急性胆囊炎及合并症的超声诊断分析

Objective To study the ultrasonic diagnosis value of acute cholecystitis and its complication. Methods The ultrasonic images of 148 cases with acute cholecystitis and its complication were retrospective analysised. Result Fifteen cases with simplicity acuteness cholecystitis, thirty-three cases with purulent acuteness cholecystitis, three cases with acuteness gangrenous cholecystits. Ninety- seven cases was chronic cholecystitis with acute attack merging gallbladder calculous. In them, four cases with biliary tract roundworm, nine cases with gallbladder polypus, two cases with perforation of gallbladder. Conclusion The ultrasonic has very high detectable rate and diagnose exactness rate in acute cholecystitis and its complication.     

微创内镜保胆取石术后结石复发率及影响因素分析

目的 探讨微创内镜保胆取石术后结石复发率及影响因素,以合理选择手术适应证、降低结石复发率.方法 对我院1998年1月至2003年1月微创内镜保胆取石术后65例患者的临床资料和随访资料进行分析研究.结果 微创内镜保胆取石术后结石总的复发率为38.5%(25例),5例再次行胆囊切除术,占复发患者的20.0%.单因素分析得出5个与结石复发相关因素,胆囊功能[正常6.3%(2/32)比减低69.7%(23/33),P＜0.01]、胆囊壁厚度[≥0.3 cm者78.3%(18/23)比＜0.3 cm者16.7%(7/42),P＜0.01]、家族史[有家族史者63.0%(17/27)比无家族史者21.1%(8/38),P＜0.01]、血甘油三酯水平[(4.45±2.16)mmol/L比(3.37±2.35)mmol/L,P＜0.01]、术后是否服用熊去氧胆酸[服用者18.2%(4/22)比未服用者48.8%(21/43),P＜0.05];最后引入COX回归分析进行多因素分析,得到2个影响复发的因素,分别是胆囊功能和胆囊壁厚度(B=1.747、-1.123,SE=0.855、0.507,Wald=4.172、4.902,P=0.041、0.027,Exp (B)=5.737、0.325).结论 胆囊功能、胆囊壁厚度是影响结石复发的重要因素,前瞻性判断保胆取石后结石复发的可能性,有利于合理选择手术适应证,降低术后结石复发率.

Abstract：

Objective To explore recurrent rate of the gallstone after cholecyst olithotomy and identify the variables predicting the recurrence. Methods A retrospective analysis of 65 patients among 70 patients who were in hospital from 1998 to 2003 was performed. Results The total recurrent rate was 38.5%. There were 5 factors might influent the recurrent rates byx2 test, such as function of gallbladder, the thickness of gallbladder wall, Ursodeoxycholic acid, family history of gallstone, triglyceride in blood. Two factors among them were identified as independent risk factors for recurrence by multivariate model: function of gallbladder, the thickness of gallbladder wall. The gallstone recurrent rate of patient who has normal function of gallbladder and thickness of gallbladder wall ＜ 0. 3 cm is 8.0%. Conclusions Function of gallbladder, the thickness of gallbladder wall and triglyceride in blood are strong predictors for recurrence after cholecystolithotomy. The gallstone recurrent rate is low among those patients who have normal function of gallbladder andthickness of gallbladder wall ＜0.3 cm.     

急性胆囊炎的腹腔镜手术治疗

Objective To summarize the operating experience in the treatment of acute cholecystitis. Methods The clinical data and therapeutic outcome of 63 cases with acute cholecystitis in lapanoscopic cholecystectomy (LC)were reviewed. Results All of the cases were cured by LC, no serious postoptative complications and death occurred.Conclusion It is salty for laparoacopic cholecyst ectomy in treating acute cholecystitis.     

雷公藤多苷联合泼尼松治疗紫癜性肾炎51例疗效观察

Objective To observe the effect of tripterygium glycosides combined with prednisone in treatment of purpura nephritis.Methods 51 patients with purpura nephritis were selected and treated by tripterygium glycosides (1.5～2.0mg/kg) combined with prednisone(1.5～2.0mg/kg) ,three times every day.The total course was 6 to 9 months.Before and after the treatment, the five indicators of bleeding and coagulation, urine protein, occult blood changes and drug side effects and recurrence after drug withdrawal were observed.Results The high coagulation of the blood was improved,and the renal function of 94.1%children recovered.Only 6 cases had little complication and only 1 case had recrudescence 1 year after leaving hospital.Conclusion Tripterygium glycosides combined with prednisone was effective in treating children with purpura nephritis.     

山莨菪碱辅助治疗慢性重症乙型肝炎的临床研究

目的 研究山莨菪碱辅助治疗慢性乙型重型肝炎的临床疗效.方法 将150例慢性乙型重型肝炎患者按抽签法随机分为对照组和治疗组,各75例.对照组入院后接受拉米夫定100 mg/d抗病毒治疗及给予常规护肝,同时强调基础治疗及积极补充鲜血浆、白蛋白等综合治疗,有并发症者给予相应处理,有条件者常规接受人工肝血浆置换治疗1～3次,治疗组在此治疗基础上加用山莨菪碱20 mg/d静脉滴注或分2次静脉注射,对比2组患者病死率以及治疗前和治疗后2、4及8周血清总胆红素(TBiL)、ALT、凝血酶原时间(PT)等血清学指标的变化.结果 治疗8周后对照组好转42例(56.0%),无效33例(44.0%),死亡30例(40.0%);治疗组好转54例(72.0%),无效21例(28.0%),死亡18例(24.0%).治疗组好转率优于对照组(x2=4.17,P=0.041),病死率低于对照组(x2=4.41,P=0.036).2组存活患者(治疗组57例,对照组45例)治疗后肝功能均逐渐恢复,但治疗组血清肝功能指标下降迅速.结论 山莨菪碱辅助治疗慢性重型乙型肝炎有助于快速恢复肝功能、减低病死率.

Abstract：

Objective To study the clinical efficacy of anisodamine as adjuvant therapy of chronic severe hepatitis B. Methods One hundred and fifty cases of chronic severe hepatitis B were randomly divided into control group (75cases) and treated group (75cases). The control group were given lamivudine 100 mg/d and conventional treatment. Meanwhile some patients accepted 1-3 times of the treatment of Plasma Exchange. Besides the treatment in control group,the treated group had anisodamine (20 mg every day by intravenous drip or injection 2 times every day). The mortality rate and the changes of serum (such as TBIL,ALT,etc)of two groups before treatment and two weeks,4 weeks,8 weeks after treatment were compared. Results The mortality rate of treatment group decreased significantly(18/75),compared with control group(30/75)(x2=4.41,P＜0.05). The liver function of survival cases in both two groups (57 cases of treatment group,45cases of control group)was restored gradually. But the serum indicators of liver function of the treatment group decreased more rapidly that those in control group at 2 weeks,4 weeks and 8 weeks after treatment(P＜0.01). Conclusion Anisodamine can restore the liver function and reduce mortality in the treatment of chronic severe hepatitis B.     

腹腔镜胆囊切除术常见并发症分析及预防策略

目的 分析腹腔镜胆囊切除术并发症发生的原因,探讨如何减少和预防腹腔镜胆囊切除术并发症的发生.方法 回顾性分析2000年6月至2010年6月2341例胆囊良性疾病患者行腹腔镜胆囊切除术的临床资料.结果 中转开腹145例(6.2%);发生各种并发症43例(1.8%),其中胆道损伤5例,胆囊管残端钛夹滑脱导致胆漏8例,胆囊动脉出血3例,胆囊床渗血致二次手术2例,胃肠道损伤3例,胆总管结石残留6例,右肝下包裹性积液4例,腹腔脓肿3例,切口感染3例,腹部少量皮下气肿6例.结论 严格掌握手术适应证,规范化的手术操作,熟练掌握预防并发症发生的手术技巧及方法,对中转开腹的正确判断,术后严密观察病情变化,及早发现并发症,可以有效地防止并发症发生.

Abstract：

Objective To analyze the reason of complications in laparoscopic cholecystectomy (LC) ,and to explore ways of reducing and preventing the incidence of complications. Methods The clinical data of 2341 patients receiving LC was analyzed retrospectively. Results One hundred and fourty-five patients (6.2% ) were converted from LC to open cholecystectomy. The complication rate of complications was 1. 8% (43 cases) , included 5 cases of extra-hepatic bile duct injury, 8 cases of bile leakages resulting from slippery of the titanium clips on cystic duct stump, 3 cases of cystic artery bleedings, 3 cases of gastrointestinal injuries, 6 cases of residual common bile duct stones, 4 cases of right sub-hepatic encapsulated fluids, 3 cases of intra-abdominal abscesses, 3 cases of inci-sional infections, and 6 cases of abdominal subcutaneous emphysema. Conclusions In order to effectively prevent complications of laparoscopic cholecystectomy, the following measures should be enforced cautiously: strict control of surgical indications, standardization of surgical procedures, mastering the surgical techniques and methods of preventing complications, timely laparotomy, close observation of changes in condition after the surgery, early detection of complications, timely and correct treatment, as well as making correct decision for laparotomy.     

腹腔镜手术与开腹手术治疗胆囊炎、胆结石的疗效比较

Objootive To explore the curative effect difference of laparoscopic cholecysteetomy and open cholecystectomy on patients with eholecystitis and/or gallstone.Methods The clinical efficacy data of 86 patients with cholecystitis and/or gallstone underwent laparoscopic cholecystectomy in our hospital from Jan.2007 to Dec.2009 was retr~pectively analyzed,and compare with clinical efficacy data of 86 cases underwent open cholecystectomy before this time.Results There's significant difference on surgical operation time,bleeding volume,and postoperative complications between the laparoscopic cholecvsfeetomy group and the open cholecystectomy group(P＜0.05).Condusion Laparoscopie cholecystectomy is a safe and effective method for acute cholecystitis,and woah for spread application.     

来氟米特治疗狼疮肾炎的临床研究

目的 观察新型免疫抑制剂来氟米特治疗狼疮肾炎的临床疗效和安全性.方法 将51例狼疮肾炎患者完全随机、开放分为2组:来氟米特组27例;环磷酰胺组24例.2组均联合泼尼松治疗,对比观察2组治疗前和治疗后1、3、6个月的系统性红斑狼疮活动性指数(SLEDAI)积分、24 h尿蛋白定量、肾功能、血浆白蛋白、抗核抗体滴度、抗ds-DNA滴度、补体C3水平的变化及临床疗效,并分别记录不良反应.结果 来氟米特和环磷酰胺治疗狼疮肾炎的疗效相近(77.8%比62.5%),差异无统计学意义(P＞0.05).与治疗前比较,2组SLEDAI积分、24 h尿蛋白定量、血浆白蛋白、血肌酐、尿素氮水平和免疫学指标均明显改善,差异均有统计学意义(均P＜0.05).且随着治疗时间延长,各项检测指标改善愈明显.来氟米特组恶心呕吐、肝功能损害、白细胞数降低、脱发、皮疹、腹泻、月经不调等不良反应发生率[分别为18.5%(5例)、11.1%(3例)、7.4%(2例)、0%、3.7%(I例)、3.7%(1例)、25.9%(7例)],明显少于环磷酰胺组[分别为62.5%(15例)、37.5%(9例)、45.8%(11例)、20.8%(5例)、12.5%(3例)、16.7%(4例)、37.5%(9例)],差异均有统计学意义(均P＜0.05).结论 来氟米特治疗狼疮肾炎的疗效与环磷酰胺相近,但安全性较环磷酰胺高,值得临床推广使用.

Abstract：

Objective To observe the effect of new immunosuppressant leflunomide (LEF) for treatment of lupus nephritis(LN). Methods Fifty-one patients were divided into two groups randomly on principle of openess:LEF group with 27 cases and cyclophosphamide( CTX ) group with 24 cases. Two groups both were combined with prednisone for treatment of LN. Then the effect of two groups were observed by monitoring level change of the accumulate points of systemic lupus erythematosus disease activity index ( SLEDAI ), 24 hour urine protein, renal function, plasma albumin, immune body ANA titer, anti-ds-DNA titer and complement C3 and treatment effect before and after the treatment 1 month, 3 months and 6 months. And the adverse reactions are recorded respectively. Results The results show that LEF group was similar to CTX group with regard to clinical efficacy (77.8% vs 62.5% ). The difference was not statistically significant ( P ＞ 0. 05 ). Compared with every observation indicators of group 2 before treatment, the accumulate points of SLEDAI, 24 h urine protein quota, the blood plasma albumin level, the blood myo-bitter wine, the urea nitrogen value and the immunology index were obviously improved. And the difference was statistically significant (all P ＜ 0.05 ). And the longer the treatment time was, the more obviously all kinds of detection indexes were improved. The rate of adverse reactions (disgusting vomit, liver function harm,white blood cell reduction, hair losing, skin rash, diarrhea and abnormal menstruation) of LEF group[18.5% (5 cases), 11.1%(3 cases), 7.4%(2 cases), 0.0%( 0 case), 3.7%(1 case), 3.7%(1 case), 25.9%(7 cases)] were much less than that of CTX group [62.5% ( 15 cases), 37.5% (9 cases), 45.8% ( 11 cases), 20.8%(5 cases), 12.5% (3 cases), 16.7% (4 cases), 37.5% (9 cases)]. The difference were statistically significant ( all P ＜ 0.05 ). Conclusions LEF is similar to CTX with regard to clinical efficacy of the treatment of LN. Moreover, it is safer than CTX.     

胆益宁片联合曲匹布通治疗慢性胆囊炎的临床研究

目的探讨胆益宁片联合曲匹布通治疗慢性胆囊炎的临床疗效。方法选取2020年2月—2021年2月在咸阳市第一人民医院诊治的114例慢性胆囊炎患者,依据用药的差距分为对照组和治疗组,每组各57例。对照组口服曲匹布通片,40 mg/次,3次/d;治疗组在对照组基础上口服胆益宁片,0.6 g/次,3次/d。两组患者均治疗2周。观察两组患者临床疗效,比较治疗前后两组患者临床症状缓解时间、胆囊壁厚度、胆囊容积、胆囊收缩功能及血清C反应蛋白(CRP)、白细胞介素6(IL-6)、瘦素(LEP)、核因子κB(NF-κB)和IL-13水平。结果经治疗,治疗组总有效率显著优于对照组(98.25%vs 82.46%,P0.05)。经治疗,治疗组症状缓解时间明显早于对照组(P0.05)。经治疗,两组患者胆囊壁厚度、胆囊容积明显下降,而胆囊收缩功能明显升高(P0.05),且治疗组改善最显著(P0.05)。经治疗,两组患者血清CRP、IL-6、LEP、NF-κB水平明显下降,而IL-13明显升高(P0.05),且治疗组明显好于对照组(P0.05)。结论胆益宁片联合曲匹布通片治疗慢性胆囊炎可有效改善患者临床症状,降低机体炎症因子水平,提高患者胆囊功能,具有一定的临床推广应用价值。     

胆乐胶囊联合茴三硫治疗慢性胆囊炎的临床研究

目的 探讨胆乐胶囊联合茴三硫片治疗慢性胆囊炎的临床疗效。方法 选取2019年4月—2021年7月在鹤壁市人民医院就诊的90例慢性胆囊炎患者作为研究对象,根据随机数字表法将所有患者分为对照组和治疗组,每组各有45例。对照组口服茴三硫片,25 mg/次,1次/d。治疗组在对照组基础上口服胆乐胶囊,1.2 g/次,3次/d。两组患者连续治疗4周。观察两组临床疗效,比较两组的胆囊收缩功能、胆囊壁厚度、视觉模拟评分法（VAS）评分以及血清C反应蛋白（CRP）、白细胞介素-6（IL-6）、瘦素（Lep）水平。结果 治疗后,治疗组总有效率（95.56%）高于对照组（82.22%）,组间比较有显著差异（P<0.05）。治疗后,两组的胆囊收缩功能明显高于治疗前,胆囊壁厚度明显低于治疗前（P<0.05）;治疗组的胆囊收缩功能比对照组高,胆囊壁厚度比对照组低（P<0.05）。治疗后,两组VAS评分明显低于治疗前（P<0.05）,且治疗组的VAS评分比对照组低（P<0.05）。治疗后,两组的血清CRP、IL-6、Lep水平显著降低（P<0.05）;治疗后治疗组的血清CRP、IL-6、Lep比对照组低（P<0.05）。结论 胆乐胶囊联合茴三硫片治疗慢性胆囊炎的疗效确切,能改善胆囊症状,减轻腹痛程度,降低炎症反应,治疗安全性良好。     

消炎利胆片联合哌拉西林钠他唑巴坦钠治疗慢性胆囊炎的临床研究

目的探讨消炎利胆片联合哌拉西林钠他唑巴坦钠治疗慢性胆囊炎的临床效果。方法选取2018年10月—2020年10月天津泰达医院收治的126例慢性胆囊炎患者,运用随机数字表法将其随机分成对照组(n=63)和治疗组(n=63)。对照组静脉滴注注射用哌拉西林钠他唑巴坦钠,2.25 g加入5%葡萄糖注射液250 mL充分稀释后给药,2次/d。治疗组在对照组基础上口服消炎利胆片,6片/次,3次/d。两组均连续治疗2周。观察两组临床疗效及患者典型症状的缓解时间,并比较治疗前后两组胆囊壁厚度、胆囊排空率、胃电图相关参数及血清总胆汁酸(TBA)、白细胞介素(IL)-6和瘦素(Lep)水平的变化情况。结果治疗后,治疗组总有效率为95.2%,显著高于对照组的81.0%(P0.05)。治疗后,治疗组各项典型症状(右上腹痛、右上腹不适、胆源性消化不良)的缓解时间均显著短于对照组(P0.05)。治疗后,两组胆囊壁厚度均显著降低,但胆囊排空率均显著增加(P0.05);治疗后,治疗组胆囊壁厚度和胆囊排空率改善优于对照组(P0.05)。治疗后,两组餐后正常胃电慢波百分比、餐后/餐前功率比均显著高于本组治疗前,但餐后胃电节律紊乱百分比均显著低于本组治疗前(P0.05);治疗后,治疗组胃电图参数改善优于对照组(P0.05)。治疗后,两组患者血清TBA、IL-6和Lep水平较本组治疗前均显著降低(P0.05);且治疗后,治疗组血清学指标低于对照组(P0.05)。结论消炎利胆片联合哌拉西林钠他唑巴坦钠治疗慢性胆囊炎具有确切的临床疗效,对患者的临床症状、胆囊壁厚度和胆囊收缩功能均有显著改善作用,同时有助于改善患者紊乱的胃电节律,减轻其肝脏损伤和体内炎症反应,值得临床推广应用。     

介入性超声在胆囊积液治疗中的应用效果研究

目的观察探讨介入性超声在胆囊积液治疗中的应用价值。方法选取因急性胆囊炎,慢性胆囊炎急性发作,胆总管结石等疾病引起的胆囊积液患者45例,在彩色多普勒超声诊断仪和诊断系统的引导下行胆囊穿刺,穿刺成功后置入导管并注入抗生素治疗,观察治疗效果。结果 8例慢性胆囊炎急性发作及3例急性胆囊炎患者,在采用抽吸减压,并注入抗生素治疗后,炎症得以控制,5例行腹腔镜下胆囊切除术,均治愈出院。其他患者均采用保守治疗,梗阻性黄疸症状减轻,肝功能好转,精神状态也明显改善。结论介入性超声引起下进行胆囊穿刺,术后置入引流管并注入抗生素治疗各种疾病引起的胆囊积液患者可取得良好的治疗效果,对于年老体弱不能耐受手术的患者是一种理想的选择。     

中医定向透药疗法联合针刺治疗偏瘫后肩手综合征的疗效观察

目的 观察中医定向透药疗法联合针刺与单纯针刺治疗偏瘫后肩手综合征Ⅰ期的疗效观察.方法 将40例患者随机分为中医定向透药疗法联合针刺（20例）、单纯针刺治疗（20例）.采用Fugl-Meyer量表评价患肢运动功能;采用ADL量表评定日常生活活动能力;采用目测类比评分（VAS）评价疼痛及观察治疗前后肿胀程度.结果 上肢Fugl-Meyer运动功能和日常生活活动能力ADL评分,两组治疗前和治疗2个疗程后比较,差异有统计学意义（均P＜0.05）,两组间比较,中医定向透药疗法联合针刺组优于单纯针刺治疗组（P＜0.05）;两组治疗前后肿胀和疼痛评分都有下降（均P＜0.05）,组间比较,疼痛、肿胀程度改善中医定向透药疗法联合针刺组优于单纯针刺治疗组（P＜0.05）.观察中医定向透药疗法联合针刺组总有效率为95％,单纯针刺组为70％,两组疗效比较,差异具有统计学意义（P＜0.05）.结论 中医定向透药疗法联合针刺治疗偏瘫后肩手综合征在减轻肿胀、疼痛、改善运动功能及提高ADL生活能力方面优于单纯针刺治疗.     

经皮肝胆囊穿刺术治疗急性胆囊炎的疗效分析

目的分析与研究经皮肝胆囊穿刺术治疗急性胆囊炎的疗效。方法本文选择80例急性胆囊炎患者进行研究,将这些患者随机分成两组,每组40例,其中有结石性胆囊炎患者28例,非结石性胆囊炎患者12例;观察组患者应用经皮肝胆囊穿刺术进行治疗,而对照组则应用经腹腔胆囊穿刺引流进行治疗。之后对比两组治疗方法的安全性以及疗效。结果患者在24h之内腹痛情况均有缓解,24～72h之内患者的体温均恢复正常,住院10～15d没有出现围术期患者死亡的情况,同时,患者手术前有伴发疾病的均无加重趋势。患者当中出现1例患者术后72h腹痛情况缓解不明显,为引流管不通,在对引流管进行通畅后患者腹痛情况有所缓解。术后,1例患者腹痛加重,通过对其进行胆囊造影检查,发现有胆汁外漏的情况,通过对症治疗以及加强抗感染治疗之后,患者腹痛情况有所缓解。结论治疗急性胆囊炎,经皮肝胆囊穿刺术创口小、操作简单、疗效确切,并且安全性高,具有着非常重要的临床应用价值。     

Loperamide inhibits gallbladder inflammatory fluid secretion in experimental cholecystitis

Summary Fluid secretion by the gallbladder mucosa is suggested to have a key pathophysiological role in acute cholecystitis, since it causes distension of the obstructed gallbladder. The present study investigates the actions of loperamide on the gallbladder function in experimental cholecystitis. Gallbladder fluid transport and motility were studied in vivo with a continuous perfusion technique. A net fluid secretion by the gallbladder mucosa was seen in cats in which cholecystitis was induced whereas there was a net fluid absorption from the gallbladder lumen in the control animals. The net fluid secretion in experimental cholecystitis was inhibited by loperamide (1 mg/kg), an effect that was blocked by naloxone (1 mg/kg), suggesting an involvement of specific opiate receptors. Loperamide (1 mg/kg) relaxed the normal gallbladder but had no significant effects on its fluid absorption. Since loperamide reduces mucosal fluid secretion in experimental cholecystitis without contracting the gallbladder wall, it is suggested that this peripherally acting opiate agonist could be useful in the treatment of patients with acute cholecystitis.     

胆囊病变组织中雌激素与孕激素受体表达和成石原因相关研究

目的 探讨胆囊病变组织雌激素受体（ER）与孕激素受体（PR）的表达及其在发病中的作用.方法 采用免疫组化法进行ER、PR的检测.结果 胆囊癌、胆囊炎伴胆石症患者的阳性表达率明显高于胆囊炎伴胆固醇沉着症、胆囊息肉及单纯性胆囊炎患者（P＜0.05）,ER及PR在胆囊癌及胆囊炎伴胆石症中的阳性表达率分别为100%、70%及100%、50%,其阳性表达率在胆囊炎伴胆石症、胆囊癌中呈现由少到多的关系.结论 雌激素通过诱导该受体表达增加了形成胆囊结石并进一步发展为胆囊癌的易感性.     

针灸治疗脑梗死的临床疗效分析

目的：探讨并分析针灸治疗脑梗死的临床疗效。方法选取2011年8月～2013年4月收治的120例脑梗死患者,基于患者临床资料的研究与分析,随机将其划分为对照组与观察组,两组病例分别为60例,其中对照组采取中西医常规的药物治疗,而观察组则基于此加用针灸治疗,对比分析两组治疗效果。结果经治疗,对照组总治疗有效率为83.3%,观察组总治疗有效率为96.7%,二者差异具有统计学意义（P＜0.05）。结论在脑梗死的临床治疗中在常规药物治疗的基础上加用针灸治疗,效果显著,能够有效降低致残率。     

胆囊穿刺同期胆道镜取石治疗高龄结石性胆囊炎效果分析

目的 分析探讨CT引导经皮经肝胆囊穿刺造瘘同期胆道镜取石治疗高龄高危急性结石性胆囊炎的疗效.方法 选择40例年龄在70岁以上的患有急性结石性胆囊炎,胆囊明显增大(胆囊长径>10 cm,横径>4 cm,胆囊泥沙样结石,或结石单发直径在1 cm以下,或结石5枚以下,直径<0.5 cm)的患者,在CT引导下穿刺置管引流胆汁,在导丝的引导下置入经皮肾镜用扩展套管扩张窦道,置入胆道镜取石网篮取石,较大结石借助双频激光碎石后取石或冲洗吸出碎石,留置引流管,2个月后复查B超后拔管,治疗结束.结果 40例患者均穿刺置管成功,37例取石成功,取石成功患者至发文前无一例胆囊炎复发,无一例胆囊结石复发.结论 CT引导下经皮经肝胆囊穿刺同期胆道镜取石术是治疗部分高龄患者急性结石性胆囊炎有效的方法,值得继续研究,扩大适应证.