胆囊十二指肠瘘伴胆石性肠梗阻1例分析并文献复习  

Cholecystoduodenal fistula with gallstone ileus: an analysis of one case and literature review

作　　者：陈海敏[1] 方宏才 吕亚军 梁博[1] 袁荣发[1] 张军[1] 胡双辉 方路[1] CHEN Haimin;FANG Hongcai;LU Yajun;LIANG Bo;YUAN Rongfa;ZHANG Jun;HU Shuanghui;FANG Lu(Department of Hepatobiliary Surgery,the Second Affiliated Hospital,Nanchang University,Nanchang 330000,China;Department of Hepatobiliory Surgery,Affiliated Hospital of Jiujiang University,Jiujiang,Jiangxi 332000,China;Department of General Surgery,Hukou People＇s Hospital,Hukou,Jiangxi 332500,Chino)

机构地区：[1]南昌大学第二附属医院肝胆外科,江西南昌330000 [2]九江学院附属医院肝胆外科,江西九江332000 [3]江西省湖口县人民医院普通外科,江西湖口332500

出　　处：《中国普通外科杂志》2018年第8期1030-1034,共5页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(81760438);江西省重点研发计划基金项目(20171BBG70063);江西省卫生厅科技计划基金资助项目(20131077)

摘　　要：目的:探讨胆囊十二指肠瘘合并胆石性肠梗阻的术前评估、诊断和手术方式。方法:回顾性分析1例胆囊十二指肠瘘合并胆石性肠梗阻术前及术中的临床资料,并复习相关文献。结果:患者术前CT检查考虑胆囊结石与胆石性肠梗阻。术中探查见回盲部40cm处结石嵌顿,随后成功行肠切开取石、十二指肠瘘口修补、胆囊切除。术后痊愈出院,随访至目前未见相关并发症。结论:胆囊十二指肠瘘合并胆石性肠梗阻临床罕见,早期的明确诊断及精确的评估是关键,应根据患者具体情况选择合适的手术方式。Objective： To investigate the preoperative evaluation, diagnosis and surgical approach of cholecystoduodenal fistula with gallstone ileus.Methods： The clinical data of a patient with cholecystoduodenal fistula and gallstone ileus were analyzed retrospectively, and the relevant literature was reviewed.Results： The patient was considered to have gallbladder stone and gallstone bowel obstruction by preoperative CT examinations. Intraoperative exploration found incarceration of a 40 cm stone at the ileocecal junction. Then, enterotomy and stone removal, duodenal fistula repair and cholecystectomy were successfully performed. The patient was discharged after postoperative recovery, and no related complications were observed up to the present time.Conclusion： Cholecystoduodenal fistula with gallstone ileus is a rare condition in clinical practice, early diagnosis and accurate assessment are critical, and appropriate surgical approach should be chosen according to the specific characteristics of individuals.

关 键 词：胆囊结石病 胆瘘 肠瘘 十二指肠梗阻 

分 类 号：R657.4[医药卫生—外科学]