胆总管十二指肠瘘的外科诊治分析

Analysis of diagnosis and surgical treatment of the choledochoduodenal fistula

目的探讨胆总管十二指肠瘘的临床特点和外科诊疗疗效。方法回顾性分析开化县中医院及衢州市人民医院2004年1月-2011年1月收治的胆总管十二指肠瘘患者78例,收集其临床分型、治疗方法和预后等。结果行单纯经内镜乳头括约肌切开术(EST)9例,EST+胆管取石15例,EST+胆管取石+经内镜鼻胆管引流术(ENBD)36例,EST+ENBD 6例,ENBD 7例,经内镜胆道内支撑引流术(ERBD)2例,经内镜胆道金属支架引流术(EMBE)3例。仅有4例术后轻度腹痛,2例术后有血尿淀粉酶一过性升高。16例实施外科手术干预,其中2例术后再发胆道感染。结论胆总管十二指肠瘘经逆行胰胆管造影术(ERCP)确诊后,首先考虑采用内镜治疗,出现反复发作的胆管炎症状导致肝损害的患者,宜行外科手术治疗。

【Objective】 To explore the clinical features, diagnosis and surgical treatment of the choledochoduodenal fistula. 【Methods】 Clinical information about 78 cases of CDF were analyzed retrospectively to summarize Clinical classification, treatment methods and prognosis. 【Results】 Among all the patients, 9 patients were under EST, 15 cases under EST ＋ Bile duct stone removed, 36 cases under EST ＋Bile duct stone removed ＋ ENBD, 6 cases under EST ＋ ENBD, 7 cases under ENBD, 2 case under ERBD, 3case under EMBE. Only 4 patients with mild abdominal pain and 2 patients with hematuria amylase a transient increase. 16 cases were treated with surgical operation intervention, including 2 cases of postoperative recurrent infection of biliary tract. 【Conclusion】 Choledochoduodenal fistula were diagnosed by ERCP, endoscopy was the first consider treatment way, and surgical treatment should be operate on the patients who was liver damage causing by the recurrent cholangitis symptoms.