腹腔镜手术治疗胆囊结石致胆囊肠道内瘘17例报告

摘要

目的：探讨腹腔镜手术治疗胆囊结石致胆囊肠道内瘘的疗效。方法2008年1月～2013年6月，行腹腔镜手术治疗胆囊结石致胆囊肠道内瘘17例，均在腹腔镜下切除胆囊和瘘管，肠道瘘口腔镜下单纯修补为主，其中1例因胆囊十二指肠瘘口较大，行十二指肠瘘口T管引流术。对合并胆总管结石的6例，均在胆道镜取石后行一期缝合或T管引流术。结果胆囊肠道内瘘的类型：单纯胆囊十二指肠瘘8例，胆囊胃瘘1例，胆囊横结肠瘘1例，胆囊十二指肠瘘合并胆囊横结肠瘘1例，胆囊十二指肠瘘合并胆总管结石5例，胆囊十二指肠瘘合并胆囊横结肠瘘、胆总管结石1例。手术时间50～150 min，平均95 min。术中出血量20～240 ml，平均55 ml。17例术后随访7～12个月，平均11个月，无肠漏、胆漏、胆道感染及肠梗阻等并发症发生。结论重视胆囊肠道内瘘患者的术前诊断和准备，术中仔细解剖操作，胆囊肠道内瘘腹腔镜下手术处理安全有效。%Objective To evaluate the efficacy of laparoscopic management for cholecystoebteric fistula ( CF) . Methods From January 2008 to June 2013, 17 cases of cholecystoenteric fistula underwent laparoscopic surgery.All the patients received laparoscopic cholecystectomy and fistula repair, except for 1 patient with cholecystoduodental fistula was treated with T-tube drainage because of large fistula.For 6 patients complicated with choledocholithiasis, one stage suture or T-tube drainage after stone extraction under choledochoscopy was carried out. Results The group comprised of 8 cases of cholecystoduodental fistula, 1 case of cholecystogastric fistula, 1 case of cholecystocolic fistula, 1 case of cholecystoduodental complicated with cholecystocolic fistula, 5 cases of cholecystoduodental fistula along with choledocholithiasis, and 1 case of cholecystoduodental fistula along with cholecystocolic fistula and choledocholithiasis.The operation time was 50 -150 min (mean, 95 min).The blood loss volume was 20 -240 ml ( mean, 55 ml) .All the patients were successfully recovered and discharged from hospital.Follow-up examinations for 7-12 months ( mean, 11 months) found no intestinal fistula, bile leakage, infection of biliary tract, intestinal obstruction, and other postoperative complications. Conclusion The laparoscopic management for CF, with attention to the preoperative diagnosis, preparation and careful operation, is not only safe and effective, but also providing more quick recovery.