胆内瘘的诊治体会

目的 探讨胆内瘘的诊断及治疗经验.方法 对1995年5月～2005年8月间收治的29例胆内瘘患者进行回顾性分析.结果 全组29例,其中10例患者术前诊断为胆内瘘,其余病例为术中发现.所有病例经手术后均痊愈出院,无严重并发症发生,随访2年,也无胆管狭窄发生.结论 胆内瘘术前诊断困难,对萎缩性胆囊炎、长期胆囊结石患者,尤其是发现胆道积气征者应高度怀疑.胆管瘘口可采用瘘口修补、T型管引流或肝胆管空肠Roux-en-Y内引流等方法治疗,对胃、肠道瘘口可采用瘘口修补或胃部分切除处理.

Discuss on diagnosis and treatment of internal biliary fistula

Objective] To explore the experience in diagnosis and treatments of Internal biliary fistula. Methods] The clinic data of 29 cases with Internal biliary fistula treated in our hospital from May. 1995 to Aug. 2005 were analyzed retrospectively. Results] All the cases were successfully cured, 10 of them were diagnosed before operation, and other cases were diagnosed by operations, no serious postoperative complications occurred. None of the cases has bile duct stricture during a two years follow-up. Conclusions] Internal biliary fistula diagnosed before operation was difficult. The atrophic cholecystitis and chronic cholelithiasis, especially the pneumotosis in biliary tract was found, usually suggest Internal biliary fistula. The biliary fistula should be treated by fistula repair, T-type tube biliary drainage or Roux-en-Y hepaticocholangiojejunostomy, and the gastrointestinal fistula should be remedy by fistula repair or subtotal gastrectomy.