Shibata S, Tanaka J, Asanuma Y, Andoh H, Yoshioka T, Koyama K, Ebina T, Koizumi R
Department of Surgery Akita, University School of Medicine, Japan.
Hepatogastroenterology. 1999 Jul-Aug;46(28):2196-8.
We report the case of a 72 year-old female patient who suffered from biliary fistulae. The biliobiliary and bilioduodenal fistulae appeared after an operation for biliary bleeding. Conventional therapy for biliary fistula would be the disconnection of the fistula by either conservative or operative treatment. In the present case, however, it was preferable to enlarge the fistula to drain bile juice into the duodenum, rather than to close the fistula because it would have been difficult to achieve a tight adhesion with this operation. The enlargement by a plastic tube stent failed to drain the bile juice into the duodenum, because the sludge made the tube stenotic. Therefore, a self-expandable metallic stent was applied in this case. An expandable stent was used because a large final caliber is necessary to prevent stenosis of the fistula by sludge and mucosal hyperplasia. After insertion of a self-expandable metallic stent by the percutaneous transhepatic biliary drainage route, the patient has not suffered from cholestasis and cholangitis for the last 30 months. It can therefore be concluded that enlargement of the fistula by a self-expandable metallic stent is a convenient therapy for such biliointestinal fistulae.
我们报告了一例72岁患有胆瘘的女性患者。胆胆瘘和胆十二指肠瘘在一次胆道出血手术后出现。胆瘘的传统治疗方法是通过保守或手术治疗来封闭瘘口。然而，在本病例中，将瘘口扩大以便胆汁排入十二指肠比封闭瘘口更为可取，因为通过该手术难以实现紧密粘连。通过塑料管道支架进行扩大未能使胆汁排入十二指肠，因为胆泥导致管道狭窄。因此，本病例应用了自膨式金属支架。使用可膨胀支架是因为需要较大的最终管径以防止因胆泥和黏膜增生导致瘘口狭窄。通过经皮经肝胆道引流途径插入自膨式金属支架后，患者在过去30个月中未出现胆汁淤积和胆管炎。因此可以得出结论，通过自膨式金属支架扩大瘘口是治疗此类胆肠瘘的一种便捷方法。
