腹腔镜外科杂志2023，Vol.28Issue(12)：906-910,5.DOI:10.13499/j.cnki.fqjwkzz.2023.12.906
腹腔镜下利用胆囊壁遮盖封闭胆囊十二指肠瘘口的临床体会
Clinical experience of laparoscopic cholecystoduodenal fistula closure using the gallbladder wall as a cover
摘要
Abstract
Objective:To investigate the surgical method and safety of laparoscopic closure of cholecystoduodenal fistula using the gallbladder wall as a cover.Methods:Fifteen patients of cholecystoduodenal fistula admitted from Oct.2012 to May 2023 were included,and their fistulas were all closed using the gallbladder wall as a cover during laparoscopic cholecystectomy.Results:Among the 15 patients,there were 8 cases of chronic atrophic cholecystitis,3 cases of chronic cholecystitis,2 cases of subacute cholecystitis,and 2 cases of acute suppurative cholecystitis.All laparoscopic cholecystectomy procedures were successfully completed without conver-sion to laparotomy.The gallbladder fistula was located in the fundus in 4 cases,the body in 10 cases,and the ampulla in 1 case.The duodenal fistula was located in the bulbous part in 6 cases and the descending part in 9 cases.The diameter of the fistula ranged from 0.5 to 2.0 cm,of which 10 cases were 0.5-1.0 cm and 5 cases were 1.0-2.0 cm.Surgical time ranged from 45 to 135 min,with a mean of(84.4±26.9)min;intraoperative blood loss ranged from 15 to 60 mL,with a mean of(29.8±11.5)mL.The postoperative peritoneal drainage fluid was lightly bloody,and the average drainage volume was(47.6±14.3)mL,(25.1±8.9)mL,and(12.2±5.6)mL on postoperative day 1,2,and 3,respectively.No jejunal endoluminal nutrition tube was placed in any of the patients,and the diet was re-sumed after 3 days of total parenteral nutrition.There were no postoperative complications such as intestinal fistula or bile leakage.All patients recovered well and were discharged from hospital after removal of the abdominal drainage tube in 3-4 d.The average hospitali-zation time after operation was(8.6±1.2)d.Follow-up B-ultrasonography conducted 3 months later revealed no encapsulated effusion in the subhepatic gallbladder bed area,and the duodenal fistula healed well without niche or stenosis demonstrated by upper gastrointes-tinal contrast or gastroscopy.Conclusions:The laparoscopic closure of cholecystoduodenal fistula using the gallbladder wall as a cover,with abundant tissue material and flexible suture(clip)closure,is a safe procedure with little trauma,simple operation and reliable effi-cacy.关键词
胆石症/胆囊十二指肠瘘/胆囊切除术,腹腔镜/胆囊壁Key words
Cholelithiasis/Cholecystoduodenal fistula/Cholecystectomy,laparoscopic/Gallbladder wall分类
医药卫生引用本文复制引用
孙跃勋,尚培中,张伟..腹腔镜下利用胆囊壁遮盖封闭胆囊十二指肠瘘口的临床体会[J].腹腔镜外科杂志,2023,28(12):906-910,5.基金项目
河北省科学技术研究与发展计划项目(11276103D-21) （11276103D-21）
中国人民解放军陆军第八十一集团军医院课题(2022-01) （2022-01）
