Dolay K, Akçakaya A, Soybir G, Cabioğlu N, Müslümanoğlu M, Iğci A, Topuzlu C
General Surgery Department, Surgical Endoscopy Unit, Haseki Research Hospital, Haseki Cad. 34280 Aksaray, Istanbul, Turkey.
Surg Endosc. 2002 Jun;16(6):985-8. doi: 10.1007/s00464-001-9020-y. Epub 2002 Mar 5.
Intrabiliary rupture is the most common complication of hepatic hydatid disease (HHD), and persistent biliary leakage is the most frequent complication after surgery for HHD. In this study, we evaluated the outcome of endoscopic sphincterotomy (ES) performed in the management of postoperative biliary fistula in 33 patients with HHD and investigated the effects of the daily output of the fistula and the timing of the ES on the duration of the fistula.
Between January 1994 and April 2000, 33 patients (20 female, 13 male; median age, 44 years; range, 17-72) underwent ES at our clinics. The daily output of the biliary fistula ranged from 100 ml to 1000 ml (mean, 430 ml; in 18 patients < or = 400 ml; in 15 patients, >400 ml). The interval between the occurrence of the fistula and the performance of the ES ranged from 7 days to 5 months (median, 20 days; in 12 patients, < or = 2 weeks; in 21 patients >2 weeks).
In patients with fistula output 400 ml (n = 18) and >400 ml (n = 15), the average closure times for the fistula after ES were 10.7 +/- 4.5 and 10.4 +/- 4.9 days, respectively (t-test: p = 0.847, t = 0.195). In patients (n = 2) with a short interval between the occurrence of the fistula and ES (<2 weeks), the average closure time for the fistula was 11.6 +/- 5.6 days, whereas for the patients (n = 15) with longer intervals (>2 weeks) it was 9.4 +/- 3.9 days (t = test: p = 0.254, t = 1.180). The drainage from the fistula stopped after an average of 9.88 +/- 4.83 days in all patients who underwent ES, and there were no any complications. Pearson's correlation test (PC) showed no significant relationship between the time for the complete closure time of the fistula after ES and the fistula output (PC=-0.253, p=0.155) or for the duration of the fistula before endoscopic retrograde cholangio pancreatography (ERCP) (PC = -0.333, p = 0.058).
Endoscopic sphincterotomy is safe and effective and should be considered the minimally invasive procedure of choice for the management of postoperative biliary fistula due to HHD because it obviates the need for reoperation. If the sphincterotomy is successful, neither the daily output not the duration of the fistula has any influence on the time required for complete closure of the fistula.
胆管内破裂是肝包虫病（HHD）最常见的并发症，而持续性胆漏是HHD手术后最常见的并发症。在本研究中，我们评估了33例HHD患者在内镜下括约肌切开术（ES）治疗术后胆瘘的疗效，并研究了胆瘘每日引流量及ES时机对胆瘘持续时间的影响。
1994年1月至2000年4月，33例患者（20例女性，13例男性；中位年龄44岁；范围17 - 72岁）在我们诊所接受了ES。胆瘘每日引流量为100 ml至1000 ml（平均430 ml；18例患者≤400 ml；15例患者＞400 ml）。胆瘘发生至ES的间隔时间为7天至5个月（中位20天；12例患者≤2周；21例患者＞2周）。
胆瘘引流量≤400 ml（n = 18）和＞400 ml（n = 15）的患者，ES后胆瘘平均闭合时间分别为10.7±4.5天和10.4±4.9天（t检验：p = 0.847，t = 0.195）。胆瘘发生至ES间隔时间短（＜2周）的患者（n = 2），胆瘘平均闭合时间为11.6±5.6天，而间隔时间长（＞2周）的患者（n = 15）为9.4±3.9天（t检验：p = 0.254，t = 1.180）。所有接受ES的患者胆瘘引流平均在9.88±4.83天后停止，且无任何并发症。Pearson相关性检验（PC）显示，ES后胆瘘完全闭合时间与胆瘘引流量（PC = -0.253，p = 0.15）或内镜逆行胰胆管造影（ERCP）前胆瘘持续时间（PC = -0.333，p = 0.058）之间无显著相关性。
内镜下括约肌切开术安全有效，应被视为治疗HHD术后胆瘘的首选微创手术，因为它无需再次手术。如果括约肌切开术成功，胆瘘的每日引流量和持续时间均不会影响胆瘘完全闭合所需的时间。
Zotero 插件