨在探讨胰十二指肠切除术后胆管炎的发病率、诊断、治疗和危险因素。我们对荷兰两个三级胰腺中心（2010-2019）连续接受胰十二指肠切除术的患者进行了回顾性队列研究。主要结局是术后胆管炎，定义为切除后至少 1 个月，伴有肝脏检查异常且无其他感染灶的全身炎症。评估了诊断和治疗策略。术后胆管炎有两种类型：阻塞性胆管炎（肝空肠吻合术良性狭窄）和非阻塞性胆管炎。使用逻辑回归分析确定潜在的危险因素。900 名患者中有 93 名（10.3%）发生术后胆管炎。胰十二指肠切除术后首次发生胆管炎的中位时间为 8 个月（四分位距 4-16）。 44 名患者（47.3%）发生多次胆管炎，83 名患者（89.2%）需要再次入院。没有观察到与胆管炎相关的死亡率。 37 名患者（39.8%）患有梗阻性胆管炎，56 名患者（60.2%）患有非梗阻性胆管炎。 7 名患者 (7.5%) 因胆管炎进行了手术，包括肝空肠吻合术修正或胆管肢延长。术后胆漏（比值比 2.56；95% 置信区间 1.42-4.62；P = .0018）与术后胆管炎独立相关。胰十二指肠切除术后 10% 的患者出现与癌症复发无关的术后胆管炎。非梗阻性胆管炎比梗阻性胆管炎更常见。术后胆漏是一个独立的危险因素。版权所有 © 2024 Elsevier Inc. 保留所有权利。

Postoperative cholangitis is a common complication after pancreatoduodenectomy that can occur with or without anatomical biliary obstruction. This study aimed to investigate the incidence, diagnosis, treatment, and risk factors of cholangitis after pancreatoduodenectomy.We performed a retrospective cohort study of consecutive patients who underwent pancreatoduodenectomy in 2 Dutch tertiary pancreatic centers (2010-2019). Primary outcome was postoperative cholangitis, defined as systemic inflammation with abnormal liver tests without another focus of infection, at least 1 month after resection. Diagnostic and therapeutic strategies were evaluated. Two types of postoperative cholangitis were distinguished; obstructive cholangitis (benign stenosis of the hepaticojejunostomy) and nonobstructive cholangitis. Potential risk factors were identified using logistic regression analysis.Postoperative cholangitis occurred in 93 of 900 patients (10.3%). Median time to first episode of cholangitis was 8 months (interquartile range 4-16) after pancreatoduodenectomy. Multiple episodes of cholangitis occurred in 44 patients (47.3%) and readmission was necessary in 83 patients (89.2%). No cholangitis-related mortality was observed. Obstructive cholangitis was seen in 37 patients (39.8%) and nonobstructive cholangitis in 56 patients (60.2%). Surgery was performed for cholangitis in 7 patients (7.5%) and consisted of revision of the hepaticojejunostomy or elongation of the biliary limb. Postoperative biliary leakage (odds ratio 2.56; 95% confidence interval 1.42-4.62; P = .0018) was independently associated with postoperative cholangitis.Postoperative cholangitis unrelated to cancer recurrence was seen in 10% of patients after pancreatoduodenectomy. Nonobstructive cholangitis was more common than obstructive cholangitis. Postoperative biliary leakage was an independent risk factor.Copyright © 2024 Elsevier Inc. All rights reserved.