胆管支气管瘘的治疗:6例报告并文献回顾

Treatment for Bronchobiliary Fistula: a Report of 6 Cases and Literature Review

目的探讨胆管支气管瘘（bronchobiliary fistula,BBF）的临床表现、影像学特征、诊断及治疗方法。方法回顾分析1975年12月~2007年6月我院收治的6例BBF的临床资料,总结患者的临床及影像学特征。结果 6例均为获得性BBF,其中继发于肝脓肿3例,肝破裂伤2例,肝癌术后1例。发热6例,咳嗽6例,咳胆汁6例,呼吸困难4例,右上腹痛4例,胸痛2例;查体：右上腹压痛4例、右下肺叩浊3例、异常呼吸音3例、肝区叩痛2例。6例接受抗感染治疗及经皮经肝胆管/脓肿引流,1例另行瘘管栓塞治疗,6例病情改善。1例痊愈,1例长期置管引流并于1年后死于胆道出血,4例失访。结论咳胆汁是BBF的特征性表现,微创治疗可作为首选治疗方法。

Objective To describe the clinical and radiological characteristics,diagnosis,and treatment of bronchobiliary fistula（ BBF）. Methods From December 1975 to June 2007,6 patients with BBF were successfully diagnosed and treated in this hospital. A retrospective analysis was performed and literatures on the disease were reviewed. Results All the cases were acquired BBF. The etiologies included liver abscess（ 3 cases）,trauma（ 2 cases）,and postoperative complication of hepatic carcinoma（ 1case）. The main symptoms the patients complained of were fever（ 6 cases）,cough（ 6 cases）,biliptysis（ 6 cases）,dyspnea（ 4cases）,abdominal pain in right quadrant（ 4 cases） and pleuritic chest pain（ 2 cases）. On physical examination,tenderness in the right upper quadrant（ 4 cases）,dull percussion（ 3 cases）,abnormal breath sounds（ 3 cases）,percussion tenderness over hepatic region（ 2 cases） were main abnormalities. All the 6 patients underwent antibiotics treatment and percutaneous transhepatic biliary /abscess drainage. One of them underwent radiological coil embolization of the fistula. All the patients showed clinical improvement.Follow-up survey showed 1 case of cure,1 case of long-term drainage until death of biliary tract bleeding one year later,and 4 cases of lost in follow-up. Conclusion Bronchobiliary fistula is characterized by biliptysis. Minimally invasive treatment should be the first therapeutic option.