胆囊十二指肠内瘘9例临床诊疗体会  

Experience in clinical diagnosis and treatment of 9 cases of cholecysto duodenal fistula

作　　者：徐红军 陈灿林 王宪成 郝小军 郭本丰 XU Hong-jun;CHEN Can-lin;WANG Xian-cheng;HAO Xiao-jun;GUO Ben-feng(the Second People's Hospital of Baoying County, Yangzhou 225800, China)

机构地区：[1]江苏省宝应县第二人民医院,江苏扬州225800

出　　处：《临床医学研究与实践》2019年第11期145-146,共2页Clinical Research and Practice

摘　　要：目的总结胆囊十二指肠内瘘9例的临床诊疗体会,以提高对胆囊十二指肠内瘘的认识和诊疗水平。方法回顾性分析我院2008年10月至2018年9月的4 117例行腹腔镜胆囊切除术(LC)中9例胆囊十二指肠内瘘病例的临床资料。结果 9例患者中,术前诊断2例,术中诊断7例;行LC、瘘口缝合修补4例,中转开腹行胆囊切除、瘘口缝合修补3例,腔镜下和中转开腹行胆囊切除、瘘口修补、胆总管切开取石引流各1例。全部病例随访1个月至5年。2例术后1个月内发生切口感染,均为中转开腹病例,1例发生肝下包裹性积液,无梗阻性黄疸,肠梗阻等。结论胆囊十二指肠内瘘缺乏典型临床表现,术前诊断困难,因此临床应提高对该疾病的认识和重视程度,谨慎手术操作和妥善处理瘘管是防范医疗风险的重要措施。Objective To summarize the experience of clinical diagnosis and treatment of 9 cases of cholecysto duodenal fistula, so as to improve the congnition and level of diagnosis and treatment of cholecysto duodenal fistula. Methods The clinical data of 9 cases of cholecysto duodenal fistula in 4 117 cases undergoing laparoscopic cholecystectomy(LC) in our hospital from October 2008 to September 2018 were retrospectively analyzed. Results Of the 9 patients, 2 cases were diagnosed preoperatively and 7 cases were diagnosed intraoperatively. LC and fistula suture repair were performed in 4 cases, conversion to laparotomy and fistula suture repair in 3 cases, cholecystectomy, fistula repair, choledocholithotomy and drainage under endoscopy and conversion to laparotomy in 1 case respectively. All cases were followed up for 1 month to 5 years. Incision infection occurred in2 cases within 1 month after operation, all of which were conversion to laparotomy. One case had subhepatic encapsulated effusion, without obstructive jaundice, intestinal obstruction, etc. Conclusion Cholecysto duodenal fistula lacks typical clinical manifestations and its preoperative diagnosis is difficult, so clinical awareness and importance of the disease should be enhanced. Careful operation and proper management of fistula are important measures to prevent medical risks.

关 键 词：慢性结石性胆囊炎 胆囊十二指肠内瘘 腹腔镜胆囊切除术 

分 类 号：R657.4[医药卫生—外科学]