胆内瘘31例诊治分析

Diagnosis and Treatment of Internal Gallbladder Fistula in 31 Cases

目的:总结胆内瘘的临床特征和诊治经验。方法:回顾分析31例自发性胆内瘘患者的临床资料。结果:术前经B超、CT、消化道造影、磁共振胰胆管造影(magnetic resnanced cholangiopancreatography,MRCP)等检查确诊胆内瘘8例,术前疑诊胆内瘘7例。术中证实胆囊十二指肠瘘23例,胆囊结肠瘘4例,胆囊胆总管瘘4例。除2例胆囊癌晚期外均切除胆囊后,行十二指肠瘘修补术18例,胆总管切开T管外引流+胃空肠吻合术2例,结肠瘘修补术3例,横结肠癌根治术1例,胆总管修补+T管引流术4例,另有3例行回肠切开取石。结论:胆内瘘患者常无特殊临床症状,结合B超、CT、消化道造影、MRCP等检查有助于术前诊断胆内瘘,治疗原则仍是切除病变胆囊和瘘管、修补瘘口、解除消化道梗阻。

Objective：To Summarize the clinical features of biliary fistula and treatment experience. Methods： Retrospective analysis of 31 cases of spontaneous internal gallbladder fistula in patients with clinical data. Results： Eight cases were confirmed by preoperative B ultrasound, CT, gastrointestinal imaging, magnetic resnanced cholangiopancreatography （MRCP） and other tests, suspected preoperative biliary fistula in 7 patients. Fistula surgery confirmed 23 cases of cholecystoduodenal fistula, cys ticolic fistula in 4 cases, 4 cases of cysticholedochi fistula. All patients except advanced gallbladder carcinoma in two cases were accepted cholecystectomy,at the same time, the duodenal fistula repair in 18 cases, common bile duct T tube drainage and gas trojejunostomy in 2 cases, colon fistula repair in 3 cases, Transverse colon cancer eradical resection in l case, common bile duct fistula repair and T tube drainage in 4 cases, and another 3 patients accepted removing the stone from the ileum. Conclusions： There is no typical clinical manifestation in most internal gallbladder fistula patients, combined with gultrasound, CT, gastrointestinal imaging, MRCP and other tests contribute to the preoperative diagnosis of internal gallbladder fistula, the principle is still the treatment of gallbladder removal, cutting off fistula, fistula repair, lifting of digestion obstruction.