胆石性肠梗阻的分析和诊治

Experience in diagnosis and treatment of the ileus caused of gallstone

目的 :分析胆石性肠梗阻的临床表现 ,探讨其诊断和治疗方法。方法 :对我院 1 980～ 2 0 0 0年收治的 1 8例胆石性肠梗阻患者资料作回顾性分析 ,其中 1 6例行肠壁切开取石术 ,同时行胆肠内瘘修补 5例、小肠部分切除 2例 ;2例以中药大承气汤治愈。结果 :本组 1 8例胆石性肠梗阻患者均治愈 ,无死亡。 1 2例随访 2～ 3年均无复发和出现胆系症状。结论 :胆石性肠梗阻以高龄女性好发、病程较长、常有中间腹痛缓解期的病史是其临床特点。术前诊断较困难 ,腹部平片、 B超有助于诊断 ,CT有较为特殊的表现 (Rigler三联征 )。解除结石梗阻是中西医结合治疗的主要目的。

Objective: It is to analyze the clinical conditions diagnosis and to observe the treatment experience of ileus reflected on gallstone. Methods: Eighteen cases ileus reflected on gallstone in hospital from 1980~2000 were reviewed. Sixteen cases were operated and taken out stone with cutting the intestine wall. At the same time five cases were repaired the inner fistula of the gall bladder and intestine. Two patients were ablated the segment of small intestine. And two patients were cured with Great Decoction for purgation. Results: Eighteen cases ileus caused of the gallstone were cured and survived. Twelve cases were return visited for 2~3 years and no recrudesce and no symptom. Conclusion: Incidence rate of ileus caused of gallstone is high in the old female. Clinic characteristic is bellyache relaxed sometimes. Diagnosis is difficulty pre diagnoses. KUB, B ultrasonic is aid to diagnosis and CT gives a special characteristic (Rigler three unite sign). Free from obstruction of gallstone use traditional Chinese medicine and western medicine is the purpose. Taking stone with cutting the intestine wall is a safe and effective operation.