摘要
目的探讨应用腹腔镜治疗胆囊十二指肠瘘的手术方法及临床疗效。方法腔镜下分离胆囊底部,观察解剖路线和胆囊与临近器官的关系,经胆囊穿刺胆系造影,发现内瘘,镜下关闭瘘口,腹腔引流、胃肠减压、应用生长抑素。结果458例腹腔镜胆囊切除术,发现胆囊十二指肠内瘘31例,均腹腔镜下解剖、关闭瘘口成功,无术后出血和十二指肠胆汁漏。结论胆囊十二指肠瘘大多继发于胆囊炎和胆囊结石,多伴有胆囊萎缩,周围粘连明显等病理情况。X线检查、钡餐、ERCP等对诊断较有价值。治疗原则是切除胆囊、清除结石、切断瘘管、修补十二指肠瘘口,并根据情况探查胆总管或行胆肠内引流。
Objective To explore the surgical methods and clinical efficacy of laparoscopic treatment in cholecystoduodenal fistula （CF）. Methods All the procedures for CF were conducted under laparoscope, After the exposure of the cholecystic base, trans-cholecystic cholangiography was performed to detect the relations between the cholecyst and neighboring organs. Once the internal fistula was confirmed,the orifice of fistula was closed laparoscopically. Then abdominal drainage,gastrointestinal decompression,and administration of somatostatin were routinely employed. Results In a series of 458 cases of laparoscopic cholecystectomy （LC） with intraoperative cholangiography, a total of 31 cases of chole cystiduodenal fistula were detected, all of which were anatomized and closed successfully under laparoscope. No postoperative hemorrhage or duodenal bile leakage occurred. Conclusion Most CF are caused by cholecystitis and cholelithiasis. X-ray film of abdomen, barium meal examination and endoscopic retrograde cholangiopancreatography （ERCP） are more useful for the diagnosis of CF. The therapeutic principle of CF is cholecystectomy,removing calculus,and repairing fistula with or without common bile duct exploration and or bilioenterostomy.
出处
《实用医药杂志》
2010年第4期294-295,共2页
Practical Journal of Medicine & Pharmacy
关键词
腹腔镜
胆囊十二指肠瘘
术中胆道造影
Laparoscopy
Cholecystoduodenal fistula
Intraoperative cholangiography
