胆石性肠梗阻的诊断与治疗

梁庆余; 杜鹏; 谢佳明; 吴浩荣; 谷春伟; 钟丰云

doi:10.3760/cma.j.issn.1673-9752.2014.08.019

胆石性肠梗阻的诊断与治疗

215000 苏州大学附属第二医院普通外科

基金项目: 苏州卫生局科教兴卫青年科技项目(SWKQ0920)

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出版历程

Diagnosis and treatment of gallstone ileus

Department of General Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215000, China

摘要

摘要:
【摘要】胆石性肠梗阻是一种较为少见的机械性肠梗阻，多因胆囊巨大结石通过胆肠内瘘排入肠道引起阻塞性肠梗阻。治疗的关键是梗阻原因的诊断，治疗方法主要为手术治疗。2013年4月苏州大学附属第二医院收治了1例老年胆石性肠梗阻患者。术前经X线片和CT检查胆囊壁增厚与十二指肠粘连窦道形成，左髂区机械性肠梗阻(胆源性结石直径约4 cm)，内科治疗3 d后行急诊剖腹探查+取石术治疗肠梗阻，术中见胆囊无结石，与家属沟通后未切除胆囊，术后随访观察。随访至2013年12月患者恢复较好，复查B超胆囊肠道内瘘口未显示，胆囊炎症消退。
- 胆石性肠梗阻 /
- 胆囊内瘘 /
- 胆石症
Abstract:
Gallstone ileus is a rare mechanical ileus, which was caused by discharge of giant gall bladder stone to the intestine. Understanding the causes of ileus is the key factor for treatment, and surgical treatment is the treatment of choice. An old patient with gallstone ileus was admitted to the Second Affiliated Hospital of Soochow University in April 2013. Preoperative X ray detection and computed tomography showed gallbladder wall thickening, formation of a sinus tract between the gall bladder and the duodenum, and intestinal ileus in the left iliac region (the diameter of the stone was about 4 cm). The patient received medical treatment for 3 days and then exploratory laparotomy+lithotomy. Gall bladder stones were not detected during the operation, so the gall bladder was preserved. The patient was followed up till December 2013, the sinus tract was disappeared under B sonography, and the cholecystitis was cured.
- Gallstone ileus /
- Internal biliary fistula /
- Cholelithiasis