ERCP在胆囊肠道瘘术前诊断中的应用进展

Advances in Preoperative Diagnostic Application of ERCP for Gallbladder Intestinal Fistula

胆囊肠道瘘是非常少见的胆囊结石并发症,术前确诊率较低,术中误诊、漏诊率较高。胆囊肠道瘘无特异性临床表现,术前可通过X线、B超、CT、磁共振胰胆管造影等检查进行诊断,但大多效果不佳。经内镜逆行胰胆管造影术的优点为可在内镜下直视观察胃、十二指肠腔有无异常开口,并经瘘口或十二指肠乳头插管注入造影剂使胆管系统显影,从而可明确胆肠内瘘的部位和类型,其确诊率可高达88%,是胆囊肠道瘘主要的术前诊断手段。

Gallbladder intestinal fistula is a rare complication of iong-standing gallstones, hard to diag- nose and difficult to manage.-The preoperative diagnosis rate of internal biliary fistula is low, and the misdiag- nosis and missed diagnosis rate is high. This disease has no typical clinical presentations, while abdominal X- ray, B-ultrasound, CT, magnetic resonance cholangiopancreatography can be applied to the preoperative diag- nosis, the results are often not as helpful as expected. The preoperative application of endoscopic retrograde cholangiopancreatography （ERCP）, has the advantages of direct display of abnormal opening in the stomach and duodenum cavity, and clearly show the site of biliary fistula and type by duodenal fistula or catheter injection of contrast agent for the bile duct system development, with a diagnostic rate amount to 88 %. ERCP plays an important role in the preoperative diagnosis of gallbladder intestinal fistula.