Rao P S, Tandon R K, Kapur B M
All India Institute of Medical Sciences, New Delhi.
Am J Gastroenterol. 1988 Jun;83(6):652-7.
We have reviewed nine cases of biliobiliary fistula operated during 1983-85. Two of these patients also had a high hepatic duct stricture, an association not highlighted before. Eight of these patients had jaundice. A classical cholecystectomy in the presence of biliobiliary fistula entails grave risk to the integrity of the upper biliary tract. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography can detect these rare fistulae. It is proposed that all patients with cholelithiasis associated with jaundice be screened by sonography for evidence of biliobiliary fistula. They should then have an ERCP to detect and delineate the biliobiliary fistula. At surgery, all of these patients have a fused gall bladder with obliteration of the Calot's triangle. Both retrograde and antegrade cholecystectomy is hazardous in these cases. Instead, the gall bladder should be opened inferiorly and evacuated of all stones, followed by a partial cholecystectomy and common hepatic duct repair over a T-tube. In the presence of an associated high or low biliary stricture, a suitable bilioenteric anastomosis may be required.
我们回顾了1983年至1985年间接受手术治疗的9例胆胆瘘病例。其中2例患者还伴有高位肝管狭窄，这种关联此前未被重点提及。这些患者中有8例出现黄疸。在存在胆胆瘘的情况下进行经典胆囊切除术会对上段胆道的完整性造成严重风险。术前内镜逆行胰胆管造影（ERCP）或经皮经肝胆管造影可检测到这些罕见的瘘管。建议对所有伴有黄疸的胆石症患者进行超声检查，以筛查胆胆瘘的证据。然后应进行ERCP以检测和明确胆胆瘘。手术时，所有这些患者的胆囊均融合，胆囊三角消失。在这些病例中，逆行和顺行胆囊切除术均有危险。相反，应在胆囊下方开口，清除所有结石，然后进行部分胆囊切除术，并通过T管修复肝总管。若存在相关的高位或低位胆管狭窄，则可能需要进行合适的胆肠吻合术。
