胆囊十二指肠内瘘并发胆石性肠梗阻16 例临床诊治分析
| 作者: |
1毛岳峰,
1罗衡桂,
1王力
1 湖南省湘潭市中心医院 普通外科，湖南 湘潭 411100 |
| 通讯: |
毛岳峰
Email: maoyuefeng0734@163.com |
| DOI: | 10.3978/.2018.08.013 |
摘要
目的：探讨胆囊十二指肠内瘘合并胆石性肠梗阻的诊断及治疗方法。
方法：回顾性分析 2013 年 1 月—2017 年 6 月手术治疗 16 例胆囊十二指肠内瘘合并胆石性肠梗阻患者的临床资料。
结果：16 例患者中，8 例患者术前明确诊断，8 例患者于术中明确诊断；术前诊断合并胆囊结石胆囊炎 7 例，合并十二指肠溃疡、胃溃疡的 5 例。16 例患者均行手术治疗，行小肠切开取石 + 胃大部切除术（Billroth II 式）+ 空肠 Braun 吻合术 7 例，行小肠切开取石 + 胃大部切除术（Billroth II 式）3 例，行胃窦部切开取石 + 胃大部切除术（Billroth II 式）+ 空肠 Braun 吻合术 2 例，行小肠切开取石 + 胆囊切除 + 十二指肠瘘修补 + 十二指肠造瘘 + 空肠造瘘术 4 例。平均手术时间 115 min，平均住院时间 8 d，平均术后 9 d 开始进食流质。术后肺部感染 4 例，十二指肠漏 2 例，术后吻合口出血 1 例，切口感染 3 例。 16 例患者均治愈出院。
结论：术前 CT 及 B 超等辅助检查对于该病的诊断十分重要，对于胆囊严重炎症粘连者，特别是合并十二指肠溃疡、胃溃疡者行胃大部切除术（Billroth II 式）+ 空肠 Braun 吻合术效果良好，对于胆囊炎症较轻者，可考虑行胆囊切除 + 十二指肠瘘修补 + 空肠造瘘术，十二指肠球部结石梗阻患者可经胃窦切开取石。
关键词：
胆囊结石病；胆瘘；肠瘘；十二指肠梗阻
方法：回顾性分析 2013 年 1 月—2017 年 6 月手术治疗 16 例胆囊十二指肠内瘘合并胆石性肠梗阻患者的临床资料。
结果：16 例患者中，8 例患者术前明确诊断，8 例患者于术中明确诊断；术前诊断合并胆囊结石胆囊炎 7 例，合并十二指肠溃疡、胃溃疡的 5 例。16 例患者均行手术治疗，行小肠切开取石 + 胃大部切除术（Billroth II 式）+ 空肠 Braun 吻合术 7 例，行小肠切开取石 + 胃大部切除术（Billroth II 式）3 例，行胃窦部切开取石 + 胃大部切除术（Billroth II 式）+ 空肠 Braun 吻合术 2 例，行小肠切开取石 + 胆囊切除 + 十二指肠瘘修补 + 十二指肠造瘘 + 空肠造瘘术 4 例。平均手术时间 115 min，平均住院时间 8 d，平均术后 9 d 开始进食流质。术后肺部感染 4 例，十二指肠漏 2 例，术后吻合口出血 1 例，切口感染 3 例。 16 例患者均治愈出院。
结论：术前 CT 及 B 超等辅助检查对于该病的诊断十分重要，对于胆囊严重炎症粘连者，特别是合并十二指肠溃疡、胃溃疡者行胃大部切除术（Billroth II 式）+ 空肠 Braun 吻合术效果良好，对于胆囊炎症较轻者，可考虑行胆囊切除 + 十二指肠瘘修补 + 空肠造瘘术，十二指肠球部结石梗阻患者可经胃窦切开取石。
Diagnosis and treatment of cholecystoduodenal fistula complicated with gallstone bowel obstruction: a clinical analysis of 16 cases
CorrespondingAuthor:MAO Yuefeng Email: maoyuefeng0734@163.com
Abstract
Objective: To investigate the diagnosis and treatment methods for cholecystoduodenal fi stula complicated with gallstone ileus.
Methods: Th e clinical data of 16 patients with cholecystoduodenal fi stula and gallstone ileus undergoing surgical treatment from January 2013 to June 2017 were analyzed retrospectively.
Results: Of the 16 patients, 8 cases were diagnosed before operation, and 8 cases were diagnosed during operation; 7 cases were diagnosed having concomitant gallstone cholecystitis, and 5 cases were diagnosed having concomitant duodenal ulcer and gastric ulcer before operation. All of the 16 patients underwent surgical treatment, which included small bowel enterotomy and stone extraction plus gastrectomy (Billroth II operation) and Braun’s anastomosis in 7 cases, small bowel enterotomy and stone extraction plus gastrectomy (Billroth II operation) in 3 cases, gastric antrotomy and stone extraction combined with gastrectomy (Billroth II operation) and Braun’s anastomosis in 2 cases, and small bowel enterotomy and stone extraction, cholecystectomy and duodenal fistula repair plus duodenostomy and jejunostomy in 4 cases. The operative average time was 115 min, the average length of hospital stay was 8 d, and liquid food intake started on average postoperative day 9. After the operation, pulmonary infection occurred in 4 cases, duodenal leakage occurred in 2 cases, anastomotic bleeding occurred in 1 case, and wound infection occurred in 3 cases, respectively. All the 16 patients were discharged after a complete cure.
Conclusion: Preoperative examinations such as CT and B ultrasound are very important for diagnosis of this condition. For patients with severe inflammatory adhesion of the gallbladder, especially with concomitant duodenal ulcers and gastric ulcers, gastrectomy (Billroth II operation) plus Braun’s anastomosis is effective, while cholecystectomy plus duodenal fistula repair and jejunostomy can be considered for those with mild cholecystitis, and gastric antrotomy and stone removal can be performed in cases with duodenal bulb stone obstruction.
Keywords：
Cholecystolithiasis; Biliary Fistula; Intestinal Fistula; Duodenal Obstruction
Methods: Th e clinical data of 16 patients with cholecystoduodenal fi stula and gallstone ileus undergoing surgical treatment from January 2013 to June 2017 were analyzed retrospectively.
Results: Of the 16 patients, 8 cases were diagnosed before operation, and 8 cases were diagnosed during operation; 7 cases were diagnosed having concomitant gallstone cholecystitis, and 5 cases were diagnosed having concomitant duodenal ulcer and gastric ulcer before operation. All of the 16 patients underwent surgical treatment, which included small bowel enterotomy and stone extraction plus gastrectomy (Billroth II operation) and Braun’s anastomosis in 7 cases, small bowel enterotomy and stone extraction plus gastrectomy (Billroth II operation) in 3 cases, gastric antrotomy and stone extraction combined with gastrectomy (Billroth II operation) and Braun’s anastomosis in 2 cases, and small bowel enterotomy and stone extraction, cholecystectomy and duodenal fistula repair plus duodenostomy and jejunostomy in 4 cases. The operative average time was 115 min, the average length of hospital stay was 8 d, and liquid food intake started on average postoperative day 9. After the operation, pulmonary infection occurred in 4 cases, duodenal leakage occurred in 2 cases, anastomotic bleeding occurred in 1 case, and wound infection occurred in 3 cases, respectively. All the 16 patients were discharged after a complete cure.
Conclusion: Preoperative examinations such as CT and B ultrasound are very important for diagnosis of this condition. For patients with severe inflammatory adhesion of the gallbladder, especially with concomitant duodenal ulcers and gastric ulcers, gastrectomy (Billroth II operation) plus Braun’s anastomosis is effective, while cholecystectomy plus duodenal fistula repair and jejunostomy can be considered for those with mild cholecystitis, and gastric antrotomy and stone removal can be performed in cases with duodenal bulb stone obstruction.