胆石性肠梗阻的诊断与治疗

doi:10.16139/j.1007-9610.2022.02.016

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

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.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. 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

摘要/Abstract

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

中图分类号:

王贵福, 刘仁杰, 柏斗胜, 蒋国庆, 张弛, 王谦, 王翱卿, 金圣杰. 胆石性肠梗阻的诊断与治疗[J]. 外科理论与实践, 2022, 27(02): 169-172.

WANG Guifu, LIU Renjie, BAI Dousheng, JIANG Guoqing, ZHANG Chi, WANG Qian, WANG Aoqing, JIN Shengjie. Gallstone ileus: diagnosis and treatment[J]. Journal of Surgery Concepts & Practice, 2022, 27(02): 169-172.

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参考文献 21

[1]	Abou-Saif A, Al-Kawas FH. Complications of gallstone disease: Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus[J]. Am J Gastroenterol, 2002, 97(2): 249-254. pmid: 11866258
[2]	Ayantunde AA, Agrawal A. Gallstone ileus: diagnosis and management[J]. World J Surg, 2007, 31(6):1292-1297. pmid: 17436117
[3]	Tornambè A, Tornambè G. Gallstone ileus in an ederly patient case report[J]. Ann Ital Chir, 2017, 6:S2239253X 17027232.
[4]	Nuño-Guzmán CM, Marín-Contreras ME, Figueroa-Sánchez M, et al. Gallstone ileus, clinical presentation, diagnostic and treatment approach[J]. World J Gastrointest Surg, 2016, 8(1):65-76. doi: 10.4240/wjgs.v8.i1.65 URL
[5]	Dunphy L, Al-Shoek I. Gallstone ileus managed with enterolithotomy[J]. BMJ Case Rep, 2019, 12(10):e231581.
[6]	Jakubauskas M, Luksaite R, Sileikis A, et al. Gallstone ileus: management and clinical outcomes[J]. Medicina (Kaunas), 2019, 55(9):598.
[7]	Inukai K. Gallstone ileus: a review[J]. BMJ Open Gastroenterol, 2019, 6(1):e000344.
[8]	Kudaravalli P, Saleem SA, Goodman A, et al. Bouveret syndrome as a rare cause of gastric outlet obstruction[J]. Proc (Bayl Univ Med Cent), 2020, 33(2):235-236. doi: 10.1080/08998280.2019.1708841 pmid: 32313470
[9]	Beuran M, Ivanov I, Venter MD. Gallstone ileus--clinical and therapeutic aspects[J]. J Med Life, 2010, 3(4):365-371. pmid: 21254732
[10]	Rigler LG, Borman CN, Noble JF. Gallstone obstruction. Pathogenesis and Roentgen manifestations[J]. J Am Med Assoc, 1941, 117(21):1753-1759. doi: 10.1001/jama.1941.02820470001001 URL
[11]	Yu CY, Lin CC, Shyu RY, et al. Value of CT in the dia-gnosis and management of gallstone ileus[J]. World J Gastroenterol, 2005, 11(14):2142-2147. doi: 10.3748/wjg.v11.i14.2142 URL
[12]	Lassandro F, Romano S, Ragozzino A, et al. Role of helical CT in diagnosis of gallstone ileus and related conditions[J]. Am J Roentgenol, 2005, 185(5):1159-1165. doi: 10.2214/AJR.04.1371 URL
[13]	王均庆, 郑庆华, 陆风旗, 等. 多排螺旋CT在胆源性胆囊-十二指肠瘘诊断中的临床价值[J]. 中华消化外科杂志, 2015, 14(7):585-589.
[14]	朱卫平, 李学庆, 程志俭. 胆石性肠梗阻的外科诊治体会[J]. 肝胆胰外科杂志, 2011, 23(2):123-124.
[15]	Zappia F, Petracca G, Talarico CA. Gallstone ileus. a case treated with minilaparotomy and a review of the li-terature[J]. Ann Ital Chir, 2017, 6:S2239253X1702535X.
[16]	Ravikumar R, Williams JG. The operative management of gallstone ileus[J]. Ann R Coll Surg Engl, 2010, 92(4):279-281. doi: 10.1308/003588410X12664192076377 URL
[17]	Rabie MA, Sokker A. Cholecystolithotomy, a new approach to reduce recurrent gallstone ileus[J]. Acute Med Surg, 2019, 6(2):95-100. doi: 10.1002/ams2.404 URL
[18]	Gungor F, Atalay Y, Acar N, et al. Clinical outcome of gallstone ileus; a single-centre experience of case series and review of the literature[J]. Acta Chir Belg, 2020:1-8.
[19]	邹文茂, 黄耿文, 李宜雄, 等. 胆石性肠梗阻的诊断与治疗: 附302例分析[J]. 中国普通外科杂志, 2014, 23(8):1093-1096.
[20]	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.
[21]	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.

胆石性肠梗阻的诊断与治疗

Gallstone ileus: diagnosis and treatment

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