76例胆总管十二指肠瘘的诊断和治疗

Diagnosis and management of 76 cases with choledochoduodenal fistula

目的分析76例胆总管十二指肠瘘临床病例,总结诊断和治疗经验。方法 1999年1月至2012年6月我院共有76例患者诊断为胆总管十二指肠瘘(CDF),并通过经内镜逆行胰胆管造影(ERCP)证实。根据胆总管十二指肠瘘口与十二指肠乳头解剖位置关系的不同,进行分型;根据瘘口大小,采取不同的治疗方法,其中接受手术治疗者有70例(92%)。结果 76名患有胆总管十二指肠瘘的患者按瘘口与十二指肠乳头解剖位置关系的不同,分为3种类型。70例接受手术治疗,6例接受药物治疗。随访6个月至10年,70例接受手术者中有66例临床预后情况满意,未再发作过胆管炎。结论既往有胆道疾病、上腹痛、发热、黄疸病史等会增加胆总管十二指肠瘘的风险;ERCP是胆总管十二指肠瘘主要诊断方式,手术是大多数CDF患者首选治疗方法。

Objective To study the case of 76 patients with choledochoduodenal fistula（ CDF）,and summarize the experience of making diagnosis and treatment. Methods From January 1999 to June 2012,76 patients with CDF were treated in our department and then was confirmed by endoscopic retrograde cholangiography（ ERCP）. All patients were classified based on the location of duodenal papilla in relation to the orificium fistulae of CDF. Different therapies were used to certain CDF depending on the diameter of the orificium fistulae of CDF.Of the 76 CDF patients,70 patients（ 92%） required surgery. Results The fistula of 76 CDF patients have three types,and the formation of this classification was based on the position between the duodenal papilla and the orificium fistulae of CDF. Different therapies referred to certain diameter of CDF,70 patients required surgery and 6 acquired pharmacotherapy. Of the 70 patients needing surgical intervention,clinical outcomes were excellent in 66 patients. Follow-up of these patients for 6 months to 10 years showed they did not suffer from further cholangitis. Conclusion The past history of biliary disease,upper abdominal pain,fever,and jaundice may lead to the disease of CDF. ERCP was the primary method for diagnosing this disease,and operative therapy was the primary treatment for most CDF patients.