胆石性肠梗阻的诊断与治疗:附302例分析

Diagnosis and treatment of biliary ileus: analysis of 302 cases

目的：分析胆石性肠梗阻（BI）的临床特点和诊治现状。方法：回顾1995年1月—2014年12月间中南大学湘雅医院收治的18例BI患者资料,并汇总近20年22篇中文文献中284例患者资料,分析并总结BI发病特点与诊治现状。结果：302例BI患者中男86例（28.2%）,女216例（71.8%）;年龄36～89岁,平均63.4岁;术前确诊率为24.2%（73/302）;294例（97.4%）行小肠切开取石术,8例（2.6%）行肠切除肠吻合术;结石嵌塞于十二指肠27例（8.9%）,空肠71例（23.5%）,回肠末端201例（66.6%）,结肠3例（1.0%）;一期行胆囊切除术94例（31.1%）,胆管切开取石术4例（1.3%）;术后并发症发生率为27.2%（82/302）,术后病死率为0.7%（2/302）。结论：BI多见于老年女性患者,常伴有较低的术前确诊率和较高的术后并发症率。

Objective： To analyze the clinical features ofbiliary ileus （BI） and current status of its diagnosis and treatment. Methods： The clinical data of 18 BI patients treated during January 1995 and December 2014 in Xiangya Hospital were reviewed, and the records of 284 BI patients from 22 Chinese articles published during the last 20 years were also collected. The clinical features of BI and current status of its diagnosis and treatment were extracted and analyzed. Results： Of the 302 patients, 86 cases （28.2%） were male and 216 cases （71.8%） were female; ages ranged from 36 to 89 with an average age of 63.4; preoperative diagnosis was 24.2% （73/302）; 294 cases （97.4%） underwent enterotomy with stone extraction and 8 cases （2.6%） were subjected to intestinal resection and anastomosis; the stone lodged in the duodenum in 27 cases （8.9%）, in the jejunum in 71 cases （23.5%）, in the distal ileum in 201 （66.6%） and in the colon in 3 cases （1.0%）; primary cbolecystectomy was performed in 94 cases （31.1%） and choledocholithotomy was performed in 4 cases （1.3%）; the incidence of postoperative complications was 27.2% （82/302） and mortality was 0.7% （2/302）.Conclusion： BI frequently occurs in elderly women, its accurate preoperative diagnosis is unusual and incidenceofpostoperative complications is high.