Quiroga-Garza Alejandro, Alvarez-Villalobos Neri Alejandro, Muñoz-Leija Milton Alberto, Garcia-Campa Mariano, Angeles-Mar Hermilo Jeptef, Jacobo-Baca Guillermo, Elizondo-Omana Rodrigo Enrique, Guzman-Lopez Santos
Human Anatomy Department, Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey 64460, Nuevo Leon, Mexico.
General Surgery Division, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social, Monterrey 64000, Nuevo Leon, Mexico.
World J Gastrointest Surg. 2023 Jun 27;15(6):1191-1201. doi: 10.4240/wjgs.v15.i6.1191.
The management of gallbladder perforation (GBP) with fistulous communication (Neimeier type I) is controversial.
To recommend management options for GBP with fistulous communication.
A systematic review of studies describing the management of Neimeier type I GBP was performed according to the PRISMA guidelines. The search strategy was conducted in Scopus, Web of Science, MEDLINE, and EMBASE (May 2022). Data extraction was obtained for patient characteristics, type of intervention, days of hospitalization (DoH), complications, and site of fistulous communication.
A total of 54 patients (61% female) from case reports, series, and cohorts were included. The most frequent fistulous communication occurred in the abdominal wall. Patients from case reports/series had a similar proportion of complications between open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) (28.6 12.5; = 0.569). Mortality was higher in OC (14.3 0.0; = 0.467) but this proportion was given by only one patient. DoH were higher in OC (mean 26.3 d 6.6 d). There was no clear association between higher rates of complications of a given intervention in cohorts, and no mortality was observed.
Surgeons must evaluate the advantages and disadvantages of the therapeutic options. OC and LC are adequate options for the surgical management of GBP, with no significant differences.
胆囊穿孔合并瘘管形成（内梅耶尔I型）的治疗存在争议。
推荐胆囊穿孔合并瘘管形成的治疗方案。
根据PRISMA指南，对描述内梅耶尔I型胆囊穿孔治疗的研究进行系统评价。检索策略于2022年5月在Scopus、科学网、医学期刊数据库和荷兰医学文摘数据库中进行。提取患者特征、干预类型、住院天数、并发症及瘘管形成部位的数据。
共纳入54例来自病例报告、系列研究和队列研究的患者（61%为女性）。最常见的瘘管形成部位在腹壁。病例报告/系列研究中的患者，开腹胆囊切除术（OC）和腹腔镜胆囊切除术（LC）的并发症发生率相似（28.6比12.5；P = 0.569）。OC的死亡率更高（14.3比0.0；P = 0.467），但该比例仅由1例患者构成。OC的住院天数更长（平均26.3天比6.6天）。队列研究中特定干预措施的较高并发症发生率之间无明确关联，且未观察到死亡病例。
外科医生必须评估治疗方案的优缺点。OC和LC都是胆囊穿孔手术治疗的合适选择，无显著差异。
