Adas Gokhan, Arikan Soykan, Gurbuz Emin, Karahan Servet, Eryasar Bahar, Karatepe Oguzhan, Tekant Yaman
Department of Surgery, Okmeydani Education and Research Hospital, Istanbul Faculty of Medicine, Istanbul, Turkey.
Surg Laparosc Endosc Percutan Tech. 2010 Aug;20(4):223-7. doi: 10.1097/SLE.0b013e3181e12ee6.
Hydatid disease most commonly affects the liver, and rupture into the bile ducts is a frequent complication occurring in 5% to 25% of patients. Biliary endoscopic procedures have become the treatment of choice for the management of biliary fistulae. Objective parameters for the endoscopic management of biliary fistulas are still necessary.
In this multicentric retrospective study, a total of 109 patients who underwent surgery for a hydatid cyst localized to the liver and presented with persistent drainage of bile from a lodge drain after surgical intervention were included in this study. All patients were treated by an endoscopic retrograde cholangiopancreatography. Patients were divided into 3 groups according to the therapeutic endoscopic procedure: group 1 (n: 70) included patients who underwent only endoscopic sphincterotomy; group 2 (n: 22) included patients who had a 10 F biliary stent inserted; and group 3 (n: 17) included patients who had a 7 F biliary stent inserted. Recorded data were reviewed and the groups were compared.
The mean daily fistula output was 247 mL (range: 100 to 600 mL) in group 1, 534 mL (range: 200 to 1000 mL) in group 2, and 372 mL (range: 120 to 780 mL) in group 3, respectively. There were significant differences between the sphincterotomy group and the stenting groups (P<0.001). The closure time of the external biliary fistula was 23.7 days (range: 6 to 60 d) in group 1, 12.6 days (range: 7 to 23 d) in group 2, and 20 days (range: 6 to 33 d) in group 3, respectively. When compared with the sphincterotomy group, the fistula closure time was shorter in group 2 than in group 1 (P<0.001). There were no differences in this respect between the groups 1 and 3 (P=0.214). Group 2 also had a shorter fistula closure time than group 3 (P<0.001). There was no mortality in any of the study groups. Mild bleeding was observed in 3 cases in group 1 and in 1 in group 3. CONCULUSIONS: Endoscopic retrograde cholangiopancreatography and related therapeutic procedures are safe and valuable in the postoperative management of external biliary fistulae in the hepatic hydatid disease. In high-output fistulae (>300 mL/d), indicating a major cystobiliary communication, stent placement may be preferred. The diameter of the stent should preferably be 10 F. This 10 F stent is superior to other endoscopic approaches in the treatment of biliary fistulas.
包虫病最常累及肝脏，破裂入胆管是常见并发症，发生率为5%至25%的患者。胆道内镜手术已成为治疗胆瘘的首选方法。仍需要用于胆瘘内镜治疗的客观参数。
在这项多中心回顾性研究中，本研究纳入了总共109例因肝包虫囊肿接受手术且术后经引流管持续有胆汁引流的患者。所有患者均接受内镜逆行胰胆管造影术治疗。根据内镜治疗方法将患者分为3组：第1组（n = 70）包括仅接受内镜括约肌切开术的患者；第2组（n = 22）包括插入10F胆管支架的患者；第3组（n = 17）包括插入7F胆管支架的患者。对记录的数据进行回顾并比较各组情况。
第1组每日胆瘘引流量平均为247 mL（范围：100至600 mL），第2组为534 mL（范围：200至1000 mL），第3组为372 mL（范围：120至780 mL）。括约肌切开术组与支架置入组之间存在显著差异（P<0.001）。第1组外胆瘘闭合时间为23.7天（范围：6至60天），第2组为12.6天（范围：7至23天），第3组为20天（范围：6至33天）。与括约肌切开术组相比，第2组瘘管闭合时间比第1组短（P<0.001）。第1组和第3组在这方面无差异（P = 0.214）。第2组瘘管闭合时间也比第3组短（P<0.001）。所有研究组均无死亡病例。第1组有3例出现轻度出血，第3组有1例。结论：内镜逆行胰胆管造影术及相关治疗方法在肝包虫病术后外胆瘘的管理中是安全且有价值的。对于提示存在较大囊肿胆管瘘的高流量瘘管（>300 mL/d），可能更倾向于放置支架。支架直径最好为10F。这种10F支架在胆瘘治疗中优于其他内镜方法。
