胆囊胆管十二指肠瘘的诊断及个体化治疗22例报告  

Diagnosis and personalized management of cholecystoduodenal fistula

作　　者：叶启文[1] 李林立[1] 张代场[1] 占文峰[1] 林枫[1] 黄驿胜[1] 

机构地区：[1]福建医科大学附属闽东医院十三病区,福安355000

出　　处：《中华肝胆外科杂志》2013年第1期55-57,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 探讨胆囊胆管十二指肠瘘的术前诊断及治疗.方法 总结从2001年至2012年1242例胆道手术中发现22例胆肠内瘘患者的诊断及治疗经验.结果 术前符合以下五项中三项者之诊断符合率达64％：（1）反复畏寒发热为主,无黄疸或仅有轻度黄疸；（2）CT胆囊明显萎缩或无法找到胆囊；（3）CT提示右上腹结构紊乱、肠管扩张、紧贴肝缘；（4）B超或CT提示胆囊或胆道积气；（5）胃肠钡透或十二指肠镜发现球部明显变形或异常开口.全组无死亡病例.发生胆瘘2例,分别于术后第6天、第7天出现胆瘘,胆汁每日引流量约500 ml,经持续引流1个月后胆瘘自愈；切口感染6例,右侧胸腔积液8例,残余结石8例.无肠瘘,无胆管狭窄.结论 术前仔细询问病史及研读CT及B超结果可明显提高诊断率；采取个体化治疗可取得较好疗效,明显减少并发症.Objective To explore the factors which could lead to a preoperative diagnosis and to guide the management of cholecystoduodenal fistula （CDF）.Method The experience on the diagnosis and treatment of 22 patients with CDF were retrospectively studied.These patients came from 1242 patients who received biliary tract operation in our hospital from 2001 to 2012.Results 64% （14 of 22 patients） had 3 out of 5 of the following symptoms/signs：（1） symptoms of recurrent chills and fever,with no or only mild jaundice; （2） significant atrophy or disappearance of gallbladder on computed tomography （CT） ; （3） CT revealed complex anatomy in right upper abdomen with dilated loops of bowel; （4） ultrasound or CT revealed pneumobilia or pneumo-gallbladder; （5） barium study or duodenal endoscopy revealed obvious deformation in duodenal bulb or abnormal opening.There was no perioperative death.Morbidities included biliary fistula which presented on postoperative day 6 and day 7 in 2 patients,respectively.The daily volume of bile drainage was about 500 ml,and the biliary fistula healed after a month of conservative treatment.In addition,there were 6 patients who had infected wound,8 patients with right pleural effusion,and 8 patients with residual calculi.There was no intestinal fistula or biliary stricture.Conclusions Careful preoperative history taking and CT/uhrasound studies significantly improved the diagnostic rate of CDF.Individualized treatment reduced complications and improved clinical results.

关 键 词：胆道 肠瘘 胆瘘 

分 类 号：R657.4[医药卫生—外科学]