壶腹癌并病理性胆肠瘘的术前诊断和治疗：附12例报告

目的:探讨壶腹癌并病理性胆肠瘘的临床表现，以提高其术前诊断率。方法:回顾性分析近9年间以壶腹部癌收治入院，术中诊断合并病理性胆肠瘘12例患者的临床资料。结果:所有患者术前临床无阻塞性黄疸的症状及体征。B型超声检查提示壶腹部占位并肝内外胆管扩张，胆囊萎缩，与周围组织粘连，轮廓不清。胆肠瘘均在术中确诊，胆囊十二指肠瘘7例，胆囊结肠瘘5例，瘘口直径为0.4～2.8 cm。4例行根治;8例姑息性手术。术后病理证实均为壶腹癌。结论:对于超声检查有上述发现的老年患者，若临床无阻塞性黄疸的表现，往往反映病理性胆肠瘘存在。

Ampullary carciloma with pathologic cholecystointestinal fistula: a report of 12 cases

Abstract:Objective:To discuss the clinical manifestations of ampullary carcinoma with pathologic cholecystointestinal fistula, so as to improve the rate of preoperative diagnosis.Methods :The clinical data of 12 cases of ampullary carcinoma admitted to our hospital in recent nine years, and with cholecystointestinal fistula diagnosed at operation, were analyzed retrospectively.Results:None of the patients had clinical manifestations of obstructive jaundice preoperatively. Ultrasonography suggested ampullary space occupying Flesion with dilatation of extrahepatic and intrahepatic bile ducts, and atrophic gallbladder with indefinite outline and adherence of gallbladde to surrounding tissues in all the cases; the diagnosis of cholecystointestinal fistula was made during operation. There were 7 cases of cholecystoduodenal fistula and 5 cases of cholecystocolonic fistula. The fistula ranged from 0.4 to 2.8 cm in diameter. Four cases underwent radical operation and 8 cases had palliative surgery. Postoperative pathologic examination verified the diagnosis of ampullary carcinoma.Conclusions:The above-mentioned ultrasonggraphic features in elderly patients with no manifestations of obstructive jaundice, usually indicate the presence of pathologic cholecystointestinal fistula.