胆囊内瘘的诊断与治疗

目的探讨胆囊内瘘的临床特征及诊治方法。方法回顾性分析16例胆囊内瘘患者的临床资料。结果 16例多表现为反复右上腹痛伴右肩部或右腰背部放射痛,部分伴有恶心、呕吐、发热、黄疸等症状。其中胆囊十二指肠瘘7例,胆囊结肠瘘4例,胆囊胃瘘4例,胆囊胆总管瘘1例。B超仍是首选的检查手段。B超均发现胆囊结石,12例提示胆囊呈萎缩状。本组仅有5例术前确诊,其中1例行钡灌肠诊断为胆囊结肠瘘,2例B超示胆囊内积气,1例行腹部平片示胆管内积气,诊断胆囊结肠、胃瘘,1例行CT检查诊断胆囊十二指肠瘘。治疗均手术切除胆囊,行十二指肠瘘修补术3例,十二指肠瘘修补术 胃大部切除术4例;横结肠癌根治性切除1例,结肠瘘修补3例,胃瘘修补4例,胆总管空肠Roux-en-Y吻合术1例。结论胆囊内瘘的手术的原则仍然是切除病变的胆囊、切断瘘管、修补瘘口、酌情胆道探查、T管引流、解除消化道梗阻。

DIAGNOSIS AND TREATMENT OF GALLBLLADDER INTERNAL FISTULA(16 cases)

Objective To investigate the clinical experience in the treatment and diagnosis of gallbladder internal fistula. Methods Clinical data of 16 cases were analyzed retrospectively. Result Most of the patients had the clinical manifestation of right abdominal pain accomplished with right shoulder or right back pain, and some patients had the clinical manifestation of nausea, fever and jaundice at the same time. There were 7 cholecystoduodenal fistula cases, 4 cysticolic fistulas, 4 cholecystogastric fistulas and 1 cysticholedochi fistula. B ultrosounography was the first choice of examination. Under the B ultrosound, gallbladder stone was found in all patients and atrophic gallbladder was found in 12 patients. In this group, only 5 gallbladder internal fistulas were diagnosed preoperatively, the others were confirmed in operation. All patients were accepted cholecystectomy. At the same time, 3 patients underwent duodenal fistula repair, 4 patients did duodenal fistula repair and gastric resection, 1 patient did transverse colon cancer radical resection, 3 did colon fistula repair and 4 did gastric fistula repair, 1 patient did choledochojejunostomy. Conclusion The operative principle of gallbladder internal fistula includes cholecystectomy, cutting off the fistula, fistula repair, and biliary tract exploration, T tube drain and relieving the digestive tract obstruction according to the patients' condition.