腹腔镜下胆囊十二指肠内瘘的诊治

摘要

Objective:To investigate the diagnostic methods of cholecystoduodenal fistula and the feasibility of laparoscopic re-pair of cholecystoduodenal fistula. Methods:The clinical data of 18 patients who underwent laparoscopic surgery for cholecystoduodenal fistula from Mar. 2008 to Dec. 2015 were retrospectively analyzed. Results:All cases were confirmed by intraoperative observation. 14 patients underwent laparoscopic surgery,4 cases were converted to open procedure. All cases were finally cured. 14 patients of laparo-scopic cholecystoduodenal fistula repair began eating liquid diet in 5-23 d ( M=9 d) after operation,in 3-22 d ( M=5 d) after operation negative pressure ball was removed,operation time was (166±59) min (range,90-235 min),hospital stay was 8-30 d (M=13 d), postoperative hospital stay was 5-27 d ( M=10 d) . Fistula of duodenum occurred in 1 patient who was completely cured after drainage, anti-infection and parenteral nutrition support treatment. No duodenal stenosis was found in the follow-up period. In the 4 patients who were converted to laparotomy,2 cases were complicated with gallbladder-bile duct fistula,after open choledochoscopic exploration,1 un-derwent cholecystectomy+bile duct exploration and primary suture of bile duct,and 1 underwent cholecystectomy+bile duct exploration+T tube drainage;1 patient with large fistula underwent gastrojejunal Roux-en-Y procedure;1 case was converted to open repair of chole-cystoduodenal fistula. After operation,2 cases of incision infection were healed after dressing change. Conclusions:Selective laparoscop-ic repair of cholecystoduodenal fistula is safe and feasible.%目的:探讨胆囊十二指肠内瘘诊断方法及腹腔镜下胆囊十二指肠内瘘修补术的可行性.方法:回顾分析2008年3月至2015年12月18例腹腔镜下胆囊十二指肠内瘘修补术患者的临床资料.结果:18例患者均于术中明确诊断,腹腔镜手术14例,中转开腹4例,18例均治愈.14例腹腔镜下胆囊十二指肠内瘘修补术患者术后5~23 d(M=9 d)开始进流质饮食,术后3~22 d(M=5 d)开始拔负压球,手术时间90~235 min,平均(166±59)min;住院8~30 d(M=13 d),术后住院5~27 d(M=10 d).1例术后肠瘘经充分引流、抗感染及肠外营养支持等治疗痊愈,随访未见十二指肠狭窄.4例中转患者中合并胆囊胆管内瘘2例,中转开腹行胆道镜探查术后,1例行胆囊切除+胆管探查+胆管一期缝合术,另1例行胆囊切除+胆管探查+T管引流术;1例因瘘口较大中转开腹行胃空肠Roux-en-Y术;1例中转开腹行胆囊十二指肠内瘘修补术.术后2例切口感染,经换药治愈.结论:选择性地开展腹腔镜下胆囊十二指肠内瘘修补术是安全、可行的.