Parra-Membrives Pablo, Martínez-Baena Darío, Lorente-Herce José Manuel, Martín-Balbuena Ramón
Departamento de Cirugía, Facultad de Medicina, Universidad de Sevilla, Sevilla, España; Unidad de Cirugía Hepatobiliar y Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Valme, Sevilla, España.
Unidad de Cirugía Hepatobiliar y Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Valme, Sevilla, España.
Cir Esp (Engl Ed). 2018 Aug-Sep;96(7):429-435. doi: 10.1016/j.ciresp.2018.03.007. Epub 2018 May 21.
In spite of the acquired experience with laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis management, there is still a risk of biliary leakage of 5% to 15% following choledochotomy closure. We evaluate the usefulness of fibrin-collagen sealants to reduce the incidence of biliary fistula after laparoscopic choledochorrhaphy.
We report a retrospective analysis of 96 patients undergoing LCBDE from March 2009 to March 2017, whose closure of the bile duct was completed by antegrade stenting and choledochorraphy or by performing a primary suture. The study population was divided into two groups according to whether they received a collagen-fibrin sealant covering the choledochorrhaphy or not, analyzing the incidence of postoperative biliary fistula in each group.
Thirty-nine patients (41%) received a fibrin-collagen sponge while the bile duct closure was not covered in the remaining 57 patients (59%). The incidence of biliary fistula was 7.7% (3 patients) in the first group and 14% (8 patients) in the second group (P=.338). In patients who underwent primary choledochorraphy, the fibrin-collagen sealant reduced the incidence of biliary leakage significantly (4.5% vs. 33%, P=.020), which was a protective factor with an odds ratio of 10.5.
Fibrin-collagen sealants may decrease the incidence of biliary fistula in patients who have undergone primary bile duct closure following LCBDE.
尽管在腹腔镜胆总管探查术（LCBDE）治疗胆总管结石方面已有一定经验，但胆总管切开闭合术后仍有5%至15%的胆漏风险。我们评估纤维蛋白-胶原蛋白密封剂在降低腹腔镜胆总管缝合术后胆瘘发生率方面的有效性。
我们报告了一项对2009年3月至2017年3月期间接受LCBDE的96例患者的回顾性分析，这些患者的胆管闭合通过顺行支架置入和胆总管缝合或直接缝合完成。根据是否接受胶原蛋白-纤维蛋白密封剂覆盖胆总管缝合术，将研究人群分为两组，分析每组术后胆瘘的发生率。
39例患者（41%）使用了纤维蛋白-胶原蛋白海绵，其余57例患者（59%）的胆管闭合未使用该材料。第一组胆瘘发生率为7.7%（3例），第二组为14%（8例）（P = 0.338）。在接受直接胆总管缝合术的患者中，纤维蛋白-胶原蛋白密封剂显著降低了胆漏发生率（4.5%对33%，P = 0.020），这是一个保护因素，优势比为10.5。
纤维蛋白-胶原蛋白密封剂可能会降低LCBDE术后直接胆管闭合患者的胆瘘发生率。
