摘要
目的总结胆内瘘的临床诊治体会。方法回顾性分析12例胆内瘘的临床资料。6例(50.0%)患者术前获确诊,其中经T管造影确诊1例,胃镜、钡餐各确诊1例,胃镜和钡餐共同确诊1例,内镜逆行胆胰管造影(endoscopic retrograde cholangiopancreatography,ERCP)确诊2例;6例(50.0%)患者为术中发现。5例行胆道探查+T管引流+胆囊切除+内瘘修补术;1例行再次胆道探查+T管引流+内瘘修补术;1例十二指肠球部溃疡并穿孔、胆囊十二指肠瘘者,行BillrothⅡ式胃大部切除术+十二指肠旷置术,瘘口未予处理;1例胆石性肠梗阻患者行胆囊造瘘+十二指肠内瘘修补术+回肠部分切开取石术。另4例行保守治疗。结果手术治疗的8例均治愈出院,保守治疗的4例亦获好转。结论 B超、胃镜、钡餐、ERCP及胆道造影有助于胆内瘘的诊断;选择合适的手术时机和正确的处理方法,有利于提高胆内瘘的治疗水平。
Objective To investigate the diagnosis and treatment effects of the internal biliary fistula.Method The clinical data of 12 patients with internal biliary fistula were retrospectively analyzed.6 patients（50%） were diagnosed before operation,while the other 6 patients were diagnosed according to the intraoperative judgement.The operations were used in 5 cases of biliary tract exploration＋T tube drainage＋cholecystectomy ＋ internal fistula neoplasty,1 case of secondary biliary tract exploration＋T tube drainage＋internal fistula neoplasty,1 case of Billroth Ⅱ subtotal gastrectomy,and 1 of cholecyst stoma＋lithotomy by partial ileotomy.The other 4 cases were treated by expectant treatment.Results All the 8 patients treated by operation were cured.And the other 4 cases improved too.50%（6/12） patients with internal biliary fistula were diagnosed before operation,while 50%（6/12） patients were diagnosed after the operation.These patients had taken the examinations such as ultrasonography、gastroscopy、ERCP、T tube cholangionraphy、choledochofiberscopy pre-operatively.6 out of them were cured and 6 reliefed.Conclusions B ultrasound,endoscopy,barium meal,ERCP and cholangiography contribute to the diagnosis of internal biliary fistula.It is important to improve the clinical effects of the internal biliary fistula by the appropriate timing of surgery and the correct approach.
出处
《中国现代手术学杂志》
2010年第3期177-179,共3页
Chinese Journal of Modern Operative Surgery
关键词
胆结石
胆内瘘
gallstone
internal biliary fistula
