胆总管十二指肠瘘的诊断与治疗

Diagnosis and treatment of choledochoduodenal fistula

目的 探讨胆总管十二指肠瘘的诊断和治疗方法。方法 回顾性分析经内镜检查证实的33例胆总管十二指肠瘘病例的临床资料。结果 本组33例均经十二指肠镜和ERCP检查明确诊断。其中行横断胆总管及胆总管空肠Roux-en-Y吻合术14例，胆总管空肠Roux-en-Y吻合术7例，胆总管切开取石及T管引流术7例，非手术治疗5例。30例获随访9个月～11年，其中14例行横断胆总管及胆总管空肠Roux-en-Y治疗者术后症状消失或明显缓解。结论 十二指肠镜和ERCP检查是诊断胆总管十二指肠瘘的最佳方法，横断胆总管及胆总管空肠Roux-en-Y吻合术是治疗瘘口较大的胆总管十二指肠瘘较满意的外科手术术式。

AIM To evaluate the diagnosis and treatment of fistula（CDF）. METHODS The clinical data of 33 cases of CDF confirmed by duodenoscopic examination and ERCP in our hospital were analyzed, retrospectively. RESULTS There were 12 males and 21 females with average age of 54.2 years. Diagnosises were made according to duodenoscopic examination and ERCP.Of the 33 cases,14 cases were treated with Roux-en-Y choledochojejunostomy plus transection of choledochus, ？ cases with Roux-en- Y choledochojejunostomy, ？ cases with choledocholithotomy and extemal drainage and 5 cases with nonoperative treatment.Thirty cases were followed up for 9 months- 11 years, and the outcomes of patients treated with Roux- en- Y choledochojejunostomy plus transection of choledochus were satisfactory. CONCLUSIONS The best diagnostic methods for CDF.are duodenoscopic examination and ERCP. Roux- en- Y choledochojejunostomy plus transection of choledodus is the choice of surgical therapy for CDF.