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1、胆内痿32例临床分析上海交通大学医学院附属第九人民医院普外科杨建军楼晓楼刘文勇顾岩［摘要］目的：探讨胆内痿的诊断和治疗。方法：回顾性分析1990.12——2006.12我院收治的32例胆内痿资料。结果：胆内痿术前诊断率仅为12.5%;68.8%(22/32)为胆囊十二指肠痿，12.5%(4/32)为胆囊胆总管痿，3.1%(1/32)为胆囊肝总管痿，6.3%(2/32)为胆囊横结肠痿，6.3%(2/32)为胆囊胃痿，3.1%(1/32)为胆总管十二指肠痿。胆石性肠梗阻占胆内痿的6.3%(2/32)
2、。本组行择期手术15例，急诊手术17例。平均住院天数16.2天，术后3例发生胆瘗漏，5例切口感染，2例死亡。结论：胆内痿术前诊断率低，对萎缩性胆囊炎、长期胆道结石、B超提示胆道积气、原有胆道结石消失者，应提高警惕，术中胆道造影有助于明确诊断。发生胆囊炎后及时手术是预防胆内屡发生的关键。关键词：胆内瘗；诊断；治疗Internalbiliaryfistula:areportof32casesJian-JunYang,Xiao-LouLou,Wen-YongLiu,YanGu,Jian-JunYang
3、,Xiao-LouLou,Wen-YongLiu,YanGu,DepartmentofGenera1Surgery,theAffi1iatedNinthPeople5sHospitalofShanghaiJiaoTongUniversityMedicalCollege,Shanghai200011,ChinaCorrespondenceto:Jian-JunYang,DepartmentofGenera1Surgery,theAffi1iatedNinthPeople'sHospitalofSh
4、anghaiJiaoTongUniversityMedicalCollege,639ZhizaojvRoad,Shanghai200011,China.ayangl2306)126.comAbstract:Objective:Toinvestigatethediagnosisandtherapyforinterna1bi1iaryfistula.MethodsAretrospectiveanalysisoftheclinicaldataof32patientswithinternalbiliar
5、yfistulawasmade.Results:Among32caseswithinternalbiliaryfistula,thepreoperativediagnosisratewas12.5%(4/32cases),68.8%(22/32)hadcholecystoduodena1fistula,12.5%(4/32)hadcholecysto-commonbileductfistula,3.1%(1/32)cholecysto-hepaticductfistula,6.3%(2/32)h
6、adcholecystocolonicfistula,6.3%(2/32)choledochogastricfistula,3.1%(1/32)wascholedochoduodena1fistulao6.3%(2/32)veregallstoneileus。Therewerel5patientswithtimeselectingoperationinthisteam,andatientsunderwentemergencylaparotomyoThemeanhospitalstaywas16
7、.2d.Threebileleakages,fivewoundinfections,andtwomortalitieswereobserved.ConclusionsThepreoperativediagnosisrateofinternalbiliaryfistulawas1ow.Awarenessofinternalbi1iaryfistulamustbeheightenedifthereisatrophiccholelithiasis,longtimebiliarystoneorbi1ia
8、rypneumatosisshownonultrasonography,endoscopyandvisualizationduringoperationarereliablemethodsindiagnosisofinternalbi1iaryfistula.Fistulacanberepaireddirectlyorwithpartofthegallbladderwal1.Keywords:Bi1iaryFistula;Diagnose;Therapy胆内痿是胆囊、胆管树之间或与临近脏器之间形
