胆石性肠梗阻五例报告并文献复习

Intestinal obstruction caused by gallstone： report of 5 cases and review of the literature

目的 探讨胆石性肠梗阻的临床特点及诊治方法.方法 回顾性分析5例胆石性肠梗阻患者的临床资料,并复习2000-2009年国内相关文献,对胆石性肠梗阻的发病情况、临床表现、影像学检查、诊断及治疗情况进行总结.结果 本组5例患者中4例为60岁以上女性,其中3例有胆石病史,胆石经胆囊十二指肠瘘排入肠道 另2例有胆肠内引流术史,胆石经内引流口排入肠道.4例行肠切开取石并肠道胆道彻底手术,另1例行单纯肠切开取石 5例患者均手术治愈,术后无复发病例.国内文献复习共获取胆石性肠梗阻有效病例441例,占所有肠梗阻的1.15%,其中女性患者占67.12%,老年患者占73.56%.87.92%的胆石是经胆肠内瘘口排入肠道 64.17%的梗阻位于回肠.术前有71.89%的患者误诊为其他类型肠梗阻.225例行肠切开取石并肠道胆道彻底性手术,其术后复发率及胆囊癌变率低于216例行单纯肠切开取石患者（均P＜0.05） 而术后胆肠瘘、切口感染、肺部感染、治愈率及死亡率两种术式间差异则无统计学意义（均P＞0.05）.结论 胆石性肠梗阻发病率低,以老年女性多见 胆石多经胆肠内瘘口进入肠道,梗阻部位以回肠多见.单纯肠切开取石术后有一定的复发及胆囊癌变风险,故若患者全身情况允许,应首选肠切开取石并胆道肠道彻底性手术.

Objective To explore clinical features, diagnostic methods and treatment of gallstone ileus. Methods Clinical data of 5 patients with gallstone ileus were analyzed retrospectively. Pertinent literature from China between 2000 and 2009 were reviewed. The disease onset, clinical manifestations, imaging characteristics, diagnosis and treatment of gallstone ileus were studied. Results Four out of 5 patients were female aged over 60, of whom 3 had a previous history of cholelithiasis, 2 had a history of cholangiojejunostomy internal drainage procedure. Four patients underwent enterotomy and gallstone extraction combined with hepatobiliary operation, while one underwent enterotomy alone. There was no postoperative recurrence. A review of the literature from China revealed 441 cases with intestinal obstruction caused by gallstone, consisting 1.15% of all the cases with bowel obstruction. 67.12% were female. 73.56% were elderly. 87.92% were from cystoenteral fistula. Site of bowel obstruction in ileum was 64.17% of the cases. 71.89% were misdiagnosed with other types of obstruction. Two hundred twenty-five patients underwent enterotomy and gallstone extraction combined with hepatobiliary operation, which carried a lower rate of postoperative recurrence and malignancy（P〈0.05） than enterotomy alone. There were no statistical significant differences in the occurrence of postoperative cystoenteral fistula, wound infection, pulmonary infection, cure rate, and mortality（P〉0.05）. Conclusions The incidence of gallstone ileus is low and more common in female elderly. The gallstones often drain through cystoenteral fistula and lodge in the ileum. Enterotomy without hepatobiliary operation is associated with potential risk of recurrence and development of gallbladder malignancy. Combined hepatobiliary operation is recommended in patients without significant comorbidities.