腹腔镜治疗胆囊内瘘24例临床分析  

Laparoscopic treatment of gallbladder fistula： a retrospective clinical analysis of 24 cases

作　　者：李树强[1] 赵文嫣[1] 刘宝林[1] Li Shuqiang;Zhao Wenyan;Liu Baolin(Department of General Surgery,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院普通外科,沈阳110004

出　　处：《中国医师进修杂志》2018年第10期918-921,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨胆囊内瘘的腹腔镜诊治经验及疗效。方法回顾性分析2012年1月至2018年1月收治的24例经腹腔镜探查/手术治疗的胆囊内瘘患者的临床资料。 结果24例患者均行腹腔镜探查，证实胆囊十二指肠瘘16例，胆囊结肠瘘3例，胆囊胃瘘3例，胆囊胆总管瘘（Mirizzi综合征）2例。本组患者均行胆囊切除术，合并胆总管结石者行胆总管探查＋ T管引流。内瘘处理方式：十二指肠瘘修补术16例，结肠瘘修补术3例，胃瘘修补术3例，十二指肠瘘修补＋胃大部切除术1例，胆管空肠Roux-en-Y吻合术1例。其中11例（45.8%）经由腹腔镜下完成；13例（54.2%）中转开腹手术。术后2例出现轻微胆漏，积极引流2个月后治愈，余均恢复良好，随访6个月，无消化道瘘、梗阻或狭窄等并发症发生。结论胆囊内瘘的临床表现缺乏特异性，术前诊断有一定困难，胆囊内瘘多难自愈，目前仍以外科手术治疗为主，随着腹腔镜技术的发展，对于有经验的术者在腹腔镜下处理胆囊内瘘是较好的治疗方式。ObjectiveTo explore the experience and efficacy of laparoscopic diagnosis and treatment of internal gallbladder fistula （IGF）.MethodsThe clinical data of 24 cases of IGF treated by laparoscopic exploration/surgery were retrospectively analyzed in Shengjing Hospital of China Medical University from January 2012 to January 2018.ResultsAll the 24 patients had underwent laparoscopic exploration and were confirmed as IGF. Among these patients, 16 cases had cholecystoduodenal fistula, 3 cases had cholecystocolic fistula, 3 cases had cholecystogastric fistula, and 2 cases had cholecystocholedo fistula （Mirizzi syndrome）. All patients underwent cholecystectomy, and patients with common bile duct stones underwent common bile duct exploration and T tube drainage. Treatment of internal fistula including： duodenal fistula repair （16 cases）, colon fistula repair （3 cases）, gastric fistula repair （3 cases）, duodenal fistula repair and gastrectomy （1 case）, and Roux-en-Y cholangiojejunostomy （1 case）. Eleven cases were performed laparoscopically （45.8%）; 13 cases were converted to open surgery （54.2%）.Postoperatively, 2 patients experienced mild bile leakage and healed after active drainage for 2 months, and the rest recovered well. After 6 months of follow-up, no complications such as gastrointestinal fistula, obstruction, or stenosis occurred.ConclusionsThe clinical manifestations of gallbladder fistula generally lack specificity, so that preoperative diagnosis is difficult. IGF is hardly to self-heal, and surgical treatment is still the mainstay for treatment. For appropriate situation, experienced surgeons with the developed laparoscopic techniques are reliable treatment for IGF.

关 键 词：腹腔镜 胆囊内瘘 治疗结果 

分 类 号：R657.4[医药卫生—外科学]