胆总管下端术后十二指肠瘘19例治疗分析

Duodenal fistula caused by surgical procedures of the distal common bile duct

目的 了解胆总管下端手术后十二指肠瘘发生的原因及处理。方法 回顾性分析1 975～ 2 0 0 2年收治的 1 9例胆总管下端手术后十二指肠瘘发生的原因、诊断和治疗。十二指肠瘘经确诊后均经手术治疗。治疗方式 :脓肿引流 1 3例 ,十二指肠修补 5例 ,胃大部切除幽门旷置胃空肠吻合、空肠造口 1例。结果 十二指肠瘘治愈 1 5例 ,死亡 4例。死亡原因 :消化道大出血 2例 ,腹膜后严重感染 1例 ,并发重症胰腺炎 1例。结论 行胆总管下端探查操作时应谨慎 ,避免发生医源性损伤。十二指肠损伤后早期诊断尤为重要 ,十二指肠瘘手术以引流为主 ,并应予以充分的肠内营养支持。

Objective To investigate the etiology of and therapy for duodenal fistula caused by distal common bile duct operation. Methods An retrospective analysis of 19 cases of duodenal fistula after distal common bile duct operation was made.All cases received surgical management after the fistula was identified.Surgical procedures included abdominal abscess drainage in 2 cases, gastrostomy and jejunostomy combined with abscess drainage in 11 cases, gastrostomy and jejunostomy combined with duodenal repair?abscess drainage in 3 cases,gastrojejunostomy with pyloric exclusion combined jejunostomy in 1 case, repair of fistula with padicled intestinal seromuscular patch combined with gastrostomy and jejunostomy in 1 case, and repair of fistula with padicled intestinal seromuscular patch combined with gastrostomy and jejunostomy plus sphincteroplasty in one case. Results Among 19 cases,15 were cured. Two died of gastrointestinal bleeding, one of severe retroperitoneal infection,one of severe pancreatitis. ConclusionsEarly diagnosis is of great importance for the treatment of duodenal injury. Drainage is the mainstay for the treatment of iatrogenic duodenal fistula, while enough enteral nutrition should be given to accelerate spontaneous closure of the fistula.