摘要
目的:探讨胆内瘘的诊断及治疗方法。方法:对2003～2012年我院胆内瘘病人临床资料进行回顾性分析。结果:28例仅4例病人(14.3%)术前诊断胆内瘘,24例(85.7%)为术中发现;在胆内瘘类型中,75%(21/28)为胆囊十二指肠内瘘,14.3%(4/28)为胆囊胆总管内瘘,7.1%(2/28)为胆囊胃内瘘,3.6%(1/28)为胆囊横结肠瘘。全部病例均行胆囊切除,21例行十二指肠修补术,4例行胆总管探查、T管支撑引流(其中1例行胆管空肠Roux-en-Y吻合术),2例行胃修补(其中1例行胃部分切除并毕Ⅱ式吻合),结肠修补1例。所有患者均顺利出院。结论:胆内瘘术前诊断困难,主要为术中诊断;胆内瘘手术遵循切除胆囊、修补瘘口、通畅引流原则;腔镜治疗胆内瘘前景广阔。
Objective： To investigate the approaches to diagnosis and treatment of internal biliary fistula .Methods：The clinical data were retro-spectively analyzed in 28 patients with internal biliary fistula undergone treatment in our hospital between 2003 and 2012.Results： Only 4 （14.3%,4/28） patients were diagnosed with internal biliary fistula be-fore operation,and 24（85.7%,24/28）were confirmed intraoperatively. The fistulae were found with internal cholecystoduodenal in 75%（21/28） cases,gallbladder common bile duct in 14.3%（4/28）,gallbladder stom-ach in 7.1%（2/28）and gallbladder transverse colon in 3.6%（1/28）, respectively.The total patients were undergone cholecystectomy,in whom 21 received duodenum repair,4 common bile duct exploration combined with T-tube drainage（one case managed by bile duct-jejunum Roux-en-Y anastomosis） ,2 stomach repair（ one managed with stomach local excision and Billroth-Ⅱ anastomosis） and 1 repair of colon.Conclusion： Internal biliary fistula is hard to diagnose before operation and generally relys on intraoperative finding.The procedure for this entity shall sequentially con-sist of incision of the gallbladder , repair of the fistula and unobstructed drainage.In addition, laparoscopic cholecystectomy appears promising management of internal biliary fistula .
出处
《皖南医学院学报》
CAS
2013年第6期474-476,共3页
Journal of Wannan Medical College
关键词
胆内瘘
诊断
治疗
internal biliary fistula
diagnosis
treatment
