胆囊结石合并胆囊内瘘的诊治体会  

DIAGNOSIS AND TREATMENT OF GALLBLADDER STONE WITH INTERNAL GALLBLADDER FISTULA

作　　者：晏建军[1] 黄胜 曹杰[1] 严以群[1] 

机构地区：[1]上海第二军医大学东方肝胆外科医院,上海200438 [2]浙江省象山县人民医院

出　　处：《肝胆外科杂志》2008年第5期357-359,共3页Journal of Hepatobiliary Surgery

摘　　要：目的分析总结胆囊结石合并胆囊内瘘的临床特征和诊治经验。方法回顾性分析20例胆囊结石合并胆囊内瘘患者的临床资料。结果20例患者临床症状无明显特殊,其中胆囊十二指肠瘘9例,胆囊结肠瘘5例,胆囊胃瘘4例,胆囊胆总管瘘2例。B超是目前首选的检查手段,其中16例提示胆囊呈萎缩状。本组仅有5例术前疑诊为胆囊内瘘(25%),其中1例行钡灌肠诊断为胆囊结肠瘘,2例B超示胆囊内积气,1例行腹部平片示胆管内积气,诊断胆囊结肠、胃瘘,1例行CT检查诊断胆囊十二指肠瘘。治疗均切除胆囊后,行十二指肠瘘修补术5例,十二指肠瘘修补术+胃大部切除术4例;横结肠癌根治性切除1例,结肠瘘修补4例,胃瘘修补4例,胆总管修补+T管引流1例,胆总管空肠Roux-en-Y吻合术1例。结论胆囊内瘘治疗原则仍然是切除病变的胆囊、切断瘘管、修补瘘口、酌情胆道探查、T管引流、解除消化道梗阻。Objective To investigate the clinical feature and summarize the experience in the treatment and diagnosis of gallbladder stone with intemal gallbladder fistula. Methods Clinical data of 20 cases were analyzed retrospectively. Results There is no typical clinical manifestation in all patients, most of the patients had fight abdominal pain accomplished with right shoulder or right back pain. There were 9 cholecystoduodenal fistula cases, 5 eysticolic fistulas, 4 cholecystogastric fistulas and 2 cysticholedochi fistula. B ultrosounography is the first choice of examination, gallbladder stone was found in all patients and atrophic gallbladder was found in 16 patients under the B ultrasound. In this group, only 5 internal gallbladder fistulas were diagnosed preoperatively, the others were confirmed in operation. All patients were accepted cholecystectomy, at the same time, 5patients accepted duodenal fistula repair, 4 patients accepted duodenal fistula repair and gastric resection, 1 patient accepted transverse colon cancer eradical resection, 4 accepted colon fistula repair and 4 accepted gastric fistula repair, 1 patient accepted common bile duct fistula repair and T-tube drainage, 1 patient accepted choledochojejunostomy. Conclusion The operative principle of internal gallbladder fistula includes cholecystectomy, cutting off the fist, fistula repair, and biliary tract exploration, T tube drainage and relieving the digestive tract obstruction according to the patients＇ condition.

关 键 词：胆囊内瘘 诊断 治疗 

分 类 号：R575.6[医药卫生—消化系统]