RESUMO
Hilar biliary stricture is usually divided into malignant stricture and benign stricture. How to effectively deal with hilar biliary stricture has always been the focus in biliary surgery. Because it involves bile duct, hepatic artery,portal vein and liver parenchyma, the choice of surgical path is very important. The approach based on perihilar surgical technique can better expose the operative area and have the advantage of performing precise treatment, thus effectively improving the radical cure rate of hilar cholangiocarcinoma and reducing the surgical difficulty.
RESUMO
<p><b>OBJECTIVE</b>To evaluate stenosis of the lower rectum following PPH with special respect to potential predictive factors or stenotic events.</p><p><b>METHODS</b>A retrospective analysis of 554 consecutive patients, which underwent PPH from July 2000 to December 2004 was performed.</p><p><b>RESULTS</b>Only patients with follow-up check were evaluated, thus the analysis includes 489 patients (489/554, 88.3%) with a mean follow-up of (324 +/- 18) days. Rectal stenosis was observed in 12 patients (12/489, 2.5%), the median time to stenosis was 89 - 134 (125 +/- 5) days. All the patients complained of obstructive defecation and underwent strictureplasty with electrocautery or balloon dilation through colonoscopy. A statistical analysis revealed that patients with stenosis had significantly more often prior sclerosis therapy for hemorrhoids (58.3% vs. 20.0%, P = 0.02) and severe postoperative pain (25.0% vs. 6.7%, P = 0.003). Other factors, such as gender (P = 0.32), prior surgery for hemorrhoids (P = 0.11), histological evidence of squamous skin (P = 0.77) or revision (P = 0.53) showed no significance.</p><p><b>CONCLUSION</b>Rectal stenosis is an uncommon event after PPH. Early stenosis will occur within the first four months after surgery. The majority of the stenosis can be cured through colonoscopy surgery. The predictive factors for stenosis are previous sclerosis therapy for hemorrhoids and severe postoperative pain.</p>