肝胆管结石合并支气管胆瘘35例诊治经验

Diagnosis and treatment of hepatolithiasis complicated by bronchobiliary fistula： a study on 35 patients

目的探讨肝胆管结石合并支气管胆瘘的诊治方法。方法回顾性分析10年来35例患者的临床资料。结果全组均行手术治疗，修补膈肌瘘口。其中行肝叶切除22例，胆管梗阻狭窄切开整形13例。胆总管T管支撑引流19例，肝断面胆管空肠内引流3例，肝胆管盆式Roux-en-Y内引流术13例。术后支气管胆瘘均无复发，肝内胆管结石残留4例。结论患者咯出极苦的黄色脓痰是较为典型的临床特征。解除胆管梗阻，建立通畅引流是手术治疗的关键。

Objective To investigate the diagnosis and treatment of hepatolithiasis complicated by bronchobiliary fistula. Method The data of 35 patients with hepatolithiasis and bronchobiliary fistula treated in our department in the last 10 years were retrospectively studied. Results The operations were =-repair of fistula in the diaphragm （n= 35）, hepatic segmentectomy （n= 22） biliary stricturoplasty （n=13）, T-tube drainage of common bile duct （n= 19）, hepaticojejunostomy （n= 3） and bilateral hepatojejunostomy with a Roux-en Y loop of jejunum （n= 13）. Residual stones were left in 4 patients. There was no recurrence of the bronchobiliary fistula on follow-up. Conclusions Expectoration of bitter and purulent yellow sputum was an important clinical feature of bronchobiliary fistula. The key steps in a successful operation were reliefing the obstructed bile duct and reestablishment of adequate biliary drainage.