胆内瘘:附32例漏诊分析

目的:探讨胆内瘘术前漏诊的原因及减少漏诊的方法。方法:回顾性分析32例胆内瘘漏诊患者的临床资料,平均年龄52.1(25~72)岁,患者分别行B超,T管造影,消化道钡餐,胃镜,胆道镜,ERCP,PTC检查,所有患者均行手术治疗。结果:32例均为术前漏诊者,占同期收治的44例胆内瘘的72.73%。32例均术中确诊。结论:胆内瘘术前漏诊率高,应提高对该病的警惕性;注意寻找该病的特征性表现;尤其当B超发现有胆道积气时,应行进一步检查 如内镜和造影检查,这是提高术前诊断的重要方法。

Internal biliary fistula: a report of 32 cases

Objective To analyze the causes and prevention measures of missed diagnosis of internal biliary fistula. Methods A retrospective analysis of the clinical data of 32 patients with missed diagnosis of internal biliary fistula was made. Their mean age was 52.1(range 25~72)years. Ultrasonography, T tube cholangiography, upper gastrointestinal endoscopy and bariums meal examination, choledochofiberscopy, ERCP, and PTC were taken in these patients. All of the patients were treated by open laparotomy. Results Among 44 cases with internal biliary fistula ,the preoperative missed diagnosis rate was 72.73%(32/44cases), and all of the 32cases were correctly diagnosed during operation. Conclusions The preoperative missed diagnosis rate of internal biliary fistula was high. Awareness of internal biliary fistula must be heightened. Clinical features, history and laboratory evidence characteristic of the disease must be sought preoperatively. When biliary pneumatosis is shown on ultrasonography, endoscopy and visualization must be done. These are reliable methods in preoperative diagnosis of internal biliary fistula.