胆囊肠道内瘘的诊断与治疗  

Diagnosis and treatment of cholecystoenteric fistula

作　　者：赵鑫[1] 冯涛[2] 相小松[1] 考晓明[1] 郑鹏[1] 李向阳[1] 李东虎[1] 嵇武[1] 

机构地区：[1]南京大学医学院附属金陵医院南京军区南京总医院解放军普通外科研究所,210002 [2]徐州医学院附属连云港医院连云港市第一人民医院普通外科,222002

出　　处：《中华消化外科杂志》2016年第6期600-604,共5页Chinese Journal of Digestive Surgery

基　　金：基金项目：国家自然科学基金（81300278）;江苏省临床医学科技专项（BL2012006）

摘　　要：目的：总结胆囊肠道内瘘（CEF）的临床表现特点及术前诊断方法，探讨腹腔镜手术治疗的临床价值。 方法：采用回顾性描述性研究方法。收集2000年1月至2014年12月南京军区南京总医院收治的29例CEF患者的临床资料。29例CEF患者均接受腹上区超声检查，根据患者个体情况选择其他辅助检查。患者均先试行腹腔镜手术治疗，若局部致密粘连难以分离、缝合关闭窦道困难或术中出血较多，即行中转开腹手术治疗。观察指标：（1）记录患者临床表现。（2）术前辅助检查和术前诊断结果。（3）术中情况（手术方式、手术时间、术中出血量）。（4）术后情况（术后肛门排气时间、引流管拔除时间、术后住院时间、并发症发生情况）。（5）随访情况。采用电话或门诊方式进行随访，随访内容主要为术后远期相关并发症，随访时间截至2015年9月。正态分布的计量资料以平均数（范围）表示，偏态分布的计量资料以M（范围）表示。 结果：（1）临床表现：29例CEF患者均有右季肋区或腹上区疼痛。（2）术前辅助检查和术前诊断结果：29例患者术前均行腹部超声检查，其中胆囊壁增厚17例，萎缩性胆囊炎12例，胆囊壁增厚合并萎缩性胆囊炎5例，胆道积气2例。15例患者术前行腹部CT检查，其中胆囊与周围胃肠道界限不清晰15例，胆道积气5例。7例患者行ERCP检查，其中内镜直接发现窦道开口及胆汁溢出和（或）胆总管内注入造影剂后窦道显示4例。5例患者行胃镜检查，直接发现窦道开口及结石1例。3例患者行结肠镜检查，其中直接发现窦道开口及胆汁溢出1例，结肠肝区炎症反应2例。术前明确诊断9例，术前诊断率为 31.0%（9/29），其中6例胆囊十二指肠内瘘，2例胆囊结肠内瘘，1例胆囊胃内瘘。（3）术中情况：29例CEF患者中，24例成功行腹腔镜手术，平均手�Objective：To summarize the clinical characteristics and effective preoperative diagnosis of cholecystoenteric fistula （CEF）, and investigate clinical effect of laparoscopic surgery. Methods：The retrospective descriptive study was adopted. The clinical data of 29 patients with CEF who were admitted to the Nanjing General Hospital of Nanjing Military Command from January 2000 to December 2014 were collected. All the 29 patients received upper abdominal ultrasonography, and other accessory examinations were selected according to the condition of individual patient. All the patients received laparoscopic surgery initially. If locally dense adhesions around the gallbladder, difficulty of laparoscopic suture or massive bleeding were encountered intraoperatively, patients were then converted to open surgery. The clinical features, results of accessory examinations and preoperative diagnosis, intraoperative status （operation method, operation time, volume of blood loss）,postoperative status （time to anal exsufflation, drainagetube removal time, duration of hospital stay, complications） and followup status were recorded. The followup including longterm complication was performed by telephone interview and outpatient examination till September 2015. Measurement data with normal distribution were presented as average （range）. Measurement data with skewed distribution were presented as M （range）. Results：（1） Clinical features： all the 29 patients had pain in right hypochondriac region or epigastric region. （2） Preoperative accessory examinations and diagnostic results： preoperative ultrasound examination of all the 29 patients demostrated gallbladder wall thickening in 17 patients, atrophic cholecystitis in 12 patients, gallbladder wall thickening combined with atrophic cholecystitis in 5 patients and pneumobilia in 2 patients. Of 15 patients receiving preoperative abdominal computed tomography （CT） examination, 15 had unclear boundary between gall bladder and gastrointestinal tr

关 键 词：胆囊肠道内瘘 临床特征 诊断 腹腔镜检查 

分 类 号：R657.4[医药卫生—外科学]