外科理论与实践

外科理论与实践 ›› 2022, Vol. 27 ›› Issue (02): 169-172.doi: 10.16139/j.1007-9610.2022.02.016

• 论著 • 上一篇    下一篇

胆石性肠梗阻的诊断与治疗

王贵福1, 刘仁杰2, 柏斗胜2, 蒋国庆2, 张弛2, 王谦2, 王翱卿2, 金圣杰2()   

  1. 1.粤北人民医院肝胆外科,广东 韶关 512025
    2.扬州大学临床医学院 江苏省 苏北人民医院肝胆外科 普通外科研究所,江苏 扬州 225001
  • 收稿日期:2020-12-24 出版日期:2022-05-25 发布日期:2022-06-16
  • 通讯作者: 金圣杰 E-mail:webjin@163.com

Gallstone ileus: diagnosis and treatment

WANG Guifu1, LIU Renjie2, BAI Dousheng2, JIANG Guoqing2, ZHANG Chi2, WANG Qian2, WANG Aoqing2, JIN Shengjie2()   

  1. 1. Department of Hepatobiliary Surgery, Yuebei People’s Hospital, Guangdong Shaoguan 512025, China
    2. Clinical Medical College of Yangzhou University, Department of Hepatobiliary Surgery, Northern Jiangsu People’s Hospital, Institute of General Surgery, Jiangsu Yangzhou 225001, China
  • Received:2020-12-24 Online:2022-05-25 Published:2022-06-16
  • Contact: JIN Shengjie E-mail:webjin@163.com

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摘要：

目的： 探讨胆石性肠梗阻的诊断与治疗,提高对胆石性肠梗阻的认识。方法： 回顾性分析2014年1月至2019年12月江苏省苏北人民医院收治12例胆石性肠梗阻病人的临床资料,包括临床表现、影像学特征和治疗。结果： 12例均出现腹痛、腹胀、恶心、呕吐。术前确诊胆石性肠梗阻6例,其中5例为CT检查确诊,1例为MRI检查确诊。11例行手术治疗,1例保守治疗。其中6例一期行肠切开取石+胆囊切除+胆肠瘘修补术,平均手术时间（167.5±23.2） min,术后平均住院时间（15.5±3.2） d。5例单纯行肠切开取石术,平均手术时间（96.2±31.1） min,术后平均住院时间（16.25±2.7） d。单纯行肠切开取石组病人的手术时间短于一期联合胆囊切除+胆肠瘘修补术组（P<0.05）,但两组术后住院时间比较,差异无统计学意义（P>0.05）。1例保守治疗排石,1年后行胆囊切除、胆肠瘘修补。结论： 胆石性肠梗阻临床症状不典型,易漏诊。腹部CT检查有助于诊断,手术为主要治疗方法。

关键词: 胆石性肠梗阻, 诊断, 手术治疗

Abstract:

Objective To investigate the diagnosis and treatment of gallstone ileus and improve to recognize gallstone ileus. Methods The clinical data including clinical manifestations, imaging features, and treatment in 12 patients with gallstone ileus admitted to Northern Jiangsu People’s Hospital from January 2014 to December 2019 were retrospectively analyzed. Results All 12 patients had abdominal pain and distension, nausea and vomiting. Six cases with gallstone ileus were diagnosed preoperatively with 5 cases diagnosed by CT scanning and 1 case by magnetic resonance imaging. All cases, except 1 case non-surgical, had surgical treatment. A one-stage procedure consisting of enterolithotomy, cholecystectomy and fistula closure was performed in six cases with operative time(167.5±23.2) min and postoperative hospital stay (15.5±3.2) d. Five cases underwent simple enterolithotomy with operative time(96.2±31.1) min and postoperative hospital stay (16.25±2.7) d. The operative time in patients with simple enterolithotomy was shorter than that in patient with one-stage procedure(P<0.05). However, there was no significant difference in the postoperative hospital stay between simple enterolithotomy and one-stage procedure (P>0.05). One case with non-surgical treatment had spontaneous evacuation of gallstones, and both cholecystectomy and fistula closure were performed one year later. Conclusions Missed diagnosis of gallstone ileus might be present for the atypical symptoms. Abdominal CT examination is helpful for diagnosis of gallstone ileus and operative treatment is the key therapy.

Key words: Gallstone ileus, Diagnosis, Surgical treatment

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