胆总管十二指肠瘘的诊断和外科治疗

Diagnosis and surgical management of choledochoduodenal fistula

目的 :总结胆总管十二指肠瘘的诊断方法和治疗措施。方法 :从 1981年 1月至 1998年 9月共收治胆总管十二指肠瘘 (CDF) 79例 ,68例接受各种手术治疗 ,其中行胆肠吻合术 46例 ,胆道探查术 11例 ,经内镜乳头括约肌切开术 (EST) 8例 ,胃大部切除 3例。其它 11例行保守治疗。结果 :79例CDF可分为 3种类型。Ⅰ型 :瘘口距十二指肠乳头 2cm以上 ,共 5例。Ⅱ型 :瘘口距十二指肠乳头 1 5cm以内 ,共 2 9例。Ⅲ型 :瘘口在十二指肠纵形皱襞上 ,共 45例。接受手术治疗的 68例患者中 ,5 7例愈后良好 ;11例术后仍有不同程度的临床症状 ,其中 5例再次行胆总管 空肠吻合术后症状缓解。保守治疗的 11例患者中 ,5例效果较好 ,6例有长期慢性右上腹痛或反复发作的胆管炎存在。结论 :胆结石、医源性胆管损伤是造成CDF的重要原因 ,ERCP是诊断CDF的主要方法 ;胆管 空肠吻合术是治疗CDF的主要手术方式。

Objective: To summarize the experience in diagnosis and surgical management of choledochoduodenal fistula (CDF) Methods: Seventy nine patients with CDF were found and treated at our department from January, 1981 to September, 1998 Sixty eight patients were managed with various operations Among them, 46 were treated with biliary enteric anastomosis, 11 with common duct exploration and T tube drainage, 8 with endoscopic sphincterotomy (EST) and 3 with gastrectomy The left 11 patients were treated with medicine Results: Seventy nine patients with CDF were divided into 3 types Type A (5 cases): the orifice of CDG was more than 2 cm far from the papilla Type B (29 cases): the orifice of CDF was less than 1 5 cm around the papilla Type C (45 cases): the orifice of CDF was just on the papillary fold Of the 68 patients deserving surgical intervention, clinical outcome was excellent in 57 patients Eleven patients complaned with abdomianl pain, fever or jaundice after operations and re biliary enteric anastomosis was carried in 5 of these patients In 11 patients deserving medication, 5 were well, 6 had long term abdominal pain or persistent cholangitis and biliary enteric anastomosis was carried out finally in 2 Conclusion: Cholelithiasis and iatrogenic common bile duct injury during common duct exploration are important causes of CDF ECRP is very helpful in the diagnosis of CDF and biliary enteric anastomosis was the major surgical intervention in the treatment of CDF