老年壶腹周围癌患者病理性胆肠内瘘

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1、老年壶腹周围癌患者病理性胆肠内瘘【摘要】目的:探讨老年壶腹周围癌患者的病理性胆肠内瘘的诊断。方法:对9例老年因壶腹周围癌所引发的病理性胆肠内瘘的临床资料的回顾性分析。临床资料:其中4例胰头癌患者,4例十二指肠乳头腺癌及1例胆总管下段癌。患者均具有以下特点:①上述病例均为高龄,入院前均有长期反复的右上腹隐痛为主要特点。②上述病例入院时主要有进行性消瘦、营养不良及有长期反复的胆囊炎病史,一过性黄疸病史。③影像学诊断提示:肝内外胆管扩张,胆囊肿大,胆管积气。④无梗阻性黄疸常见的临床表现。结果:手术前后的临床资料证实患者的临床诊断:壶腹周围

2、癌伴胆肠内瘘。结论:对在临床上有反复发作的老年慢性胆囊炎伴有进行性消瘦,无明显梗阻性黄疸的表现者及影像学提示壶腹周围占位性病变者,临床审核应高度怀疑有胆肠内瘘的病理性改变。【关键词】壶腹部肿瘤;胆肠内瘘;老年人PeriampullarycancerinelderlypatientswithpathologicdiagnosisofbiliaryentericfistulaYangPeijiZhangHanzhong【Abstract】ObjectiveToinvestigatethediagnosisofperiampullaryc

3、ancerinelderlypatientswithpathologicbiliaryentericfistula.Metheds9Retrospectivlyanalysisofninecasesofperiampullarycancerinelderlywithbiliaryentericfistula.Including4casesofpancreaticheadcancer,4casesofduodenaladenocarcinomaand1casesofcommonbileductcancer.Patientsischar

4、acterizedbythefollowing:(1)Allcaseswereseniorpatient,hadrepeatedlong-termabdominalpainbefreadmissiontohospotial.(2)Allcaseswereprogressivewasting,malnutritionandrepeatedlong-termhistoryofcholecystitisandtransientjaundice.(3)Imagingdiagnosis:theexpansionofthebileduct,ga

5、llbladderenlargementandbileductpneumatosis.(4)Therewasnoclinicalmanifestationsofobstructivejaundice.ResultsSurgeryconfirmed:Periampullarycarcinomaassociatedwithbiliaryentericfistula.CoclusionThose,inclinicalofelderlypatientswithchronicmanifestationsofobstructivejaundic

6、e.ResultsSurgeryconfirmed:Periampullarycarcinomaassociatedwithbiliaryentericfistula.CoclusionThose,inclinicalofelderlypatientswithchroniccholecystitisassociatedwithprogressiveweight9loss,noclinicalmanifestationsofobstructivejaundiceandimagingdiagnosisindicatingperiampu

7、llarycancer,shouldhaveahighdegreeofsuspicionofpathologicbiliaryentericfishulacausedbyperiampullarycancer.【Keywords】Ampullarytumor;Biliaryentericfistula;Elderlypatients【中图分类号】R774【文献标识码】B【文章编号】1005-0515(2010)009-0017-02病理性胆肠内瘘临床上较为少见,且多以胆囊-十二指肠瘘为主,胆囊-结肠瘘为次之。由慢性胆囊炎、胆囊结石及

8、某些先天因素等造成。由于胆-肠内瘘本身没有特异性的临床症状和临床体征,特别在高龄患者缺乏明确的临床表现,常被其它疾病的临床症状所掩盖,而壶腹周围部肿瘤合并病理性胆、肠内瘘者临床则更为罕见,极易误诊、临床处理相对困难[1],笔者对9例高