【摘要】 目的:探讨胆内瘘的诊断及治疗方法。方法:对2003～2012年我院胆内瘘病人临床资料进行回顾性分析。结果:28例仅4例病人(14.3%)术前诊断胆内瘘,24例(85.7%)为术中发现;在胆内瘘类型中,75%(21/28)为胆囊十二指肠内瘘,14.3%(4/28)为胆囊胆总管内瘘,7.1%(2/28)为胆囊胃内瘘,3.6%(1/28)为胆囊横结肠瘘。全部病例均行胆囊切除,21例行十二指肠修补术,4例行胆总管探查、T管支撑引流(其中1例行胆管空肠Roux-en-Y吻合术),2例行胃修补(其中1例行胃部分切除并毕Ⅱ式吻合),结肠修补1例。所有患者均顺利出院。结论:胆内瘘术前诊断困难,主要为术中诊断;胆内瘘手术遵循切除胆囊、修补瘘口、通畅引流原则;腔镜治疗胆内瘘前景广阔。更多还原

【Abstract】 Objective: To investigate the approaches to diagnosis and treatment of internal biliary fistula. Methods: The clinical data were retrospectively analyzed in 28 patients with internal biliary fistula undergone treatment in our hospital between 2003 and 2012. Results: Only 4( 14. 3%,4/28) patients were diagnosed with internal biliary fistula before operation,and 24( 85. 7%,24 /28) were confirmed intraoperatively. The fistulae were found with internal cholecystoduodenal in 75%( 21 /28) cases,gallbladder common bile duct in 14. 3%( 4 /28),gallbladder stomach in 7. 1%( 2 /28) and gallbladder transverse colon in 3. 6%( 1 /28), respectively. The total patients were undergone cholecystectomy,in whom 21 received duodenum repair,4 common bile duct exploration combined with T-tube drainage( one case managed by bile duct-jejunum Roux-en-Y anastomosis),2 stomach repair( one managed with stomach local excision and Billroth-Ⅱ anastomosis) and 1 repair of colon. Conclusion: Internal biliary fistula is hard to diagnose before operation and generally relys on intraoperative finding. The procedure for this entity shall sequentially consist of incision of the gallbladder,repair of the fistula and unobstructed drainage. In addition,laparoscopic cholecystectomy appears promising management of internal biliary fistula.更多还原