Huang Shi-Fei, Han Ye-Hong, Chen Jie, Zhang Jun, Huang Hai
Department of General Surgery, Hangzhou TCM Hospital affiliated to Zhejiang Chinese Medical University, Hangzhou, China.
Front Surg. 2022 Jul 8;9:950292. doi: 10.3389/fsurg.2022.950292. eCollection 2022.
Cholecystoenteric fistula (CEF) is an uncommon complication of cholelithiasis. Here, we report our experience on diagnostic methods and surgical management of CEF patients with and without gallstone ileus (GI).
This is a retrospective cases series over an 11-year period (2011-2022). Data analyzed included preoperative characteristics, ultrasound, imaging features, operation findings and postoperative course.
A total of 29 patients diagnosed with CEF were enrolled, 51.7% (15/29) of whom were female, with a median age of 66 years (range: 35-96 years). With regards to subtype distribution, seventeen patients had cholecystoduodenal fistula (CDF), six had cholecystoconlonic fistula (CCF), three exhibited cholecystogastric fistula (CGF), one CDF combination with CCF and two CDF combination with type I Mirizzi syndrome. Twelve patients presented with gallstone ileus, and received one stage procedure or simple Enterolithotomy. The median operation time and blood loss of 157 min (range: 65-360 min) and 40 ml (range: 10-450 ml), respectively. Surgical complications, evidenced by fistula recurrence, were recorded in three patients (3/22; 13.6%), while four (4/29; 13.8%) and one patient (1/29; 3.4%) presented with wound infection and residual stone in common bile duct, respectively. No deaths were reported in our study.
CEF is a rare complication of gallstone disease that is occasionally found during operation. To date, no consensus has been reached regarding efficacious treatment therapies for CEF patients. For a CEF patient with GI, one stage procedure should be selected prudently, while simple Enterolithotomy would be a mainstream choice for relieving bowel obstruction.
胆囊肠道瘘（CEF）是胆石症一种不常见的并发症。在此，我们报告我们对伴有和不伴有胆石性肠梗阻（GI）的CEF患者的诊断方法和手术治疗经验。
这是一项为期11年（2011 - 2022年）的回顾性病例系列研究。分析的数据包括术前特征、超声、影像学特征、手术发现和术后病程。
共纳入29例诊断为CEF的患者，其中51.7%（15/29）为女性，中位年龄66岁（范围：35 - 96岁）。关于亚型分布，17例患者有胆囊十二指肠瘘（CDF），6例有胆囊结肠瘘（CCF），3例有胆囊胃瘘（CGF），1例CDF合并CCF，2例CDF合并Ⅰ型Mirizzi综合征。12例患者出现胆石性肠梗阻，并接受了一期手术或单纯肠切开取石术。中位手术时间和失血量分别为157分钟（范围：65 - 360分钟）和40毫升（范围：10 - 450毫升）。3例患者（3/22；13.6%）出现手术并发症，表现为瘘复发，而4例（4/29；13.8%）和1例患者（1/29；3.4%）分别出现伤口感染和胆总管残余结石。我们的研究中未报告死亡病例。
CEF是胆石症的一种罕见并发症，偶尔在手术中发现。迄今为止，对于CEF患者的有效治疗方法尚未达成共识。对于伴有GI的CEF患者，应谨慎选择一期手术，而单纯肠切开取石术将是缓解肠梗阻的主要选择。
