胆石症合并胆囊内瘘21例临床诊治分析  

Clinical analysis of diagnosis and treatment in 21 cases of cholelithiasis complicated by cholecystoenteric fistula

作　　者：金家伟 侍阳[1] 何骏[1] 沈丹阳 唐祖雄[1] JIN Jiawei;SHI Yang;HE Jun;SHEN Danyang;TANG Zuxiong(Department of General Surgery,the First Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215000,China)

机构地区：[1]苏州大学附属第一医院普通外科,江苏苏州215000

出　　处：《中国普通外科杂志》2024年第8期1251-1257,共7页China Journal of General Surgery

基　　金：苏州大学优秀研究生教学案例培育基金资助项目(5832016423)。

摘　　要：背景与目的:胆囊内瘘(CEF)属于胆囊疾病的一种罕见并发症,其诊断困难且治疗复杂。因此,本研究通过对笔者收治的胆石症合并CEF病例的总结分析,探讨该病的临床诊断方法与治疗方式。方法:回顾性分析2019年1月—2023年12月苏州大学附属第一医院普通外科经手术治疗的21例胆石症合并CEF患者的临床资料。结果:21例患者中,胆囊十二指肠瘘14例、胆囊结肠瘘3例、胆囊胃瘘4例,其中2例胆囊十二指肠瘘患者在术前确诊。所有患者均按计划择期行腹腔镜手术治疗,其中完成腹腔镜手术11例,中转开腹10例。21例患者的瘘口大小0.15~3.0 cm,平均(0.75±0.70)cm;手术时间89~270 min,平均(169±50)min;术中出血量10~200 mL,平均(58±63)mL;术后住院时间1~90 d,中位时间7 d;术后拔出腹腔引流管时间2~90 d,中位时间7 d;术后恢复流质饮食时间1~15 d,中位时间3 d。腹腔镜手术与中转开放手术患者比较,前者在减少术中出血量、缩短手术时间和住院时间等方面具有优势。1例患者术后发生伤口感染行清创缝合处理后痊愈,1例患者术后出现急性心肌梗死于ICU救治后痊愈,无患者死亡。术后随访5~12个月,平均11个月,无胆汁漏、肠瘘、胆道感染及肠梗阻等并发症发生。结论:对于在临床上怀疑为CEF的患者,结合患者病史,合理应用CT、磁共振胆胰管成像等检查综合判断有助于提高此类疾病的术前确诊率;对于CEF的治疗,确切切除病变胆囊及瘘管并修补瘘口是其治疗原则,有选择性地行腹腔镜手术治疗CEF是安全可行的。Background and Aims:Cholecystoenteric fistula(CEF)is a rare complication of gallbladder disease that is difficult to diagnose and complex to treat.Therefore,this study was performed to explore its clinical diagnostic methods and treatment approaches by summarizing and analyzing cases of cholelithiasis complicated with CEF that the authors treated.Methods:The clinical data of 21 patients with cholelithiasis complicated by CEF who underwent surgical treatment in the Department of General Surgery of the First Affiliated Hospital of Soochow University from January 2019 to December 2023 were retrospectively analyzed.Results:Among the 21 patients,14 had cholecystoduodenal fistula,3 had cholecystocolonic fistula,and 4 had cholecystogastric fistula.Two cases of cholecystoduodenal fistula were diagnosed before the operation.All patients were scheduled for elective laparoscopic surgery,with 11 completing laparoscopic surgery and 10 converting to open surgery.The size of the fistulas ranged from 0.15 to 3.0 cm,with an average of(0.75±0.70)cm.The duration of surgery ranged from 89 to 270 min,averaging(169±50)min.Intraoperative blood loss ranged from 10 to 200 mL,with an average of(58±63)mL.Postoperative hospital stay ranged from 1 to 90 ds,with a median of 7 ds.The time to postoperative removal of the abdominal drainage tube ranged from 2 to 90 d,with a median of 7 d.The time to resume liquid diet after the operation ranged from 1 to 15 d,with a median of 3 d.Compared to conversion to open surgery,laparoscopic surgery had advantages in reducing intraoperative blood loss,shortening surgery duration,and reducing hospital stay.One patient experienced a postoperative wound infection,which was treated and cured with debridement and suturing.Another patient developed acute myocardial infarction postoperatively and recovered after treatment in the ICU.No patient deaths occurred.During the followup period of 5 to 12 months(mean 11 months),no complications such as bile leakage,intestinal leakage,biliary infection,or intestinal obs

关 键 词：胆石症 肠瘘/诊断 肠瘘/治疗 腹腔镜 

分 类 号：R657.4[医药卫生—外科学]