胆内瘘的诊断与治疗

Diagnosis and treatment of internal biliary fistula

目的探讨胆内瘘的发病原因、病理改变、诊断方法及治疗过程中的注意事项。方法回顾性分析近10年收治的43例胆内瘘病人的临床资料。结果40例继发于胆囊炎胆结石，3例为溃疡病所致，43例全部经手术证实并治疗，治愈39例、好转3例、死亡1例。结论胆内瘘术前诊断困难，钡餐、CT、ERCP、胆道造影等检查有助于术前确诊；手术治疗原则是关闭瘘管和解除梗阻，术中手术方式的选择和术后营养支持治疗是预防术后肠瘘及改善病人愈后的关键因素。

Objective To explore the pathogens, pathomorphology, diagnosis and management of internal biliary fistula（IBF）. Methods Clinical data of 43 cases of IBF admitted in our hospital in recent 10 years were analyzed retrospectively. Results All the patients were confirmed and treated by operation. Thirty-nine of them were cured, and 3 improved. There was one death. Conclusion It is difficult to diagnose the IBF before operation. Ultrasonography, gastrocopy, ERCP, CT scan, T-tube cholangiography and choledochofiberscopy can elevate preoperative diagnosis rate. Most IBF is caused by cholecystitis and cholelithiasis. The operative principle of IBF includes closure of the fistula, fistula repair, and relief of the tract obstruction. The proper surgical model and nutrition support post-operation are very important to prevent the gut fistula and acquire prompt prognosis.