Trigui Aymen, Rejab Haitham, Krichene Jihene, Tlili Ahmed, Trabelsi Jihene, Kachoua Ahmed, Boujelbene Salah, Mzali Rafik
Department of General and Digestive Surgery, Faculty of Medicine, University of Sfax, Habib Bourguiba Hospital, Sfax, Tunisia.
Department of General and Digestive Surgery, Faculty of Medicine, University of Sfax, Ibn El Jazzar Hospital, Kairouan, Tunisia.
Pan Afr Med J. 2021 Feb 22;38:195. doi: 10.11604/pamj.2021.38.195.27098. eCollection 2021.
the treatment of large biliocystic fistulas is not unanimous among authors in the absence of consensus or a high level of evidence. There is a controversy over the use of a radical approach which allows the fistula to be sutured in a healthy area or conservative treatment that poses repair issues. The purpose of this study is to compare different conservative techniques to treat large biliocystic fistulas.
we conducted a retrospective study of 54 patients with large fistulas in the Department of General Surgery at the Habib Bourguiba University Hospital in Sfax over a period of 9 years (2010 - 2018).
fourty-four patients were enrolled in the study. Abdominal ultrasound suggested opening of the bile ducts in 18 cases (47.4%) while computed tomography (CT) scan suggested opening in 28 patients (68.3%). The treatment of fistulas was based on DITFO (internal trans-fistulary drainage) in 18 cases (33.3%), cystobiliary disconnection (PERDROMO) in 11 cases (20.4%) and bipolar drainage in 25 cases. Specific surgical morbidity rate was 31.5% and it was dominated by postoperative biliary fistula in 18.5% of cases. DITFO technique was associated with shorter hospital stay (p=0.028) and lower morbidity rates (22.2%) with no statistically significant difference.
DITFO technique is the gold standard technique in the treatment of biliocystic fistula because it is associated with lower morbidity rates and the shortest hospital stay.
在缺乏共识或高水平证据的情况下，作者们对于大的胆囊肿瘘的治疗方法并不统一。对于采用能在健康区域缝合瘘管的根治性方法还是存在修复问题的保守治疗方法存在争议。本研究的目的是比较治疗大的胆囊肿瘘的不同保守技术。
我们对斯法克斯哈比卜·布尔吉巴大学医院普通外科9年间（2010 - 2018年）的54例大瘘管患者进行了回顾性研究。
44例患者纳入研究。腹部超声提示18例（47.4%）胆管开放，而计算机断层扫描（CT）提示28例（68.3%）胆管开放。瘘管治疗采用经瘘管内引流（DITFO）18例（33.3%），胆囊胆管离断术（PERDROMO）11例（20.4%），双极引流25例。特异性手术发病率为31.5%，主要为术后胆瘘，占18.5%。DITFO技术与住院时间缩短（p = 0.028）和发病率较低（22.2%）相关，但无统计学显著差异。
DITFO技术是治疗胆囊肿瘘的金标准技术，因为它与较低的发病率和最短的住院时间相关。
