胆囊十二指肠瘘临床分析

目的 在一般人群中,胆囊十二指肠瘘发生率低,术前诊断困难.胆囊十二指肠瘘在治疗方面有一定争议,该文就胆囊十二指肠瘘的诊断和治疗作一分析.方法 回顾性分析20例胆囊十二指肠瘘患者的临床资料,该组患者平均年龄55岁（25～72岁）.所有患者术前分别行B超、胃镜、PTC、ERCP和CT检查,均开腹手术.结果 17例既往有胆道疾病史,10例发现胆结石,3例为十二指肠球部溃疡.PTC或胃镜发现异常造影剂分流或胆汁流,术前通过PTC或胃镜分别诊断1例.18例行胆囊切除、胆总管切开和引流并关闭瘘口.所有患者均治愈.结论 B超示胆道积气时,患者术前应行胃镜、PTC、ERCP等检查.术中探查在诊断胆囊十二指肠瘘时起重要作用,可避免漏诊.选择合适的手术时机和正确的处理方法,有利于提高胆囊十二指肠瘘的治疗水平.

Clinical study of billiary-duodenal fistula

[Objective] In general population, the occurrence rate of cholecystoduodenal fistula was rare, and its preoperative diagnosis was low. The management of cholecystoduodenal fistula is controversial. This study investigated the diagnosis and treatment of cholecystoduodenal fistula. [Method] A retrospectively analysis was made of 20 patients with a mean age of 55 (range 25~72) years. Ultrasonography, upper gastrointestinal endoscopy, PTC, ERCP, and CT were taken in these patients. All patients were treated by open laparotomy. [Results] 17 patients were associated with previous biliary tract disease, 10 patients were found gallstone, and 3 patients were duodenial peptic ulcer. Abnormal contrast medium or bile fluxion found in upper gastrointestinal endoscopy or PTC. The diagnosis was made before operation in 2 patients by upper gastrointestinal endoscopy and PTC, respectively. Cholecystectomy and choledochotomy with T-tube drainage of the CBD and fistula closure were performed in 18 cases. [Conclusions] Biliary pneumatosis was shown in ultrasonography, upper gastrointestinal endoscopy, PTC and ERCP must be taken in patients. Intraoperative exploration played an important role of the final diagnosis. Selecting suitable time of operation and correct treatment had great influence on improvement of treatment results. All patients were recovered and discharged.