Li Zhi-Hua, Ding Jun, Ye Yongqian, Cai Lei, Liu Xiangde, Liu Jikui, Chen Ming, Li Xiaowu, Dong Jiahong
Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China.
ANZ J Surg. 2006 Sep;76(9):796-800. doi: 10.1111/j.1445-2197.2006.03870.x.
Choledochoduodenal fistula (CDF) is a complication of common bile duct stones or cholangitis in Asia. It is unclear as to which type of the fistula needs surgical treatment.
To determine whether the sizes of CDF imply different clinical presentations and treatments, we reviewed 50 patients with CDF and their treatments during a recent 14-year period. For treatments of CDF, we applied the conventional methods, including removal of stone and complete decompression of biliary obstruction to treat the original bile lesions. In addition, according to the sizes of fistula and the frequencies of ascending cholangitis, we proposed the following strategies for fistula treatments: (i) for fistula orifices larger than 1 cm, a transection of common bile duct was applied to prevent the reflux of duodenal juice; (ii) for fistula orifices between 0.5 and 1.0 cm, an effective biliary drainage was applied; and (iii) for fistula orifices less than 0.5 cm, non-surgical treatments were applied.
We found that hepatic biliary duct stones and hepatic biliary duct strictures were associated with more severe cholangitis (P = 0.037 and P = 0.009, respectively), but not with the episodes of cholangitis (P = 0.654 and P = 0.664, respectively). In contrast, the sizes of fistula >1 cm were associated with more frequent episodes of cholangitis (r = 0.774; P < 0.001).
The larger fistula increases frequency of cholangitis episodes and needs surgical treatment for fistula itself.
在亚洲，胆总管十二指肠瘘（CDF）是胆总管结石或胆管炎的一种并发症。目前尚不清楚哪种类型的瘘需要手术治疗。
为了确定CDF的大小是否意味着不同的临床表现和治疗方法，我们回顾了最近14年期间50例CDF患者及其治疗情况。对于CDF的治疗，我们采用了传统方法，包括去除结石和完全解除胆道梗阻以治疗原发病变。此外，根据瘘口大小和胆管炎发作频率，我们提出了以下瘘口治疗策略：（i）对于瘘口大于1 cm的情况，采用胆总管横断术以防止十二指肠液反流；（ii）对于瘘口在0.5至1.0 cm之间的情况，采用有效的胆道引流；（iii）对于瘘口小于0.5 cm的情况，采用非手术治疗。
我们发现肝内胆管结石和肝内胆管狭窄与更严重的胆管炎相关（分别为P = 0.037和P = 0.009），但与胆管炎发作次数无关（分别为P = 0.654和P = 0.664）。相比之下，瘘口>1 cm与更频繁的胆管炎发作相关（r = 0.774；P < 0.001）。
较大的瘘口会增加胆管炎发作频率，且瘘口本身需要手术治疗。
