肝癌复杂治疗后胆管支气管瘘1例及文献分析

目的探讨胆管支气管瘘（BBF）患者的临床症状、体征及诊断思路。方法通过回顾性分析住院治疗的1例肝癌复杂治疗后胆管支气管瘘合并肺部感染患者的病史资料、实验室及影像学检查、诊疗经过，结合国内外相关文献综合分析。结果患者在行肝脏微创介入治疗后第2天出现咳苦胆味痰，痰胆色素检查阳性。结论患者有肝肿瘤微创治疗病史如射频消融术（PRFA）、肝动脉插管化疗栓塞术（TACE），合并咳嗽、咳苦涩痰，痰胆色素检查阳性，经抗感染治疗效果欠佳等特点时，高度考虑患者胆管支气管瘘可能。其中胆色素痰为确诊最主要依据，患者一旦考虑该诊断，应结合患者病史及一般情况，可采用保守治疗或手术治疗，综合分析，提高患者生活质量及预后。     

胆管支气管瘘17例诊治体会

目的　探讨胆管支气管瘘的病因及诊治方法。方法　回顾分析 17例经检查和手术确诊的胆管支气管瘘患者的病理生理、临床表现、诊疗措施及疗效。结果　 17例患者痊愈 10例 ,好转 3例 ,死亡 4例。结论　胆管支气管瘘的主要病因为肝胆管梗阻和感染 ;病理过程为胆源性肝脓肿致脓胸和肺脓肿 ;诊断主要依靠临床表现及体征 ;治疗以手术解除梗阻 ,引流脓肿为主     

肝包虫并发肝支气管胆瘘16例报告

目的 探讨胆管、肝包、支气管瘘形成的机制及治疗方法。方法 清除包虫内囊、修补支气管及胆瘘口、带蒂大网膜填塞包虫残腔。结果 全组16例术后胆瘘、支气管瘘闭合．肝包虫残腔消失。结论 包虫内囊清除、瘘口修补、残腔大网膜填塞加置管引流是治疗肝包虫并发肝支气管胆瘘的有效方法。     

阿米巴肝脓肿并胆管支气管瘘1例报告

阿米巴肝脓肿并胆管支气管瘘１例报告邵倩，付双来山东省单县中心医院（２７３７００）患者男，４１岁，农民。因反复间断性咳嗽、咳胆汁样痰６ａ；加重２０ｄ于１９９２年１１月３０日入院。６ａ前无诱因发高热，咳嗽、咳白色粘痰，外院以“肺炎”治疗，次日胸闷、憋喘严...     

多因素致胆管支气管瘘一例

胆管支气管瘘是胆道系统与支气管树之间的病理性交通,是肝胆疾病的严重并发症,病因众多,临床上较少见,且极易漏诊误诊[1-4]。现将郑州大学第一附属医院收治的多因素致胆管支气管瘘1例报道如下。1病例资料     

镍钛合金支气管封堵器在支气管瘘封堵中的应用

目的:评价镍钛合金支气管封堵器对支气管瘘实施封堵的疗效及安全性.方法:选择2例胆道支气管瘘的患者为研究对象,经支气管镜以及胆管造影确定瘘道部位和拟封堵的靶位支气管.局麻后在支气管镜引导下,将导引钢丝插入拟封堵的靶位支气管腔内;留置导丝撤出支气管镜;沿导丝将封堵器外鞘管送至拟封堵的靶位支气管,撤出导丝;通过外鞘管将携有封堵器的推送装置送至靶位支气管;在支气管镜以及X线透视下释放封堵器,将靶位支气管完全封堵.术后1周内每天观察咳嗽、咯痰等症状及体温变化,术后1、7、30 d分别复查支气管镜及X线胸片.术前及术后3 d预防性使用抗生素.结果:镍钛合金支气管封堵器均一次置入成功.术后当天咯出胆汁样痰量明显减少,术后7 d咯胆汁样痰症状完全消失;术后1、7、30 d X线胸片显示封堵器均位于靶位,且逐渐膨胀完全;支气管镜检查显示术后1 d封堵区支气管黏膜轻度充血、水肿,术后7 d可见封堵器局部肉芽组织增生明显;术后30 d时肉芽及上皮组织完全将封堵器覆盖.2例患者围术期及术后随访至今(分别为10、14个月),均未发生封堵器移位、脱落以及与手术相关的感染.结论:本组病例中所采用的镍钛合金支气管封堵器及其推送装置是一种置入方便、安全有效的支气管专用封堵器材,为临床各种原因造成的支气管瘘治疗提供了一种安全、有效和微创的新选择.     

胸腔胃-气管／支气管瘘和支气管胸膜瘘的覆膜内支架封堵治疗

胸腔胃-气管／支气管瘘和支气管胸膜瘘多发生于恶性肿瘤术后,临床处理非常网难。这些患者由于肿瘤复发、瘘周感染和恶劣的体质情况使手术修补不能实施,而内科保守治疗效果不佳。Ranu等报道采用内镜下注人生物胶可成功地进行封堵,但一般仅适于较小的瘘口。近年来有报道采用气管或支气管内植入覆膜支架或覆膜盲端内支架封堵瘘口并取得成功。笔者采用该方法治疗胸腔胃-气管／支气管瘘和支气管胸膜瘘5例,均取得满意疗效,现报道如下。     

肝胆管结石合并支气管胆瘘的外科治疗

目的:探讨肝胆管结石合并支气管胆瘘的外科治疗策略.方法:回顾性分析1983年5月～2009年5月间湖南省人民医院肝胆医院收治的8例肝胆管结石并支气管胆瘘患者的临床治疗经过.结果:本组8例患者全部经外科手术清除病灶,通畅引流后,6例治愈、1例效果不佳、1例死亡.结论:肝胆管结石合并流出段胆管的狭窄和梗阻是支气管胆瘘发生的...     

胆管支气管瘘(附6例报告)

目的 :探讨胆管支气管瘘的病因、发病机制、诊断与治疗。方法 :回顾性收集胆管支气管瘘 6例 ,复习相关文献。结果 :5例治愈 ,1例因毒血症、肝肾功能衰竭死亡。结论 :在积极一般治疗基础上设法解除胆道梗阻是成功治疗的关键 ;在急性期 ,手术应以解除胆道梗阻为主要目的     

经支气管镜安置支架治疗气道狭窄及气管食道瘘21例分析

目的探讨支气管镜直视下安置镍钛合金支架对气管、支气管狭窄及支气管食道瘘的治疗效果及不良反应.方法对21例不同原因引起的气管、主支气管狭窄在支气管镜直视下施行了气道镍钛记忆合金支架置入,其中2例合并支气管食道瘘患者置入的为带膜支架,对其中4例严重气道狭窄患者在安置支架前进行了气道球囊扩张,对其中3例主支气管内肿瘤患者在支架上捆绑 125I粒子.结果所有患者术后呼吸困难均立即明显缓解.2例合并气管食道瘘患者在置入带膜气管支架后进食呛咳消失.4例严重气道狭窄患者在进行球囊扩张后均顺利置入气管支架.3例在支架上捆绑 125I粒子的支气管内肿瘤患者1个月后肿瘤组织明显减少.术后出现痰带血2例,肉芽组织增生2例.结论纤支镜直视下安置镍钛合金支架是治疗中心气道狭窄安全而有效的方法之一,支气管球囊扩张可使支架置入更加顺利,带膜支架置入是治疗气管食道瘘的有效手段,支架上捆绑 125I粒子可对支气管腔内肿瘤起到有效控制作用.     

Bronchopancreatic fistula following traumatic rupture of the diaphragm

A bronchopancreatic fistula developed in a 14-year-old boy two weeks following transabdominal splenectomy and repair of a ruptured diaphragm. This unusual entity should be suspected when a patient with pancreatitis or pancreatic trauma has pleural complications associated with profuse, frothy sputum. The diagnosis is established by the presence of high levels of amylase in the sputum or by the appearance in the sputum or the bronchi of dye or contrast material injected into the external fistula. The primary goal of treatment, in addition to the management of the thoracic complications, is subdiaphragmatic control of the pancreatic fistula. A brief summary of seven previously reported cases is presented.     

生长抑制素在治疗胰瘘和预防胰腺手术后并发症中的作用

应用生长抑制素治疗５例胰瘘和１８例壶腹周围癌行胰十二指肠切除术患者。结果表明生长抑制素具有明显抑制胰液、胆汁、胃液等消化液分泌的作用。对促进手术后胰瘘的愈合具有十分满意的疗效。对少数高危的胰头癌患者，于围手术期预防性应用生长抑制素，术后病程平稳，未发生消化道瘘并发症。提示生长抑制素有助于治疗胰瘘和预防胰腺手术后并发症。     

Biliary Pancreatic Portal Fistula as a Complication of Chronic Pancreatitis

In this study we describe an unusual complication in a patient suffering from chronic calcifying pancreatitis. The patient had a fistula between the common bile duct, the pancreatic duct, and the portal vein. He received supportive medical treatment and achieved long-term survival. A review of the literature including diagnosis, treatment and outcome of this rare complication is presented.     

Biliary pancreatic portal fistula as a complication of chronic pancreatitis: a case report with review of the literature

In this study we describe an unusual complication in a patient suffering from chronic calcifying pancreatitis. The patient had a fistula between the common bile duct, the pancreatic duct, and the portal vein. He received supportive medical treatment and achieved long-term survival. A review of the literature including diagnosis, treatment and outcome of this rare complication is presented.     

Spontaneous cholecystocutaneous fistula in a case of chronic colculous cholecystitis--a case report

Chronic calculous cholecystitis is quite a common disease entity today. However, advances in diagnostic imaging and use of broad-spectrum antibiotics have facilitated its early detection and treatment. Hence complications of untreated calculous cholecystitis have shown a steady decline. Spontaneous cholecystocutaneous fistula is one such rare complication. A 45-year-old female presented with acute onset of pain and swelling in the right hypochondrium. She had leucocytosis. The swelling ruptured spontaneously and 200 ml frank yellow pus along with multiple stones were expelled from the site. Completion drainage was done. A fistulogram confirmed the diagnosis of a cholecystocutaneous fistula. The patient underwent open cholecystectomy and excision of the fistulous tract.     

胰十二指肠切除术后并发症的防治分析(附36例报告)

目的 分析胰十二指肠切除术后并发症发生原因及防治办法。方法 通过分析我院10年间36例接受胰十二指肠切除术的患者的临床资料,分析其术后主要并发症的原因和诊治经验。结果 36例中6例出现术后并发症,发生率16.7%,包括胰瘘3例、胆瘘1例、腹腔出血1例、消化道出血1例。死亡2例,死亡率5.6%。结论 提出防治胰瘘、胆瘘、腹腔出血、消化道出血及腹腔感染的具体措施。     

胰十二指肠切除术后并发症的防治分析（附36例报告）

目的 分析胰十二指肠切除术后并发症发生原闪及防治办法。方法 通过分析我院10年问36例接受胰十二指肠切除术的患者的临床资料，分析其术后主要并发症的原因和诊治经验。结果 36例中6例出现术后并发症，发生率16．7％，包括胰瘘3例、胆瘘1例、腹腔出血1例、消化道出血1例。死亡2例，死亡率5．6％。结论 提出防治胰瘘，胆瘘、腹腔出血、消化道出血及腹腔感染的具体措施。     

大网膜填充治疗肝包虫残腔胆汁瘘并感染的临床研究

目的:利用大网膜有较强的吸收粘连、抗感染能力和增加局部肝组织的免疫及修复能力,填充肝包虫残腔,治疗胆汁瘘合并感染,消灭残腔。方法:以胃网膜右动脉为蒂,切断结扎大网膜中动脉,再斜向上到达大网膜左动脉附近切断,裁剪呈L型约15cm×30cm网膜片,填入肝包虫残腔同时置橡皮引流管。结果:本组手术38例,平均带管12天,体温正常,肝功能改善,术后3个月残腔全部消失,没有出现并发症,平均住院时间2周。结论:该术式操作简便,损伤小无并发症。大网膜填入包虫残腔内具有填充止血、吸收粘连的功效,术后恢复快,住院天数缩短,降低了费用,提高了病人的生活质量。     

Portobiliary fistula: successful transcatheter treatment with embolisation coils

Although portobiliary fistula is a recognised complication of percutaneous transhepatic biliary drainage, it is extremely uncommon and can result in haemobilia. Herein, we present a case of complicated transhepatic biliary drainage catheter insertion in a patient with underlying hepatitis B liver cirrhosis, which resulted in a portobiliary fistula. The patient had a preoperative transhepatic biliary drainage procedure done prior to a Whipple’s operation for a large, obstructive, gastrointestinal stromal tumour of the duodenum. To the best of our knowledge, this is the first case in the English medical literature reporting the successful treatment of portobiliary fistula by embolisation of its tract with embolisation coils, without compromising the portal vein or bile ducts.