Department of Surgery, University of Toledo, Toledo, OH, USA.
Department of Surgery, Toledo Hospital, Toledo, OH, USA.
Am Surg. 2023 Jun;89(6):2947-2949. doi: 10.1177/00031348221088964. Epub 2022 Apr 22.
Bronchobiliary fistula (BBF) is an abnormal connection between the bronchial system and the biliary tree. It pathognomonically presents with bilioptysis (production of bilious-tinged sputum) and is associated with mortality rates up to 12.7%. Here we present a 56-year-old male with stage IV neuroendocrine pancreatic cancer status post pylorus-preserving pancreaticoduodenectomy. The patient developed an acquired BBF secondary to repeated Yttrium-90 radioembolization therapy that resulted in complete stenosis of the hepaticojejunostomy (HJ) anastomosis. The diagnosis was confirmed using cholescintigraphy and bronchoscopy. Biliary decompression with percutaneous transhepatic cholangiogram was unsuccessful, necessitating resection of the HJ anastomosis with salvage bilioenteric reconstruction using Kasai-type anastomosis between the pancreaticobiliary limb and hepatic duct. Complete resolution was noted following surgery. Although a minimally invasive approach to treatment of BBF may be favorable, patients with previous biliary reconstruction may warrant multimodal treatments including percutaneous procedures and complex surgical reconstructions.
支气管胆管瘘（BBF）是指支气管系统与胆道之间的异常连接。它的特征性表现为胆痰（胆汁样痰），死亡率高达 12.7%。这里我们介绍一位 56 岁的男性，患有 IV 期神经内分泌胰腺肿瘤，在保留幽门的胰十二指肠切除术（pylorus-preserving pancreaticoduodenectomy）后。该患者因反复钇 90 放射性栓塞治疗而发生获得性 BBF，导致肝肠吻合口（HJ）完全狭窄。诊断通过肝胆闪烁扫描和支气管镜检查得到确认。经皮经肝胆道造影术（percutaneous transhepatic cholangiogram）的胆道减压不成功，需要切除 HJ 吻合口，并采用胆肠吻合术（Kasai 型吻合术）在胰胆管支和肝管之间进行挽救性胆肠重建。手术后完全缓解。虽然对 BBF 的治疗采用微创方法可能是有利的，但对于以前有胆道重建的患者，可能需要包括经皮介入和复杂手术重建在内的多模式治疗。
