Andrianello Stefano, Marchegiani Giovanni, Malleo Giuseppe, Pollini Tommaso, Bonamini Deborah, Salvia Roberto, Bassi Claudio, Landoni Luca
General and Pancreatic Surgery Department, The Pancreas Institute, University of Verona Hospital Trust, P. le L.A. Scuro 10, 37134, Verona, Italy.
General and Pancreatic Surgery Department, The Pancreas Institute, University of Verona Hospital Trust, P. le L.A. Scuro 10, 37134, Verona, Italy.
HPB (Oxford). 2017 Mar;19(3):264-269. doi: 10.1016/j.hpb.2016.11.011. Epub 2017 Jan 11.
Biliary fistula (BF) occurs in 3-8% of patients following pancreaticoduodenectomy (PD). It usually pursues a benign course, but rarely may represent a life-threatening event.
Data from 1618 PDs were collected prospectively. BF was defined as the presence of bile stained fluid from drains by post-operative day 3 and confirmed by sinogram in the majority of cases. Three classifications were validated.
BF occurred in 58 (3.6%) patients. In 22 cases was associated with pancreatic fistula (POPF). POPF, PPH, operative time and a smaller common bile duct (CBD) were significantly associated with BF. Only CBD diameter (HR 0.55, CI 95% 0.44-0.7, p < 0.01) was an independent predictor of BF. Patients with smaller CBDs developing concomitant BF and POPF carried the highest mortality rate (34.8%, n = 8/22). All the existing classifications resulted in discrete categories of BFs when considering hospital stay and total cost as dependent variables.
Biliary fistula is rare, but it can be life threatening when associated with POPF. As the sole independent risk factor is the CBD diameter, surgical technique is crucial. Regardless of the existing classification systems, further studies must assess the additive burden of BF when a concomitant POPF is present.
胆瘘（BF）发生于3% - 8%的胰十二指肠切除术（PD）患者中。其病程通常呈良性，但极少数情况下可能危及生命。
前瞻性收集了1618例PD手术的数据。BF定义为术后第3天引流管引出胆汁样液体，并在大多数病例中经窦道造影证实。验证了三种分类方法。
58例（3.6%）患者发生BF。其中22例与胰瘘（POPF）相关。POPF、PPH、手术时间和较小的胆总管（CBD）与BF显著相关。只有CBD直径（HR 0.55，95%CI 0.44 - 0.7，p < 0.01）是BF的独立预测因素。合并BF和POPF且CBD较小的患者死亡率最高（34.8%，n = 8/22）。当将住院时间和总费用作为因变量时，所有现有的分类方法都能将BF分为不同类别。
胆瘘很少见，但与POPF相关时可能危及生命。由于唯一的独立危险因素是CBD直径，手术技术至关重要。无论现有分类系统如何，进一步的研究都必须评估合并POPF时BF增加的负担。
