微创保胆取石术联合牛磺熊去氧胆酸与腹腔镜胆囊切除术治疗胆囊结石的对比研究

目的探讨微创保胆取石术联合牛磺熊去氧胆酸与腹腔镜胆囊切除术治疗胆囊结石的疗效。方法统计贵阳医学院附属医院2011年5月至2012年5月收治的微创保胆取石治疗胆结石患者100例和腹腔镜胆囊切除治疗胆结石患者173例,保胆患者作为治疗组术后均口服牛磺熊去氧胆酸,胆囊切除患者作为对照组术后给予常规抗炎支持治疗,所有患者术后平均随访时间为1年,统计各组患者胆石症状改善情况和治疗组患者的胆囊壁厚、胆囊功能水平和结石复发率。结果治疗组患者手术前胆绞痛、腹胀、右上腹不适发生率分别为47.1%、21.8%、100%,胆囊壁厚为(3.42±0.49)mm,手术后1年胆绞痛、腹胀、右上腹不适发生率分别为2.3%、9.2%、2.3%,胆囊壁厚为(2.57±0.69)mm;胆囊结石患者组胆囊排空指数为43.11±20.82,保胆取石术后两年患者组胆囊排空指数为56.00±10.77,正常组胆囊排空指数为56.65±13.45,患者手术前后胆石症状、胆囊壁厚的差异均具有统计学意义(P<0.05),保胆取石术后两年患者组胆囊排空指数与正常组差异无统计学意义(P>0.05),而与胆囊结石组患者组差异有统计学意义(P<0.05);术后1年治疗组患者腹泻、腹胀、右上腹不适症状发生率分别为2.3%、9.2%、2.3%,对照组患者腹泻、腹胀、右上腹不适症状发生率分别为33.6%、25.5%、17.3%,两组之间胆石症状的差异均具有统计学意义(P<0.05),治疗组患者术后胆固醇结石复发率有降低趋势。结论保胆取石术后口服牛磺熊去氧胆酸对术后患者胆囊功能的恢复及预防胆囊胆固醇结石的复发有重要意义。     

硬性胆道镜下胆囊结石(或息肉)保胆手术200例临床研究

目的 探讨胆囊结石及胆囊息肉经硬性胆道镜下微创保胆取石(或息肉)手术的适应证以及预防结石术后复发.方法 采用WOLF新式硬性胆道镜完成保胆取石手术200例.其中2例急性胆囊炎、8例萎缩性胆囊炎均行保胆取石术,利用气压弹道碎石技术13例,45例采取腔内电凝导丝电凝止血.保胆取石术后患者常规服用步长胆石利通片,防止胆汁胆固醇饱和,防止结石复发.结果 200例患者平均手术时间(55±5)min、平均住院时间5 d,其中放置胆囊造瘘管9例.除1例保胆失败最终选择切胆手术、3例保胆取石术后发现胆囊内沉积物外,其余患者均获得近期较为理想的疗效.结论 硬性胆道镜下微创保胆取石(息肉)手术安全、可行、疗效满意.     

完全腹腔镜结合胆道硬镜保胆取石术和取息肉术

目的 探讨完全腹腔镜结合胆道硬镜保胆取石和取息肉的手术方法 和应用价值.方法 总结2009年1月～2009年4月91例完全腹腔镜下保胆取石(或息肉)术的经验,其中胆囊结石67例,胆色素结石36例,胆固醇结石26例,混合性结石5例.在胆囊结石中合并有胆囊壁问结石23例,占34.33%,行胆囊切开胆道硬镜取石术;胆囊息肉24例患者中,22例胆固醇性息肉,2例为胆囊腺瘤样息肉,用胆道镜取尽息肉.结果 91例保胆患者手术均获成功.手术时间80～190(109±33)min,术后住院4～7(6.0±0.8)d,术后排气时间6～30(14.3±4.2)h,所有患者均治愈.因术后时间短,无随访结论 .结论 完全腹腔镜结合胆道硬镜保胆取石(或息肉)术对于保留胆囊及胆囊的功能具有重要的意义.     

胆囊壁结石微创保胆手术价值的探讨

目的 研究胆囊壁结石组织病理学特征及其对胆囊收缩功能的影响,探讨为其施行保胆取石手术(EGPCL)的价值.方法 ①复习观察胆囊结石胆囊切除标本的病理切片912例,找到胆囊壁结石的组织病理切片,观察显微镜下病理特征及分布.②回顾分析保胆取石病例108例,重点分析胆囊内镜下发现胆囊壁结石患者的临床资料,了解胆囊壁结石与胆囊收缩功能的关系以及保胆手术效果.结果 切除胆囊的病理切片中发现胆囊壁结石32例(3.51%),共71颗.其中黏膜层结石5颗(7%),肌层结石16颗(23%),浆膜层结石50颗(70%).扩张的罗一阿氏窦包裹胆囊壁结石而形似憩室,窦上皮为排列整齐、基本完整的粘膜上皮细胞.在108例保胆取石手术中发现胆囊壁黏膜层以及"黏膜下"结石10例(9.26%),其中术前检查收缩功能良好者8例(80%),功能欠佳2例;8例患者均有轻重不等的临床症状,包括功能欠佳者2例和功能良好者6例.取石术后全部胆囊壁间结石患者症状都得到改善,但2例术前功能欠佳者,术后B超检查分剐提示胆囊壁针尖样胆固醇沉积以及胆囊腔内淤滞物.结论 胆囊壁结石与胆囊腔内压力增高以及罗一阿氏窦形成密切相关;大部分胆囊壁结石位于浆肌层,保胆手术中难以全部观察到.胆囊内镜仅能取黏膜层结石以及部分浆肌层结石.胆囊壁结石大多数有临床症状.对那些壁间结石少、胆囊壁薄(<4mm)、胆囊功能好者,可取净结石,保留胆囊.而对那些有明显临床症状、胆囊壁结石多和壁厚≥4mm的患者,即使胆囊收缩功能好,笔者也建议行胆囊切除术.     

140例胆囊切除与保胆取石的临床观察

目的分析胆囊切除手术与保胆取石手术两种治疗手术的应用效果。方法选取我院接受治疗胆囊结石的患者140例,随机分为两组,观察两组的治疗效果,手术时间,手术中出血量,手术后住院天数以及手术后饮食恢复时间。对于保胆手术治愈后观察复发情况,统计复发率。结果在手术时间,手术后住院天数,住院费用上保胆取石手术组与胆囊切除组无显著差异(P>0.05),保胆取石组在手术中出血量,手术后饮食恢复时间明显高于胆囊切除组,两组差异显著,具有统计学意义(P<0.05),术后胆囊收缩功能比手术前有明显改善(P<0.05)。结论胆囊切除手术与保胆取石手术各有优势,相比较保胆取石复发率低,更加安全,具有临床采用价值。     

超声评价微创保胆取石术前后胆囊收缩功能的对比分析

选取2011年8月~2013年8月我院33例行微创保胆取石术患者为研究对象,根据术前患者胆囊收缩功能可分为A组(良好)11例、B组(尚可)12例、C组(欠佳)10例。对比三组患者超声评价手术前后胆囊收缩功能的变化。A组11例患者术后胆囊收缩恢复正常,B组8例恢复正常,C组6例有所改善或恢复正常。超声为临床微创保胆取石术前后胆囊收缩功能评估提供给了依据,是临床诊断胆囊功能或胆囊结石疾病重要的手段。     

保胆取石术后口服牛磺熊去氧胆酸预防结石复发的临床观察

目的评价选择性保胆取石术后口服牛磺熊去氧胆酸预防胆囊结石复发的临床价值。方法将成都军区总医院2004年至2008年符合微创保胆取石术条件的80例胆囊结石患者按随机序列表分为两组,每组各40例。两组患者均经微创保胆取石术后保留功能良好的胆囊,治疗组患者术后口服牛磺熊去氧胆酸2年,对照组患者除不用服药外,其余护理、饮食等与治疗组相同。术后2年复查胆囊壁厚度及胆囊收缩功能,统计胆结石症状和胆囊结石复发率。结果两组患者保胆取石术均获成功。术后2年治疗组和对照组胆囊壁厚度差值、胆囊收缩功能差值的差异均有统计学意义(P<0.05),术后2年治疗组结石复发明显减少(P<0.05)。结论保胆取石术后患者口服牛磺熊去氧胆酸对胆囊结石的复发有预防作用。     

腹腔镜联合胆道镜保胆取石治疗胆囊结石术式探讨(附65例报告)

目的 探讨腹腔镜联合纤维胆道镜保胆取石治疗胆囊结石的手术方式.方法 回顾分析采用腹腔镜联合纤维胆道镜保胆取石术治疗65例胆囊结石患者的临床资料.结果 63例均成功取尽结石.行腹腔镜下腹腔外胆道镜保胆取石术46例,平均手术时间65 min,平均住院时间5 d;行腹腔镜下腹腔内胆道镜取石术17例,平均手术时间96min,平均住院时间6.5 d;腹腔镜胆囊切除术2例.结石最大直径约3 cm,无出血、胆漏、伤口感染、脂肪液化及心肺等并发症发生.对56例患者随访1～30个月,2例复发.结论 腹腔镜联合纤维胆道镜保胆取石术是根据术中探查情况,对各种保胆取石术式取长补短,尽最大可能既使手术安全、操作简单、微创、手术时间短、术后并发症少,又尽可能保留了胆囊的功能,值得临床推广应用.     

双镜联合保胆取石与胆囊切除术治疗胆囊结石的疗效及安全性比较

目的探讨双镜联合行保胆取石术与腹腔镜胆囊切除术治疗胆囊结石的临床疗效差异。方法回顾性分析收治的94例胆囊结石患者的临床资料,根据手术方式分为保胆取石组(36例)和胆囊切除组(58例),比较两组患者的手术过程情况、术后并发症情况及术后1年随访两组患者的生存质量差异。结果保胆取石组患者的手术时间明显长于胆囊切除术组(P0.05),保胆取石组的术中出血量、饮食恢复时间明显低于胆囊切除术组。两组患者的肠蠕动恢复、住院时间、住院费用以及术后并发症发生率差异无统计学意义(P0.05)。保胆取石组的结石复发率明显高于胆囊切除术组(P0.05)。保胆取石组术后1年的主观症状评分和消化病生存质量指数量(GLQI)总分明显高于胆囊切除术组(P0.05)。结论保胆取石术对于胆囊切除术手术时间稍长,术后结石复发率较高,但是术后患者恢复时间短,保留胆囊对于提高患者术后生存质量具有显著作用。     

腹腔镜联合胆道镜保胆取石术治疗胆囊结石效果观察

目的探讨腹腔镜联合胆道镜保胆取石术治疗胆囊结石的临床效果。方法选取胆囊结石患者70例,将其随机分为对照组与观察组,每组35例。对照组采用腹腔镜保胆取石术治疗,观察组采用腹腔镜联合胆道镜保胆取石术治疗。比较两组手术相关指标、手术前后胆囊收缩功能及并发症发生率。结果对照组患者手术时间、术中出血量、术后排气时间及住院时间均大于观察组,差异有统计学意义(P0.05);手术前后两组患者胆囊最小剩余容积、胆囊最大收缩率及空腹时胆囊的容积比较,差异未见统计学意义(P0.05);对照组患者并发症发生率(22.86%)明显高于观察组(2.86%),差异有统计学意义(P0.05)。结论腹腔镜联合胆道镜保胆取石术治疗胆囊结石在保留胆囊的同时恢复了胆囊收缩功能,其安全性高,临床效果显著。     

内镜微创保胆术后结石复发的胆囊因素分析

目的研究内镜微创保胆术后复发的胆囊病变因素。方法将行内镜微创保胆手术的患者根据胆囊的病变的情况分为9组:1胆囊壁光滑,厚度小于5 mm,2胆囊壁光滑,厚度大于5 mm,3胆囊内分隔,4胆囊壁间结石,5胆囊颈部结石嵌顿,6胆囊壁胆固醇沉积,7胆囊壁厚度大于5 mm伴有胆囊壁间结石,8胆囊分隔,胆囊壁厚度大于5 mm,9胆囊分隔伴有胆囊壁间结石。每年B超复查,在第5年后统计结石复发率。结果胆囊壁光滑,厚度小于5 mm,其5年复发率为3.0%;胆囊壁光滑,厚度大于5 mm,其5年复发率为2.4%;胆囊分隔术后5年复发率为4.7%;胆囊颈部结石嵌顿术后5年复发率为2.3%;胆囊壁胆固醇沉积术后5年复发率为2.3%~4.5%;胆囊分隔,胆囊壁厚度大于5 cm术后5年复发率为6.4%;胆囊壁间结石术后5年复发率为0.0%~7.5%;胆囊壁间结石伴有胆囊分隔术后复发率为7.4%~16.9%;胆囊壁厚度大于5 mm伴壁间结石其术后5年复发率为12.5%。结论胆囊结石行保胆手术时,胆囊壁厚度、胆固醇沉积、胆囊分隔及胆囊壁间结石其复发率不高,可行保胆手术,当胆囊壁间结石合并有胆囊分隔,其术后5年复发率明显升高,应考虑胆囊切除。     

Ultrasound patterns of metastatic tumors in the gallbladder

Eleven cases of sonographically detected metastatic disease to the gallbladder are reported. This paper represents the first comprehensive review of the ultrasonographic findings in this not infrequently encountered disease process. Four distinctive sonographic diagnostic patterns have evolved and are described. The suspicion of metastatic tumors in the gallbladder should be raised, particularly in the presence of focal gallbladder wall thickening in association with nonshadowing intraluminal soft tissue masses. In contrast to primary carcinomas of the gallbladder, cholelithiasis usually is absent. The differential diagnosis, which includes various benign conditions of the gallbladder, is discussed.     

Septate gallbladder: A rare congenital anomaly

The septate gallbladder is a rare congenital malformation. It is considered a risk factor of complications after laparoscopic cholecystectomy. We are reporting an image in surgery of a septate gallbladder. It was discovered at an adult age. We are showing the difficulty of the diagnosis preoperatively on the radiological find.     

局限型胆囊腺肌增生症的超声影像学特征分析

目的:探讨局限型胆囊腺肌增生症(gallbladder adenomyomatosis)的超声影像学特征。方法:回顾性分析2014年2月至2017年3月经手术病理确诊的30例局限型胆囊腺肌症的病例资料,分析其超声二维声像图特征。结果:30例局限型胆囊腺肌增生症中28例(93.1%)病灶位于胆囊底部,29例(96.7%)为宽基底,28例(93.1%)为低回声或中等回声,29例(96.7%)病灶处胆囊内壁连续性完整,21例(70%)病灶内可见囊样无回声区,12例(40%)病灶内可见点状强回声伴彗尾征,28例(93.1%)未见明显彩色血流信号。联合应用高频超声共正确诊断21例,诊断符合率为70.0%。结论:局限型胆囊腺肌增生症超声二维声像图具有一定特征性,联合应用高频超声有助于提高诊断符合率。     

Angiographic findings in two carcinoid tumors of the gallbladder

Angiography was performed in 2 patients with carcinoid tumors of the gallbladder. In the first case, proper hepatic angiography revealed an obstruction and irregular neovascularization of the cystic artery and an encasement of the right hepatic artery. In the second case, celiac angiography revealed a dilatation and fine neovascularization of the cystic artery. In both cases, moderate hypervascular metastatic lesions were demonstrated in the liver. Although hypervascular metastases might suggest the diagnosis of metastasis from carcinoid tumor, the specific diagnosis of carcinoid tumor of the gallbladder must rely on the pathologic evidence.     

三维超声成像对胆囊疾病的应用价值

目的:评价三维超声成像在胆囊疾病中的临床应用价值。方法:对胆囊结石、胆囊息肉、胆囊癌和胆囊腺肌增生症共49例不同的胆囊病变进行三维重建。结果:①三维超声可清晰、直观地显示息肉的部位和表面特征,准确评价息肉是否带蒂及基底部的宽窄;②三维超声可清楚地显示胆囊癌的范围、胆囊壁的连续性以及浸润周围脏器结构的程度;③三维超声可清晰显示结石的数目及形态;④三维超声可清晰显示胆囊腺肌增生症病变累及范围。结论:三维超声重建可以更直观地显示胆囊疾病的形态特点及与周围脏器结构的关系,能够提供较二维超声更丰富的信息,对明确诊断及确定治疗方案有重要的临床意义。     

胆囊癌的CT诊断

目的：通过对２２例胆囊癌ＣＴ表现分析,探讨胆囊癌ＣＴ诊断价值和鉴别诊断,提高胆囊癌ＣＴ诊断水平。材料与方法：本文收集经病理证帝的２２例胆囊癌病例,均做ＣＴ检查,其中１０例行Ｂ超检查,分析其ＣＴ表现。结果：胆囊癌女性多见,男女之比为１：２．１,好发于５０岁以上患者。临床表现为上腹痛并肩背痛、黄疸及腹部肿埠。ＣＴ表现;（１）胆区肿块,密度不均,胆囊腔缩小或消失;（２）胆囊壁增厚,呈局限或弥漫性不规则增     

Effects of exercise on gallbladder volume and motility in obese women

PURPOSE: Comparatively few prospective studies have investigated the relationship between physical activity and gallbladder motility, and the results are controversial. Exercise may affect gallbladder motility via neural or hormonal mechanisms. The purpose of this study was to evaluate the possible effects of aerobic exercise on gallbladder motility in a group of obese women without gallstones. PATIENTS AND METHODS: Twenty-three obese women (age 41.2+/-10.3 years, body mass index 40.7+/-6.7 kg/m(2)) were included in the study. Following an overnight fast, fasting and postprandial (15, 30, 45, 60, 75, 90, 120, and 150 minute) volumes and ejection fractions were evaluated with real-time ultrasonography before exercise. For all subjects, the exercise regimen consisted of daily 45-minute walking sessions at 60-80% of maximum heart rate for 4 weeks except weekends. Gallbladder volume and ejection fraction were again evaluated after exercise. RESULTS: Fasting and postprandial (15, 30, 45, 60, 75, 90, 120, and 150 minute) volumes were 38.6+/- 10.9, 32.8+/- 8.8, 27.6/- 8.1, 22.7+/- 8.5, 21.4+/- 7.2, 20.8+/- 7.0, 22.8+/- 7.3, 29.6 +/- 7.0, and 36.8+/- 6.2 cm(3) before the exercise period, respectively, and 40.8+/- 18.9, 29.9+/-11.2, 25.3+/- 9.2, 22.4+/-8.5, 19.6+/-7.8, 17.7+/- 6.8, 17.8+/- 7.3, 23.1+/-10.8, and 29.0+/-14.4 cm(3) after the exercise period, respectively. Postprandial (15, 30, 45, 60, 75, 90, 120, and 150 minute) ejection fractions were 13.5+/-15.9, 27.4+/-15.4, 39.5+/-20.0, 43.2+/-16.7, 44.3+/-17.3, 37.5 +/- 23.5, 23.5 +/-25.1, and 5.5+/- 21.6% before the exercise period, respectively, and 22.6+/- 20.1, 34.6+/-14.5, 42.0+/-13.6, 49.2+/-12.6, 53.1+/-14.1, 52.6+/-16.1, 43.6+/-17.0, and 29.2+/- 26.5% after exercise, respectively. After the exercise period, the 75, 90, 120, and 150 minute volumes were lower (p< 0.05, p< 0.05, p< 0.05, p< 0.01) and the 90, 120, and 150 minute ejection fractions were higher than before exercise (p< 0.05, p < 0.05, p< 0.01). CONCLUSIONS: Our study showed that exercise decreased late-phase postprandial gallbladder volume and increased late-phase postprandial gallbladder motility in these obese women.     

Endoscopic sonography in the diagnosis of gallbladder wall lesions in patients with gallstones

PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of endoscopic sonography (EUS) in the detection of gallbladder wall lesions in patients with and without gallstones. METHODS: We retrospectively reviewed the medical records, sonograms, and sonographic reports of 62 patients who underwent cholecystectomy for gallbladder wall lesions evaluated by EUS. We assessed the accuracy of EUS in diagnosing gallbladder wall lesions in the presence or absence of gallstones and on the basis of the size and number of stones and the size of the gallbladder wall lesions. We also evaluated the effect of acoustic shadowing. The EUS results were compared with the histopathologic results. RESULTS: EUS correctly diagnosed the gallbladder wall lesions in 17 (71%) of 24 patients with gallstones and in 34 (89%) of 38 patients without gallstones. The diagnostic accuracy of EUS was 86% in patients with gallbladder wall lesions smaller than 20 mm and 79% in patients with gallbladder wall lesions 20 mm or larger. The diagnostic accuracy was 75% in patients with gallstones smaller than 5 mm and 67% in patients with stones 5 mm or larger. The accuracy was 67% in patients with 1-5 stones and 83% in patients with 6 or more stones. None of these differences was statistically significant. Acoustic shadowing did not affect the diagnostic accuracy of EUS. CONCLUSIONS: The diagnostic accuracy of EUS for gallbladder wall lesions is not affected by the presence of gallstones. However, better diagnostic criteria must be established based on larger studies, and technical refinements of the equipment are needed to increase the accuracy of EUS in the diagnosis of gallbladder wall lesions.     

Sonographic measurements of normal gallbladder sizes in children

PURPOSE: Our goal was to establish the range of sonographic measurements of normal gallbladders in children. METHODS: Six hundred ten children aged 0-16 years (male:female ratio, 1.5:1) with normal clinical and laboratory findings were included in this study. The sonographic parameters were the length, width, and calculated volume of the gallbladder, and the clinical parameters were the age, height, weight, and body surface area of the children. Statistical significance was determined through correlation and regression analyses. RESULTS: The length of the gallbladder showed significant positive correlations with age (r = 0.65), height (r = 0.67), weight (r = 0.63), and body surface area (r = 0.65; p < 0.01). The calculated volume of the gallbladder also showed moderate correlations with age (r = 0.53), height (r = 0.55), weight (r = 0.61), and body surface area (r = 0.57; p < 0.01). The gallbladder width showed modest but significant correlations with age (r = 0.48), height (r = 0.53), weight (r = 0.53), and body surface area (r = 0.55; p < 0.01). The highest correlation coefficients were found between the gallbladder length and subject age (r = 0.65; p < 0.01) and between the gallbladder length and subject height (r = 0.67; p < 0.01). For all correlations, statistical significance remained after regression analysis (p < 0.01). CONCLUSIONS: Values for the size of the normal pediatric gallbladder are defined and will be helpful in the diagnosis of gallbladder abnormalities.