腹腔镜下利用胆囊壁遮盖封闭胆囊十二指肠瘘口的临床体会  

Clinical experience of laparoscopic cholecystoduodenal fistula closure using the gallbladder wall as a cover

作　　者：孙跃勋 尚培中[2] 张伟[2] SUN Yuexun;SHANG Peizhong;ZHANG Wei(Department of General Surgery,Shangqiu Municipal Hospital,Shangqiu 476000,China;Department of General Surgery,the Hospital of PLA 81st Group Army)

机构地区：[1]商丘市立医院普通外科,河南商丘476000 [2]中国人民解放军陆军第八十一集团军医院普通外科

出　　处：《腹腔镜外科杂志》2023年第12期906-910,共5页Journal of Laparoscopic Surgery

基　　金：河北省科学技术研究与发展计划项目(11276103D-21);中国人民解放军陆军第八十一集团军医院课题(2022-01)。

摘　　要：目的:探讨腹腔镜下利用胆囊壁遮盖封闭胆囊十二指肠瘘口的手术方法及其安全性。方法:纳入2012年10月至2023年5月收治的15例胆囊十二指肠瘘患者,均于腹腔镜胆囊切除术中利用胆囊壁遮盖封闭瘘口。结果:15例患者中慢性萎缩性胆囊炎8例,慢性胆囊炎3例,亚急性胆囊炎2例,急性化脓性胆囊炎2例。均顺利完成腹腔镜胆囊切除术,无中转开腹。胆囊瘘口位于底部4例、体部10例、壶腹部1例;十二指肠瘘口位于球部6例、降部9例。瘘口直径0.5~2.0 cm,其中0.5~1.0 cm 10例,1.0~2.0 cm 5例。手术时间45~135 min,平均(84.4±26.9)min;术中出血量15~60 mL,平均(29.8±11.5)mL。术后腹腔引流液淡血性,术后第1天、第2天、第3天引流量分别为(47.6±14.3)mL、(25.1±8.9)mL、(12.2±5.6)mL。患者均未放置空肠腔内营养管,全胃肠外营养3 d左右恢复饮食,术后未发生肠瘘、胆漏等并发症。3~4 d拔除腹腔引流管,患者均恢复良好,痊愈出院。术后住院7~10 d,平均(8.6±1.2)d。3个月后复查B超,肝下胆囊床区域未见包裹性积液,行上消化道造影或胃镜检查,十二指肠瘘口愈合良好,未见龛影或狭窄。结论:腹腔镜术中利用胆囊壁遮盖封闭胆囊十二指肠瘘口,组织材料充裕,缝(钉)合方式灵活,是创伤小、操作简单、疗效可靠的安全术式。Objective:To investigate the surgical method and safety of laparoscopic closure of cholecystoduodenal fistula using the gallbladder wall as a cover.Methods:Fifteen patients of cholecystoduodenal fistula admitted from Oct.2012 to May 2023 were i ncluded,and their fistulas were all closed using the gallbladder wall as a cover during laparoscopic cholecystectomy.Results:Among the 15 patients,there were 8 cases of chronic atrophic cholecystitis,3 cases of chronic cholecystitis,2 cases of subacute cholecystitis,and 2 cases of acute suppurative cholecystitis.All laparoscopic cholecystectomy procedures were successfully completed without conversion to laparotomy.The gallbladder fistula was located in the fundus in 4 cases,the body in 10 cases,and the ampulla in 1 case.The d uodenal fistula was located in the bulbous part in 6 cases and the descending part in 9 cases.The diameter of the fistula ranged from 0.5 to 2.0 cm,of which 10 cases were 0.5-1.0 cm and 5 cases were 1.0-2.0 cm.Surgical time ranged from 45 to 135 min,with a mean of(84.4±26.9)min;intraoperative blood loss ranged from 15 to 60 mL,with a mean of(29.8±11.5)mL.The postoperative peritoneal drainage fluid was lightly bloody,and the average drainage volume was(47.6±14.3)mL,(25.1±8.9)mL,and(12.2±5.6)mL on postoperative day 1,2,and 3,respectively.No jejunal endoluminal nutrition tube was placed in any of the patients,and the diet was resumed after 3 days of total parenteral nutrition.There were no postoperative complications such as intestinal fistula or bile leakage.All patients recovered well and were discharged from hospital after removal of the abdominal drainage tube in 3-4 d.The average hospitalization time after operation was(8.6±1.2)d.Follow-up B-ultrasonography conducted 3 months later revealed no encapsulated effusion in the subhepatic gallbladder bed area,and the duodenal fistula healed well without niche or stenosis demonstrated by upper gastrointestinal contrast or gastroscopy.Conclusions:The laparoscopic closure of cholecystoduodenal fistula

关 键 词：胆石症 胆囊十二指肠瘘 胆囊切除术 腹腔镜 胆囊壁 

分 类 号：R657.4[医药卫生—外科学]