胆囊十二指肠瘘的诊断与治疗

目的 探讨胆囊十二指肠瘘的发生机制、病理改变、诊断方法及治疗过程中的注意事项。方法 回顾性分析17年间收治的11例胆囊十二指肠瘘患者的临床资料。结果 全部经手术证实和治疗。10例继发于胆囊炎、胆囊结石；1例为溃疡病所致，仅1例于术前确诊。9例痊愈，2例死亡，均死于术后腹腔严重感染。结论 胆囊十二指肠瘘大多继发于胆囊炎和胆囊结石，多伴有胆囊萎缩、周围粘连明显等病理情况。X线检查、钡餐、ERCP等对诊断较有价值。治疗原则是切除胆囊、清除结石、切断瘘管、修补十二指肠瘘口，并根据情况探查胆总管或行胆肠内引流。

Diagnosis and treatment of cholecystoduodenal fistula

Objective To explore the pathogenesis, pathomorphology, diagnosis and management of cholecystoduodenal fistula(CDF). Methods Clinical data of 11 cases of CDF admitted in our hospital in recent 17 years were analyzed retrospectively. Results All the patients were confirmed and treated by operation.Ten CDF were caused by cholecystitis and cholelithiasis,another one was caused by peptic ulcer.Only one case of CDF was diagnosed before operation. Nine patients were cured, and two patients died of severity infection of abdomen postoperatively. Conclusions Most CDF are caused by cholecystitis and cholelithiasis. X-ray film of abdomen,barium meal examination and endoscopic retrograde cholangiopancreatography(ERCP) are more useful for the diagnosis of CDF. The therapeutic principle of CDF is cholecystectomy,removing calculus, and repairing fistula with or without common bile duct exploration and/or bilioenterostomy.