自发性胆囊内瘘的临床分析.DOCVIP

临床医学论文-自发性胆囊内瘘的临床分析 【摘要】? 目的 总结胆囊内瘘的临床特征和诊治经验。方法 回顾性分析21例自发性胆囊内瘘的临床资料。结果 21例均有不同程度的右上腹痛，部分伴有发热、黄疸、恶心和呕吐等症状。胆囊十二指肠瘘9例；胆囊胆管瘘6例；胆囊结肠瘘4例，其中1例为胆囊横结肠瘘合并腹壁瘘；胆囊胃瘘2例。术前常规行B超检查，并结合CT、MRCP、ERCP、胃肠造影等检查，术前明确诊断者11例（52.38%）。全部行胆囊切除或部分切除。11例行胃肠瘘口修补术，1例行胆总管切开T管引流术和十二指肠造瘘术，2例行十二指肠瘘口修补和毕Ⅱ式胃大部切除术，5例瘘口较大的胆管瘘者用部分胆囊壁修补和T管引流，1例行胆管空肠Roux-en-Y吻合术，1例行胆囊癌姑息切除并行T管引流术。1例术后因呼吸衰竭而亡，1例死于胆囊癌复发转移，其余均痊愈出院。结论 对萎缩性胆囊炎或长期发作的胆囊炎，应考虑胆囊内瘘的可能。结合B超检查、CT、MRCP、ERCP、胃肠造影等检查，可提高术前诊断率。治疗应根据瘘口的部位、大小等个体化原则进行。 【关键词】? 胆囊内瘘；胆结石；胆囊炎???????? 　　【Abstract】? Objective????? To summarize the clinical experience in treatment and diagnosis of spontaneous gallbladder internal fistula(SIGF).Methods? Clincial data of 21 cases were analyzed retrospectively.Results? All of the patients had the clinical symptoms of different degree right abdominal pain,and some patient had the clinical manifestation of fever,nausea,vomiting and jaundice at same time.There were 9 cholecystoduodenal fistula cases,6 cholangiocholecystic fistula,4 cysticolic fistula included in 1 abdominal wall fistula case,2 cholecystogastric fistula.B ultrasonography was used in all patients combined with CT,MRCP,ERCP,gastrointestinal contrast examination and other methods in some patients.In this group,12 cases were diagnosed preoperatively to suffer from SIGF. All the 21 patients received cholecystectomy or partial cholecystectomy.Eleven fistulae in the enterogastric tract were repaired directly.One patient underwent the choledochotomy,T tube dringage and enterostomy.2 patients did duodenal fistula repair and Billroth-Ⅱ subtotal gastrectomy. T tube dringage and repair with part of the gallbladder wall were did in the higher size of fistula in 5 cholangiocholecystic fistula.One patient underwent the Roux-en-Y choledochojejunostomy and another patient did the palliative cholecystectomy of gallbladder cancer.Only 1 died of respiratory failure and another died of recurrence and metastasis of gallbladder cancer.Conclusion?We should think of the SIGF existence in the p