中国普通外科杂志 ›› 2011, Vol. 20 ›› Issue (2): 187-190.

• 临床研究 • 上一篇    下一篇

胆石性肠梗阻的诊断及治疗:附18例报告

蒋嘉睿|刘国清|苗雄鹰|谭兴国|钟德玝   

  1. (中南大学湘雅二医院 普通外科|湖南 长沙 410011)
  • 收稿日期:2010-11-14 修回日期:2011-01-15 出版日期:2011-02-15 发布日期:2011-02-15
  • 通讯作者: 钟德玝 E-mail:zhdewu@sina.com.cn
  • 作者简介:蒋嘉睿|中南大学湘雅二医院博士研究生|主要从事腹部外科疾病方面的研究。

Diagnosis and treatment of gallstone ileus: a report of 18 cases

JIANG Jiarui, LIU |Guoqing,  |MIAO Xiongying, |TAN |Xingguo, ZHONG Dewu   

  1. (Department of General Surgery, the Second Xiangya Hospital, Central South University, Changsha 410011, China)
  • Received:2010-11-14 Revised:2011-01-15 Online:2011-02-15 Published:2011-02-15

摘要:

目的:探讨胆石性肠梗阻的诊断及外科治疗方法。
方法:回顾性分析18例胆石性肠梗阻患者的临床特点、诊治方法及随访结果。
结果:18例平均年龄64.3岁,男女比例为1∶5。术前诊断率为77.8%。18例均经手术治疗,其中3例行一期肠切开取石手术,8例行一期行肠切开取石及二期胆囊切除加胆肠内瘘修补术,6例行一期手术解决肠道梗阻同时处理病变胆囊及胆肠内瘘,1例既往有胆肠内引流手术史患者一期行肠切开取石、胆肠吻合口切开取石、原胆肠吻合口整形术。术后并发症发生率38.9%,主要并发症为切口感染及肺部感染;死亡1例(5.5%),为术后第4天死于心肌梗塞。
结论:胆石性肠梗阻以老年女性患者为主,有效的影像学检查可及时诊断并为治疗提供可靠依据。胆石性肠梗阻应尽早外科干预,并根据患者具体情况选择合适的手术方式。

关键词: 肠梗阻/外科学; 胆石/并发症

Abstract:

Objective:To explore the diagnosis and surgical treatment of gallstone ileus.
Methods:We retrospectively analysed the diagnosis,treatment and follow-up outcome of 18 patients with gallstone ileus. 
Results:There were 18 patients with mean age of 64.3 years and a male to female ratio of 1∶5. Preoperative diagnosis rate was 77.8%. All 18 patients underwent laparotomy.Three patients underwent enterolithotomy alone,eight had two-stage procedure and six had one-stage procedure; 1 patient, who undergoing biliary enteric drainage before, underwent one-stage enterolithotomy, plastic surgery of biliary-enteric anastomosis and lithotomy. The perioperative complication rate was 38.9% and the main complications were wound infection and pulmonary infection. One patient died from myocardial infarction,  the perioperative mortality rate was 5.5%.
Conclusions:Elderly female patients are more susceptible to gallstone ileus. Effective use of imaging techniques can provide a timely diagnosis and reliable basis for the treatment of gallstone ileus. Surgical intervention should be adopted as soon as possible and must be individualized.

Key words: Intestinal Obstruction/surg, Gallstones/compl

中图分类号: 

  • R 656.7

[1]龚学军, 何群, 汤恢焕, 等.胆石性肠梗阻的诊断与治疗 [J].中国普通外科杂志, 2007, 16(5): 515-517.
[2]Reisner RM, Cohen JR. Gallstone ileus: a review of 1001 reported cases [J]. Am Surg, 1994, 60(6): 441-446. 
[3]Martin F. Intestinal obstruction due to gall-stones [J]. Ann Surg,1912, 55(5):725-743.
[4]Ayantunde AA,Agrawal A. Gallstone Ileus: Diagnosis and Management [J]. World Journal of Surgery, 2007, 31(6): 1294-1299.
[5]Kirchmayr W, Mühlmann G, Zitt M, et al. Gallstone ileus: rare and still controversial [J]. ANZ J Surg, 2005, 75 (4): 234-238.
[6]黄德全, 胡先典. 胆石性肠梗阻七例临床分析[J]. 中华普通外科杂志, 2007, 22(8): 628.
[7]Yakan S, Engin O, Tekeli T, et al. Gallstone ileus as an unexpected complication of cholelithiasis: diagnostic difficulties and treatment [J]. Ulus Travma Acil Cerrahi Derg, 2010, 16(4): 344-348.
[8]Gupta M, Goyal S, Singal R, et al. Gallstone ileus and jejunal perforation along with gangrenous bowel in a young patient: A case report [J]. North Am J Med Sci, 2010, 2(9): 442-443.
[9]Khan AZ, Nariculum J, Andreani SM, et al.Double gallstone ileus[J]. Hepatobiliary Pancreat Dis Int, 2008, 7(4): 437-439.
[10]Ripollés T, Miguel-Dasit A, Errando J, et al.Gallstone ileus: increased diagnostic sensitivity by combining plain film and ultrasound[J]. Abdom Imaging, 2001, 26(4): 401-405.
[11]Yu CY, Yu CY, Lin CC,  et al. Value of CT in the diagnosis and management of gallstone ileus [J]. World J Gastroenterol, 2005, 11(14): 2142-2147.
[12]Kasahara Y, Umemura H, Shiraha S, et al. Gallstone ileus: review of 112 patients in the Japanese literature [J]. Am J Surg, 1980, 140(3): 437-440.
[13]Doko M, Zovak M, Kopljar M, et al. Comparison of surgical treatments of gallstone ileus: preliminary report [J]. World J Surg, 2003, 27(4): 400-404.
[14]Zuegel N, Hehl A, Lindemann F, et al. Advantages of one-stage repair in case of gallstone ileus [J]. Hepatogastroenterology, 1997, 44(13): 59-62.
[15]Tan YM, Wong WK, Ooi LL. A comparison of two surgical strategies for the emergency treatment of gallstone ileus [J]. Singapore Med J, 2004, 45(2): 69-72.

[1] 孙茂| 周辉| 牟洪超| 郭鹭. 肠梗阻的临床诊治:附268例分析[J]. 中国普通外科杂志, 2011, 20(10): 1143-1145.
[2] 牛洪欣 综述 徐忠法 审校. 肠道慢性肉芽肿性炎症的诊断与治疗进展[J]. 中国普通外科杂志, 2011, 20(10): 1113-1116.
[3] 赵建国| 吕震| 翟会侠. 十二指肠损伤35例诊治分析[J]. 中国普通外科杂志, 2011, 20(9): 1006-1008.
[4] 毕崇尧. 空肠起始部憩室并肠梗阻1例[J]. 中国普通外科杂志, 2011, 20(6): 643-643.
[5] 孟凡斌|赵梅芬|郭克建. 肠减压导管治疗难治性肠梗阻:附23例报告[J]. 中国普通外科杂志, 2010, 19(12): 1356-1358.
[6] 罗军| 罗细章. 胶囊内镜滞留肠道2例[J]. 中国普通外科杂志, 2010, 19(12): 1310-.
[7] 余招焱| 郝朗松| 杨晓飞| 李东苗. 小肠扭转手术方式的探讨[J]. 中国普通外科杂志, 2010, 19(10): 1161-1163.
[8] 刘小伟| 欧阳春晖| 朱小寒| 刘德良| 卢放根| 吴小平| 霍继荣. 胶囊内镜对小肠出血的诊断价值和不同年龄组临床特点比较[J]. 中国普通外科杂志, 2010, 19(8): 907-911.
[9] 刘诚聪|李世宽|王培戈|李元博|彭新刚. 泛影葡胺对粘连性小肠梗阻的临床疗效[J]. 中国普通外科杂志, 2010, 19(4): 396-399.
[10] 余俊英, 冯泽荣, 黄顺荣, 覃日清, 毛国娴. 肠外瘘治疗策略的改进:附36例报告[J]. 中国普通外科杂志, 2009, 18(10): 1102-1104.
[11] 杨增玺, 陈文化, 杨顺俊, 马晓权, 李斌, 杨玉香, 雒文娟, 王煊. 健胃行气合剂对腹部术后胃肠功能恢复的临床观察[J]. 中国普通外科杂志, 2009, 18(10): 1105-1106.
[12] 张鸽文, 谭辉, 李劲东, 李新营, 周乐杜, 梁帅, 王志明. 肠梗阻非手术治疗中早期应用生长抑素的临床观察[J]. 中国普通外科杂志, 2009, 18(10): 1059-1061.
[13] 陈翔, 曾小兵, 袁杰, 耿春华. 改良纤维蛋白胶封堵治疗消化道瘘4例报告[J]. 中国普通外科杂志, 2009, 18(10): 1100-1102.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 张奇, 孙备 . 梗阻型胆源性胰腺炎内镜治疗时机的选择[J]. 中国普通外科杂志, 2008, 17(3): 1 -206 .
[2] 张昭, 赵刚, 王丹, 王春友 . 生长抑素对急性出血坏死性胰腺炎肝损伤的作用机制[J]. 中国普通外科杂志, 2008, 17(3): 6 -227 .
[3] 杨乐平, 杨竹林, 李青龙, 范文涛 . 大鼠胰腺癌和非癌胰腺组织MV,TAM,MC计数及意义[J]. 中国普通外科杂志, 2008, 17(3): 11 -249 .
[4] 所广军| 胡海 . 胆总管结石内镜治疗术式的选择[J]. 中国普通外科杂志, 2009, 18(8): 775 -778 .
[5] 董雪伟, 张岩松, 王荣朝, 许军, 李忠, 罗光华, 朱江, 徐宁. 胃癌术中腹腔游离癌细胞检测临界值的确定及其临床意义[J]. 中国普通外科杂志, 2009, 18(10): 3 .
[6] 秦龙, 张才全. 渥曼青霉素对人胃癌细胞的作用及机制[J]. 中国普通外科杂志, 2009, 18(10): 1035 -1038 .
[7] 吴继敏, 汪忠镐, 季锋, 张普德, 来运钢, 刘永飞, 申海涛, 高翔, 陈秀. 腹腔镜Nissen胃底折叠术治疗胃食管反流病[J]. 中国普通外科杂志, 2009, 18(10): 1055 -1058 .
[8] 谢放, 黄强. 染色体脆性位点抑癌基因与肿瘤关系的研究进展[J]. 中国普通外科杂志, 2009, 18(10): 1069 -1071 .
[9] 尹大龙, 杨海彦, 刘连新, 陈曦, 田蓝天, 张树庚, 姜洪池. Caspase-10与胃腺癌发生发展关系的实验研究[J]. 中国普通外科杂志, 2009, 18(10): 1076 -1079 .
[10] 何家安, 胡新华, 范玥尧, 李志文, 杨德华, 辛世杰, 段志泉. 主动脉夹层动脉瘤继发心脏-声带综合征及霍纳综合征1例[J]. 中国普通外科杂志, 2009, 18(10): 1109 -1110 .