Zarzour Jessica G, Christein John D, Drelichman Ernesto R, Oser Rachel F, Hawn Mary T
Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
J Gastrointest Surg. 2008 Jun;12(6):1103-9. doi: 10.1007/s11605-007-0456-9. Epub 2008 Jan 3.
The aim of this study was to determine the success of the nonoperative management of persistent duodenal fistulae (DF) with percutaneous transhepatic duodenal diversion (PTDD).
Retrospective chart review identified six patients with DF managed by PTDD from 2006 to 2007. Patient outcomes and complications were assessed.
The etiology of DF included pancreatic surgery (three patients), gastrectomy (two patients), and Crohn's disease (one patient). PTDD was performed by interventional radiology at a median time of 37 days after fistula recognition. After PTDD, fistula drainage decreased from 775 cc/day (range 200 to 2,525 cc/day) to <50 cc/day at a median of 8 days. Patients were discharged 32 days (median) after PTDD. One patient with Crohn's disease required definitive surgical treatment. Of the remaining five patients, the PTDD tube was capped at 27 days (median) after placement and was removed on an outpatient basis at 79 days (median) after placement. There was no mortality, no fistula recurrence, or complications associated with PTDD placement.
We present an algorithm for the nonoperative management of persistent postoperative DF. In this limited series, PTDD was highly effective at definitively treating DF, especially in the acute setting. PTDD should be considered by surgeons facing the management of postoperative DF.
本研究旨在确定经皮经肝十二指肠转流术（PTDD）对持续性十二指肠瘘（DF）进行非手术治疗的成功率。
通过回顾性病历审查，确定了2006年至2007年间6例接受PTDD治疗的DF患者。评估患者的治疗结果和并发症。
DF的病因包括胰腺手术（3例）、胃切除术（2例）和克罗恩病（1例）。PTDD由介入放射科在瘘管识别后的中位时间37天进行。PTDD后，瘘管引流量从775毫升/天（范围为200至2525毫升/天）在中位时间8天降至<50毫升/天。患者在PTDD后32天（中位时间）出院。1例克罗恩病患者需要进行确定性手术治疗。其余5例患者中，PTDD管在放置后的中位时间27天被封堵，并在放置后的中位时间79天在门诊取出。没有死亡病例，没有瘘管复发，也没有与PTDD放置相关的并发症。
我们提出了一种对持续性术后DF进行非手术治疗的方案。在这个有限的系列研究中，PTDD在确定性治疗DF方面非常有效，尤其是在急性情况下。面对术后DF治疗的外科医生应考虑采用PTDD。
