SPONTANEOUS INTERNAL BILIARY FISTULAE.
SPONTANEOUS INTERNAL BILIARY FISTULAE.
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自发性内胆瘘。
DOI：
10.1097/00000658-194206000-00016
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发表时间：
1942
影响因子：
9
通讯作者：
C. B. Puestow
中科院分区：
文献类型：
--
作者：
C. B. Puestow
已知胆道某些部分和某些中空内脏之间的瘘管存在多年。病理学家描述了胆囊或胆管与胃肠道的几乎所有部分以及膀胱、子宫、肾盂、门静脉、卵巢囊肿以及心包和支气管树等胸腔内结构之间的瘘管连通。博尔曼和里格勒在一篇出色的文献综述和对自己材料的调查中记录了 30,000 多份尸检中仅存在 67 个内胆瘘。许多这样的段落无疑被忽视了，因为早期文献中提到胆结石引起的肠梗阻的频率是胆囊肠瘘的三倍。 4 毫无疑问，大多数足以产生阻塞的胆结石已通过瘘管到达肠腔。随着手术室中对内胆瘘的认识越来越频繁以及X线诊断的频繁进行，临床对这种情况的兴趣也随之增加。 Kehr 报告称，在 2,000 例胆囊切除术中发现了 100 例胆瘘，发生率为 5%。 Bernhard 在 6,263 次胆道手术中遇到过 9 次。在爱荷华州大学医院，1.2% 的胆囊炎患者被发现患有内胆瘘。 5 Judd 和 Burden 报道了胆道和胃肠道之间有 153 个瘘管连接。其中绝大多数在手术前并未得到诊断。在 Judd 和 Burden 的系列文章中，只有 2 例在术前得到诊断，其中 1 例通过 X 线造影进行可视化。内胆瘘的 X 线造影诊断主要基于胆道中空气的存在或胃肠道研究期间钡的流入。 Hunt 和 Herbst 在 19I5 年首先注意到了钡的通过。在接下来的十年中，出现了许多关于内胆瘘的 X 线照相识别的报告。博尔曼和里格勒收集了 I937 的所有报告，总计如下：
FISTULAE between some portion of the biliary tract and some hollow viscus have been known to exist for many years. Pathologists have described fistulous communications between the gallbladder or bile ducts and nearly all portions of the gastro-intestinal tract as well as with the bladder, uterus, kidney pelvis, portal vein, ovarian cysts, and with such intrathoracic structures as the pericardium and bronchial tree. In an excellent literature review and survey of their own material, Borman and Rigler record the presence of only 67 internal biliary fistulae in over 30,000 autopsies. Many such passages undoubtedly were overlooked because intestinal obstruction due to gallstones was mentioned in the early literature three times as frequently as gallbladder intestinal fistula. 4 Undoubtedly most gallstones sufficiently large to produce obstruction have reached the lumen of the bowel through a fistula. With the more frequent recognition of internal biliary fistulae in the operating room and theirfrequent roentgenologic diagnosis, clinical interest in this condition has increased. Kehr reported the finding of ioo biliary fistulae in 2,000 cholecystectomies, an incidence of 5 per cent. Bernhard encountered them io9 times in 6,263 operations upon the biliary tract. At the University Hospitals of Iowa 1.2 per cent of all patients with cholecystitis were found to have internal biliary fistulae. 5 Judd and Burden reported 153 fistulous connections between the biliary and gastro-intestinal tracts. The great majority of these were not diagnosed before operation. In Judd and Burden's series only two were diagnosed preoperatively, one of which was visualized roentgenographically.Roentgenographic diagnosis of internal biliary fistula is based chiefly upon the presence of air in the biliary passages or the influx of barium during a gastro-intestinal study. The passage of barium was noted first by Hunt and Herbst in 19I5. During the following ten years many reports have been made of roentgenographic recognition of internal biliary fistulae. Borman and Rigler collected all reports to I937 which totaled as follows: