胆囊十二指肠瘘并发胆石性肠梗阻的诊疗分析  

Diagnosis and treatment analysis of cholecystoduodenal fistula complicated with gallstone ileus

作　　者：夏吉鹏 崔云峰[1] XIA Ji-peng;CUI Yun-feng(Department of Hepatobiliary and Pancreatic Surgery,Tianjin Nankai Hospital,Nankai Hospital Affiliated to Tianjin Medical University,Tianjin(300100),China)

机构地区：[1]天津市南开医院,天津医科大学附属南开医院肝胆胰外科,天津300100

出　　处：《中国中西医结合外科杂志》2024年第6期873-877,共5页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

摘　　要：目的:探讨胆囊十二指肠瘘(CDF)并发胆石性肠梗阻(GI)的临床特点、治疗方案及预后转归。方法:回顾性分析天津市南开医院2016年1月—2022年12月收治的19例CDF并发GI患者的临床资料。结果:19例患者平均年龄73.1岁,男女比例为1∶8.5,其中合并冠心病12例,糖尿病8例,高血压5例,脑梗死4例。15例患者接受手术治疗,其中11例行单纯小肠切开取石术,3例行小肠切开取石+胆囊切除+十二指肠瘘修补术,1例行部分小肠切除+肠吻合术,术后并发症发生率为40%,主要并发症为腹腔感染(4例),切口感染(2例),4例患者接受中西医结合非手术治疗后结石自发排出。19例患者均顺利出院,无死亡患者。结论:CDF并发GI以老年女性患者为主,常合并多种基础疾病,临床表现不典型,有效的影像学检查可及时诊断并为治疗提供重要依据。CDF并发GI患者应尽早进行外科干预,在遵从基本治疗原则的前提下,根据患者具体情况选择合理化个体化治疗。Objective To investigate the clinical characteristics,treatment options,and prognosis of cholecystoduodenal fistula(CDF)complicated with gallstone ileus(GI).Methods The clinical data follow-up in 19 patients with CDF complicated with GI admitted to Tianjin Nankai Hospital from January 2016 to December 2022 were retrospectively analyzed.Results The average age of the 19 patients was 73.1 years old,and the male to female ratio was 1∶8.5,Among the 19 patients,there were 12 patients with coronary heart disease,8 patients with diabetes mellitus,5 patients with hypertension,and 4 patients with cerebral infarction.15 patients underwent surgical treatment,including 11 cases who underwent simple enterolithotomy,3 cases who underwent enterolithotomy and cholecystectomy and duodenal fistula repair,1 case who underwent partial resection of small intestine and enterostomy.Postoperative complications were 40%,the main complications were abdominal infection in 4 cases and incision infection in 2 cases.4 cases who underwent non-surgical treatment combined with traditional Chinese and Western medicine.All 19 patients recovered and were discharged from hospital without any death.Conclusions CDF complicated with GI is mainly seen in elderly female patients,often associated with various underlying diseases and atypical clinical manifestations.Effective imaging examinations can provide a timely diagnosis and reliable basis for treatment.Surgical intervention for patients with CDF complicated with GI should be performed as early as possible.Based on adherence to basic treatment principles,individualized treatment should be chosen according to the specific circumstances of the patient.

关 键 词：胆囊十二指肠瘘 胆石性肠梗阻 个体化治疗 

分 类 号：R657.4[医药卫生—外科学]