自发性胆囊内瘘10例临床分析  

Spontaneous Internal Gallbladder Fistula:Clinical Analysis of 10 Cases

作　　者：曹水江[1] 蒋清华[1] 方子兴[1] 

机构地区：[1]第二军医大学长征医院南京分院普外科,江苏南京市210015

出　　处：《中国全科医学》2007年第20期1731-1731,1740,共2页Chinese General Practice

摘　　要：目的总结自发性胆囊内瘘的诊治经验。方法对10例自发性胆囊内瘘进行回顾性分析。结果10例中胆囊十二指肠瘘6例,胆囊胃瘘3例,胆囊结肠瘘1例。B超、CT提示10例均有胆囊结石、慢性胆囊炎、其中胆囊萎缩3例,胆囊腹腔面不完整2例,胆道积气3例。术前确诊6例,余在术中发现。本组10例均行手术治疗,无术后并发症,均康复出院。结论慢性胆囊炎、胆囊结石应警惕胆囊内瘘。有以下情况应考虑胆囊内瘘:(1)B超,CT扫描,腹部平片原有胆囊结石消失或在肠腔出现胆石性肠梗阻。(2)B超胆囊腹腔面消失。(3)ERCP、PTC发现非胆管开口胆汁溢出。(4)钡餐造影剂进入胆囊。Objective To summarize the experience in the diagnosis and treatment of spontaneous internal gallbladder fistula. Methods Clinical data of 10 cases were analyzed retrospectively. Results Among the 10 cases, there were 6 cholecystoduodenal fistula cases, 3 cholecystogastric fistula cases, 1 cysticolic fistula case, all with cholecystitis and gallstone by B ultrasonograph and CT scan. There were 3 cases with gallbladder atrophic, 3 with biliary tract pneumotosis, 2 lack of part gallbladder wall. Only 6 patients were confirmatorily diagnosed to be with internal gallbladder fistula before operation, the others were confirmed duing operations. All the patients were operated and recovered, without any postoperative complications. Conclusion Atrophic cholecystitis and cholelithiasis usually suggest internal gallbladder fistula. The diagnosis refers to the following situations ： （ 1 ） Gallstone having existed on abdominal plain film disappears or intestinal obstruction due to gallstone appears in intestinal cavity by ultrasonograph, CT scan. （ 2 ） Disappearance of gallbladder wall by B ultrasonograph. （ 3 ） Non - biliary - duct cholorrhea by ERCP, PTC. （4） Barium meal contrast medium in gallbladder.

关 键 词：胆囊内瘘 胆囊结石 诊断 治疗 

分 类 号：R657.4[医药卫生—外科学]