胆总管十二指肠瘘47例临床分析

Clinical analysis of juxtapapillary choledochoduodenal fistula: report of 47 cases

目的 探讨胆总管十二指肠瘘的发生原因、确诊方法及治疗措施。方法 对 47例患者进行经内镜逆行胰胆管造影 (ERCP)及内镜直视下观察 ,并与B超、CT结果进行对照。结果ERCP检查 380 0例次中确诊 47例 (1 2 4% ) ,其中 34例合并结石 ,19例伴有胆道积气。 38例进行手术治疗 ,其中胆总管切开取石 7例 ,胆总管空肠吻合 31例 (其中 4例行肝门部胆管狭窄整形 ,5例行肝叶切除术 )。结论 ERCP对于胆总管十二指肠内瘘是最可靠的诊断方法 ,能清楚显示胆道系统的全貌 ,对治疗方案的选择有重要的指导价值。

Objective To explore the diagnosis and surgical management of juxtapapillary choledochoduodenal fistula and to evaluate endoscopic retrograde cholangiopancreatography(ERCP) in the diagnosis of juxtapapillary choledochoduodenal fistula. Methods A retrospective clinical analysis was made in reference to the diagnosis and operative intervention for a total of 47 cases of juxtapapillary choledochoduodenal fistula.Results Forty seven fistula cases were diagnosed among 3*!800 patients undergoing ERCP. Thirty four cases were complicated with cholelithiasis and 19 bile duct pneumatosis. Thirty eight patients were operated on including choledocholithotomy in 7 cases and hepatojejunostomy in 31 cases, in which hilar choledochoplasty was added in 4 cases, and 5 cases underwent concomitant hepatic segmentectomy. Conclusion ERCP is the most valuable method in diagnosing and guiding surgical management in juxtapapillary choledochoduodenal fistula.