胆囊十二指肠瘘5例漏诊临床分析

Cholecystoduodenal fistula: a clinical analysis of missed diagnosis in 5 cases

关键词:  胆囊十二指肠瘘  诊断  手术治疗

Key words:  cholecystoduodenal fistula  diagnosis  treatment

摘要:

目的　探讨胆囊十二指肠瘘的诊断和治疗要点, 为临床医师提供参考依据。方法　回顾性分析2000年3月至2014年3月收治的5例胆囊十二指肠瘘患者的临床资料，患者平均年龄（64.8±5.3）岁，术前影像学检查均提示胆囊炎、胆囊结石。5例均择期行手术治疗。结果　5例胆囊十二指肠瘘患者均为术中诊断，手术后治愈4例，死亡1例。治愈患者平均住院时间10.1 d，术后恢复良好，无并发症发生。结论　胆囊十二指肠瘘术前诊断率低, 影像学相关表现有助于明确诊断。发生胆囊炎、胆囊结石后及时手术可预防胆囊内瘘的发生。

Abstract:

Objective 　 To analyze and summarize the experience of the diagnosis and treatment of cholecystoduodenal fistula to provide the treatment basis for the clinicians.　Methods 　 We collected five patients’ clinical data with cholecystoduodenal fistula from March 2000 to March 2014. The average age was（64.8±5.3）years old. According to the situation of the patients，we explored the factors which could lead to a preoperative diagnosis and to guide the management of cholecystoduodenal fistula.　Results 　 There were no specific clinical manifestations in the five patients. All patients were found in the process of operation, including four open surgeries and one laparoscopic surgery. Four patients well recovered after the surgery without acute complications and treatment related damages. One patient died of Asperger syndrome after operation. The median postoperative hospital stay was 10.1 days.　Conclusions Due to nonspecific clinical manifestation in cholecystoduodenal fistula patients, preoperative diagnosis is very difficult. Appropriate examination should be made to confirm or rule out the diseases. An early diagnosis can improve the cure rate of the disease and operation has been effective with fair prognosis.