皖南医学院学报
皖南醫學院學報
환남의학원학보
ACTA ACADEMIAE MEDICINAE WANNAN
2013年
6期
474-476
,共3页
张正君%葛国朝%罗传瑜%方可
張正君%葛國朝%囉傳瑜%方可
장정군%갈국조%라전유%방가
胆内瘘%诊断%治疗
膽內瘺%診斷%治療
담내루%진단%치료
internal biliary fistula%diagnosis%treatment
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。
目的：探討膽內瘺的診斷及治療方法。方法：對2003～2012年我院膽內瘺病人臨床資料進行迴顧性分析。結果：28例僅4例病人（14．3％）術前診斷膽內瘺，24例（85．7％）為術中髮現；在膽內瘺類型中，75％（21/28）為膽囊十二指腸內瘺，14．3％（4/28）為膽囊膽總管內瘺，7．1％（2/28）為膽囊胃內瘺，3．6％（1/28）為膽囊橫結腸瘺。全部病例均行膽囊切除，21例行十二指腸脩補術，4例行膽總管探查、T管支撐引流（其中1例行膽管空腸Roux-en-Y吻閤術），2例行胃脩補（其中1例行胃部分切除併畢Ⅱ式吻閤），結腸脩補1例。所有患者均順利齣院。結論：膽內瘺術前診斷睏難，主要為術中診斷；膽內瘺手術遵循切除膽囊、脩補瘺口、通暢引流原則；腔鏡治療膽內瘺前景廣闊。
목적：탐토담내루적진단급치료방법。방법：대2003～2012년아원담내루병인림상자료진행회고성분석。결과：28례부4례병인（14．3％）술전진단담내루，24례（85．7％）위술중발현；재담내루류형중，75％（21/28）위담낭십이지장내루，14．3％（4/28）위담낭담총관내루，7．1％（2/28）위담낭위내루，3．6％（1/28）위담낭횡결장루。전부병례균행담낭절제，21례행십이지장수보술，4례행담총관탐사、T관지탱인류（기중1례행담관공장Roux-en-Y문합술），2례행위수보（기중1례행위부분절제병필Ⅱ식문합），결장수보1례。소유환자균순리출원。결론：담내루술전진단곤난，주요위술중진단；담내루수술준순절제담낭、수보루구、통창인류원칙；강경치료담내루전경엄활。
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 .
