T管相关胆肠瘘9例临床分析

Clinical analysis of T-tube related choledointestinal fistula:A report of 9 cases

目的 分析胆总管探查术后长时间留置T管原因及后果 ,T管相关胆肠瘘的确诊方法及治疗措施。方法 研究 9例T管相关胆肠瘘原因 ,通过T管、瘘管造影、全消化道钡餐、全腹CT等检查确定瘘位置。结果 9例患者 1例系肿瘤复发 ,余均为慢性炎症。 3例瘘内口位于十二指肠 ,2例位于空肠 ,4例位于结肠。结果 壶腹部肿块并非一定是肿瘤 ,术中病理检查 ,术后密切随访可防止长时间留置T管并避免T管相关胆肠瘘发生 ,影像学检查能明确瘘行径。重新植入T管 ,病理肠段切除等确定性手术具有良好的疗效。

Objective To study the causes,diagnosis and management for T tube related choledointestinal fistula.Methods An clinical retrospective analysis was made in 9 patients with prolonged T tube placement and choledointestinal fistula after common bile duct exploration,with emphasis on the causes of common duct obstruction.The fistulae were positioned by T tubeography and fistulography.GI and abdominal CT were also employed when needed.Final diagnosis was made by intro opoerative biopsy.Results metastatic malignancy was confirmed in only one case whereas in the others,chronic inflammation contributed to the major reason for lower common bile duct obstruction.The inner opening of the choledointestinal fistula was found in duodenum in 3 cases,in jejunum in 2 and in Colon in 4.Conclusion The major factor of T tube related choledointestinal fistula is unnecessarily prolonged placement caused by misdiagnosis of mass around Vaters ampulla as maignancy.To avoid this complication,biopsy in operation and postoperative observation are necessary X ray examination is of importance in determining;location of the fistula and subsequent management.Good results can beachieved in patients undergoing definitive procedued including T tube replacement and resection of the involved intestine.