Yamashita H, Chijiiwa K, Ogawa Y, Kuroki S, Tanaka M
Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan.
HPB Surg. 1997;10(3):143-7. doi: 10.1155/1997/95363.
To reevaluate the current features of spontaneous internal biliary fistulas, we reviewed 1,929 consecutive patients who had been treated for biliary tract diseases during the recent 12-year period. Thirty-three patients had internal biliary fistulas and the incidence was 1.9%. Of 33 patients, 20 were women and 13 were men with the average age 63 years, and their mean duration of illness was 4 years. A total of 37 fistulas were found and the most common type was choledochoduodenal (62%), followed by cholecystoduodenal (19%), cholecystocholedochal (11%) and cholecystocolonic (8%) fistulas. Internal biliary fistulas of thirty-one patients were caused by biliary stones and those of two patients by malignant tumors. All of the 17 bile samples examined were bacteria positive and the majority of calculi were brown pigment stones. All of the choledochoduodenal fistulas were correctly diagnosed by endoscopic retrograde cholangiography. In 14 patients with cholecystoenteric or cholecystocholedochal fistulas, direct evidence of the internal fistula was obtained only in 7 patients (50%) preoperatively. Pneumobilia, a small atrophic gallbladder adherent to the neighboring organs and a history of spontaneous disappearance of jaundice in elderly patients may indicate the presence of a cholecystoentric fistula. Since the preoperative diagnostic rate for internal biliary fistula involving the gallbladder is still low, care is necessary before and at the time of surgery especially during laparoscopic cholecystectomy for elderly patients with cholelithiasis.
为了重新评估自发性胆内瘘的当前特征，我们回顾了近12年期间接受胆道疾病治疗的1929例连续患者。33例患者存在胆内瘘，发病率为1.9%。33例患者中，女性20例，男性13例，平均年龄63岁，平均病程4年。共发现37个瘘口，最常见的类型是胆总管十二指肠瘘（62%），其次是胆囊十二指肠瘘（19%）、胆囊胆总管瘘（11%）和胆囊结肠瘘（8%）。31例患者的胆内瘘由胆结石引起，2例患者的胆内瘘由恶性肿瘤引起。所有检测的17份胆汁样本细菌培养均为阳性，大多数结石为棕色色素结石。所有胆总管十二指肠瘘均经内镜逆行胆管造影正确诊断。在14例胆囊肠瘘或胆囊胆总管瘘患者中，术前仅7例（50%）获得了胆内瘘的直接证据。气肿性胆囊炎、与邻近器官粘连的小萎缩胆囊以及老年患者黄疸自发消退史可能提示存在胆囊肠瘘。由于涉及胆囊的胆内瘘术前诊断率仍然较低，对于老年胆石症患者，尤其是在腹腔镜胆囊切除术之前和手术期间，需要格外小心。
