胆石性肠梗阻的诊断及治疗:附18例报告  

Diagnosis and treatment of gallstone ileus:a report of 18 cases

作　　者：蒋嘉睿[1] 刘国清[1] 苗雄鹰[1] 谭兴国[1] 钟德玝[1] 

机构地区：[1]中南大学湘雅二医院普通外科,湖南长沙410011

出　　处：《中国普通外科杂志》2011年第2期187-190,共4页China Journal of General Surgery

摘　　要：目的探讨胆石性肠梗阻的诊断及外科治疗方法。方法回顾性分析18例胆石性肠梗阻患者的临床特点、诊治方法及随访结果。结果 18例平均年龄64.3岁,男女比例为1∶5。术前诊断率为77.8%。18例均经手术治疗,其中3例行一期肠切开取石手术,8例行一期行肠切开取石及二期胆囊切除加胆肠内瘘修补术,6例行一期手术解决肠道梗阻同时处理病变胆囊及胆肠内瘘,1例既往有胆肠内引流手术史患者一期行肠切开取石、胆肠吻合口切开取石、原胆肠吻合口整形术。术后并发症发生率38.9%,主要并发症为切口感染及肺部感染;死亡1例(5.5%),为术后第4天死于心肌梗塞。结论胆石性肠梗阻以老年女性患者为主,有效的影像学检查可及时诊断并为治疗提供可靠依据。胆石性肠梗阻应尽早外科干预,并根据患者具体情况选择合适的手术方式。Objective To explore the diagnosis and surgical treatment of gallstone ileus.Methods We retrospectively analysed the diagnosis,treatment and follow-up outcome of 18 patients with gallstone ileus.Results There were 18 patients with mean age of 64.3 years and a male to female ratio of 1∶5.Preoperative diagnosis rate was 77.8%.All 18 patients underwent laparotomy.Three patients underwent enterolithotomy alone,eight had two-stage procedure and six had one-stage procedure;1 patient,who undergoing biliary enteric drainage before,underwent one-stage enterolithotomy,plastic surgery of biliary-enteric anastomosis and lithotomy.The perioperative complication rate was 38.9% and the main complications were wound infection and pulmonary infection.One patient died from myocardial infarction,the perioperative mortality rate was 5.5%.Conclusions Elderly female patients are more susceptible to gallstone ileus.Effective use of imaging techniques can provide a timely diagnosis and reliable basis for the treatment of gallstone ileus.Surgical intervention should be adopted as soon as possible and must be individualized.

关 键 词：肠梗阻/外科学 胆石/并发症 

分 类 号：R656.7[医药卫生—外科学]