针刺穴位与脂餐试验在超声监测胆囊收缩功能诊断胆囊炎中的临床研究

目的:探讨针刺穴位与脂餐试验在超声监测胆囊收缩功能诊断胆囊炎中的临床价值。方法:临床上已经确诊的136例胆囊炎病例随机分为针刺穴位组及脂餐试验组。针刺穴位组首先行超声检查,并测量相关径线,然后针刺相关穴位,使胆囊收缩,在针刺后10 min、20 min、30 min分别行超声检查,测量相关径线,然后运用胆囊容积计算公式计算出收缩前后胆囊容积,计算胆囊收缩功能。脂餐试验组在脂餐试验胆囊收缩前后10 min、20 min、30 min行超声检查,计算胆囊收缩功能,以进行对比研究。将2组作两样本均数比较的t检验。结果:针刺穴位组与脂餐试验组在诊断胆囊炎方面无明显差异(P>0.05)。结论:在超声监测胆囊中,针刺穴位可有脂餐试验相近的刺激胆囊收缩功能,可以对胆囊炎进行诊断,并且具有无损伤、痛苦小、患者易接受、可重复等优点,是一种很有发展潜力的诊断方法。     

超声观测电针穴位后胆囊排泄率的临床价值

目的：通过超声观测电针阳陵泉穴和胆囊穴前后的胆囊容积变化,量化计算测值,判断胆囊的功能状况。方法：应用美国LOGIQ200型超声诊断仪,探头频率3.5 MHz,分别于电针前后测量计算胆囊容积,判定胆囊的排泄率,从而推断出胆囊所处的功能状态。结果：电针穴位后30 min,胆囊排泄率良好的为〉70%;减弱的为40%～69%,可疑胆囊炎;差的为13%～39%,高度提示胆囊炎：而〈12%的,强烈提示胆囊颈和胆囊管梗阻。结论：胆囊排泄率能直接反映胆囊的功能状况以及胆囊管的畅通情况。     

超声检查联合甘露醇诊断慢性胆囊炎的临床价值分析

目的 探讨超声联合应用甘露醇缩胆作用诊断慢性胆囊炎的临床价值.方法 选择近期因右上腹疼痛在我院行超声检查的患者60例,设为观察组,以及同期进行健康体检者58例,设为对照组,通过彩色超声仪检查口服甘露醇前后胆囊的最大面积,计算出胆囊收缩指数,根据胆囊收缩指数的大小,将胆囊收缩功能分为:良好(收缩指数＞0.5)、较差(收缩指数0.49～0.3)、差(收缩指数0.29～0.2)、无功能(收缩指数＜0.19),同时观察两组检查者口服甘露醇后的不良反应.结果 与对照组相比,观察组胆囊收缩指数良好者明显减少[(58.3％ vs 91.7％),P＜0.05];相反的是,与对照组相比,观察组胆囊收缩指数差及无功能者明显增高[(15.0％ vs 3.3％)、(18.4％ vs 0.0％),P＜0.05].此外,服用甘露醇后,观察组腹泻和头晕等不良反应发生率与对照组相比无明显差异[(20.0％ vs 17.2％)、(8.3％vs 5.1％),P＞0.05].结论 超声利用甘露醇缩胆作用诊断慢性胆囊炎安全可靠,简单易操作.     

超声心动图与左室造影评价室间隔缺损封诸术后左室功能变化的相关性研究

目的　通过左室造影和超声心动图同步评价室间隔缺损(VSD)封堵术前后左室功能变化,对两种方法测量的相关性进行探讨。方法　对我院2 8例成功采用新型Amplatzer封堵器治疗的VSD患者进行研究。所有患者术前2 4h、术后2 4h行经胸超声心动图(TTE)检查,封堵前及封堵后行左室造影检查,同时进行左室容积和径线的测量,将超声和造影的测量结果进行直线相关及回归分析。结果　两种方法均提示VSD封堵术后左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)、左室每博量(LVSV)减小。两者在LVEDV、LVESV、LVSV、LVEF等左室容积指标测量方面,相关系数分别为0 .81、0 .6 3、0 .6 9。在左室长径L和左室短径D等径线指标测量方面,相关系数分别为0 .84和0 .86。结论　超声心动图和左室造影在评价室间隔缺损(VSD)封堵术前后左室功能变化方面有着良好相关性,超声心动图检查可作为长期的随访手段     

老年糖尿病合并急性胆囊炎超声动态监测分析

目的：探讨超声动态监测对老年糖尿病合并急性胆囊炎的价值。方法：选择老年糖尿病合并急性胆囊炎59例为观察组，无糖尿病史的老年急性胆囊炎30例为对照组，比较两组超声动态监测与临床病程的关系。结果：观察组胆囊增大、胆汁淤积及胆囊壁增厚、胆囊穿孔发生率均明显高于对照组。结论：超声动态监测是及时诊断老年糖尿病合并急性胆囊炎的有效方法。     

超声引导下经皮经肝胆囊穿刺治疗化脓性胆囊炎的价值

目的:探讨在超声引导下经皮经肝胆囊穿刺甲硝唑冲洗、敏感抗生素注入并保留治疗化脓性胆囊炎的价值。方法:对30例急性化脓性胆囊炎在超声引导下经皮经肝胆囊穿刺抽脓、甲硝唑反复冲洗,最后注入并保留敏感抗生素,1次/2 d,连续1~3次。另对30例经皮经肝胆囊穿刺置管引流(PTGCD)急性化脓性胆囊炎作为对照组(只用甲硝唑冲洗)。结果:两组各30例均穿刺成功。治疗后两组腹痛24 h内明显减轻、体温48 h内降至正常、血白细胞一周降至正常范围、3~4周B超复查胆囊正常、单纯胆囊壁增厚、胆囊萎缩、胆囊收缩功能正常及并发症的例数分别为:治疗组28,29,30,19,10,1,26,0例;对照组23,22,23,10,18,3,20,8例,其中并发症8例中局部皮肤感染2例,引流管脱落4例,引流管堵塞1例,胆漏1例。两组病程分别为治疗组8.4±2.25 d,对照组15.6±5.82 d。经统计学处理,除腹痛24 h内明显减轻及3~4周B超复查胆囊萎缩两项指标外均有显著性差异。结论:超声引导下经皮经肝胆囊穿刺甲硝唑冲洗、敏感抗生素注入并保留治疗化脓性胆囊炎是一种简单、安全、有效的方法。     

彩色多普勒超声在胆囊结石合并胆囊炎检查中的应用价值

目的 探讨彩色多普勒超声在胆囊结石合并胆囊炎检查中的应用价值。方法 选取83例确诊的胆囊结石合并胆囊炎患者，根据腹腔镜手术中实际难度评分将其分为困难组48例，容易组35例，比较两组超声检查情况。结果 本组患者中有10例出现胆囊周围粘连情况，胆囊三角、胆囊底以及周围组织无空隙。困难组胆囊容积、胆囊壁厚度以及结石大小均明显大于容易组，胆囊壁血流信号丰富例数、胆囊内透声差例数、胆囊颈部嵌顿性结石例数以及胆囊周围粘连例数均多于容易组，差异具有统计学意义(P<0.05)。结论 彩色多普勒超声用于胆囊结石合并胆囊炎检查，可直观显示胆囊及其腔内回声情况。     

患胆囊息肉飞行人员与健康飞行人员的胆囊收缩功能比较

目的探讨飞行人员胆囊息肉患者组与健康飞行人员（对照组）胆囊排空功能的差异。方法对来院接受年度大体检的18例患有胆囊息肉的飞行人员及18例年龄、飞行机种、飞行时间相仿的健康飞行人员进行胆囊超声检查,分别于空腹状态下及脂餐后1 h 测量胆囊最大长径、上下径、前后径,根据椭圆体公式计算空腹胆囊体积及脂餐后残余胆囊体积,计算胆囊排空率。比较两组之间胆囊排空率的差异。结果 PLG 组18例,约占同期住院体检飞行人员（257例）的7.0％,总体上PLG 组的胆囊排空功能显著低于正常对照组（P<0.05）。结论 PLG 是飞行人员中的常见病,其发病可能与胆囊排空功能不良有密切关系。胆囊排空功能检查可以列为招飞体检及飞行员年度体检的常规检查项目。     

胆囊管综合征的诊断与治疗

目的:探讨胆囊管综合征(cystic duct syndrome,CDS)的诊断方法及治疗措施.方法:回顾分析36例CDS的临床症状、诊断流程及治疗结果.结果:36例CDS均具有典型的胆绞痛症状.术前常规进行腹部超声、口服胆囊造影等检查,21例行MRCP检查提示胆囊管迂曲、慢性胆囊炎或胆囊积液.12例病程中发现继发性胆囊结石.合并急性化脓性胆囊炎6例.31例顺利实施腹腔镜胆囊切除术,其中2例行经脐单孔腹腔镜胆囊切除术.5例实施开腹胆囊切除术.术中所见及术后病理学检查均支持CDS的诊断.结论:CDS的诊断需综合考虑临床症状、影像学检查、术中发现及术后病理学检查等因素,腹腔镜胆囊切除术是CDS的理想治疗方法.     

腰椎管斜径在中央型腰椎管狭窄CT诊断中的价值

目的　评价腰椎管斜径在中央型腰椎管狭窄CT诊断中的价值。方法　选择 5 0名因外伤行CT检查无任何阳性发现的病例作为正常组 ,测量其腰椎管斜径以得出正常值。对另外 5 0名经手术证实为中央型腰椎管狭窄病例的CT资料 ,进行包括腰椎管斜径在内的 6种径线的测量 ,并分别计算其诊断符合率 ,并进行统计学处理 (u检验 ,Ρ <0 .0 5为差异有显著性意义 )。结果　正常组腰椎管斜径平均值为 13 .62mm ,异常组腰椎管斜径平均值为 7.0 0mm ,两者间有明显差异 (u =3 0 .82 9,Ρ <0 .0 0 1)。异常组 6种测量径线中 ,腰椎管斜径诊断符合率最高。结论　腰椎管斜径对诊断中央型腰椎管狭窄有重要价值     

The role of morphine-augmented cholescintigraphy and real-time ultrasound in detecting gallbladder disease

OBJECTIVE: Rapid diagnosis of acute cholecystitis is essential to minimize morbidity and mortality. The purpose of this study was to assess the diagnostic utility of cholescintigraphy using morphine augmentation compared with ultrasound, in acute and chronic gallbladder disease. METHODS: Cholescintigrams were performed on 103 patients suspected of having acute cholecystitis. In 79 patients (Group A) morphine sulfate was administered to reduce the scintigraphic imaging time if the gallbladder was not visualized during the first hour. In 24 control patients (Group B) no morphine was administered. All patients were evaluated clinically and 93 patients had concurrent ultrasound examination. RESULTS: The clinical presentation was nonspecific. The ultrasound findings were sensitive in detecting gallbladder disease (100%), but had low specificity (24%). Only findings of sediments and pericholecystic fluid were specific for cystic duct obstruction. Morphine augmentation reduced the imaging time by 126 min in patients with chronic cholecystitis. CONCLUSION: Real-time ultrasound has low specificity for gallbladder disease. In the presence of an abnormal ultrasound, it is essential to perform a hepatobiliary scan, either to exclude gallbladder disease or distinguish acute from chronic cholecystitis. Low-dose morphine administration is a safe and useful adjunct to standard cholescintigraphy by substantially reducing the time required to obtain a diagnostic study.     

Cholecystokinin sonography: lack of utility in diagnosis of acute acalculous cholecystitis

It has been postulated that cholecystokinin sonography may be useful in the diagnosis of acute acalculous cholecystitis in the hospitalized patient. To evaluate this hypothesis, sincalide, a cholecystokinin derivative, was administered to 15 fasting trauma patients who had undergone laparotomy. No biliary or gallbladder disease was found in any patient. Sincalide was slowly administered intravenously, and the gallbladder was examined with ultrasound every 5 minutes for 60 minutes. The average decreases in length, height, and width of the gallbladder were 15%, 23%, and 21%, respectively. In only four of the 15 patients was there a decrease by more than 50% in any of these dimensions. The average decrease in gallbladder volume was 33% (range, 0%-97%), with no change in gallbladder volume in four patients. There is considerable variability in gallbladder response to administration of sincalide in the fasting hospitalized patient. Lack of contraction of the gallbladder after injection of cholecystokinin should not be considered a major criterion in the diagnosis of acute acalculous cholecystitis.     

Blood flow in healthy gallbladder walls on color and power Doppler sonography: effect of wall thickness and gallbladder volume.

OBJECTIVE: The purpose of this study was to determine the effect of gallbladder contraction on the conspicuity of flow in the normal gallbladder wall. SUBJECTS AND METHODS: Ten healthy adult volunteers without clinical evidence of gallbladder disease participated in the study. After patients fasted overnight, the gallbladder was scanned using gray-scale, color Doppler, and power Doppler sonography. The subjects were then given a standard meal consisting of 478 ml of a carbohydrate-rich dietary supplement, and the imaging sequence was repeated 20 and 45 min thereafter. Mural flow was graded using a four-step grading scheme. Gallbladder volume, wall thickness, and visibility of mural flow at all three time points were statistically compared. RESULTS: Enhanced mural flow was seen after meal consumption in all but one volunteer. Overall, mural flow was significantly greater 45 min after eating than at baseline or 20 min on color Doppler sonography (p = .004) and power Doppler sonography (p = .008). CONCLUSION: Flow in the gallbladder wall is a normal finding that is seen more easily when the gallbladder is contracted. This fact must be kept in mind when sonography is used with patients in whom acute cholecystitis is suspected, particularly if they do not fast before sonography.     

Echographic study of gallbladder contraction: normal and pathologic aspects. Apropos of 115 patients

The gallbladder volume was measured on abdominal ultrasonography in 115 patients consisting of three population groups, before and after ingestion of a fatty meal and/or intravenous administration of cholecystokinin. The variation in volume, estimated as a percentage, was used to assess gallbladder contraction. The first group, consisting of 40 normal individuals without gallstones or impaired gallbladder or hepatic function, can be considered to constitute a control group. In this population, gallbladder contraction exceeded 50% in every case. The second group consisted of 40 cases of acute cholecystitis, including 30 cases with acute gallstones and 10 cases of stone-free acute cholecystitis proven surgically (7 cases) or by guided aspiration (3 cases). Gallbladder contraction was less than 15% in every case. Lastly, a third group of 35 patients with uncomplicated gallstones discovered on routine ultrasonography, demonstrated gallbladder contraction of between 10 and 85%. In this last group, 12 patients with vague gastrointestinal symptoms and gallbladder contraction less than 15% were operated: the histological results demonstrated severe lesions of chronic gallstone cholecystitis. The authors believe that absent or weak gallbladder contraction after endogenous stimulation is a supplementary sign to be taken into consideration in a context suggestive of the diagnosis of acute stone-free cholecystitis and to suggest, in the presence of gastrointestinal symptoms not directly related to the gallbladder, the hypothesis of chronic gallstone cholecystitis.     

Computed tomography of the gallbladder.

Computed tomography (CT) was used to study 79 patients with suspected gallbladder disease. First and second generation scanners were used to determine the efficacy of CT in detecting cholecystitis or cholelithiasis. Manifestations of gallbladder disease such as hydrops, opaque and nonopaque gallstones, chronic cholecystitis with thickened inflammatory walls, and secondary liver abscesses can be easily detected. It is a useful technique for individuals in whom the gallbladder has failed to opacity on oral cholecystography. The scanning method is described, and estimates of reliability are given including its accuracy, limitations, and place in the management of gallbladder disease, especially cholelithiasis. When conventional radiographic examinations or ultrasound fail to give definitive diagnostic information, CT can be a useful alternative with an overall diagnostic accuracy greater than 80%.     

Refinement of the positive predictive value of gallbladder nonvisualization after morphine administration for acute cholecystitis based on the temporal pattern of common bile duct activity

The authors previously reported two major patterns in the time-activity curve of the common hepatic bile duct (BD) after morphine administration in patients with gallbladder nonvisualization. The first pattern consists of a gradual increase in BD activity (of variable duration) occurring during a simultaneous decrease in liver parenchymal activity (BD increase), representing the physiologic effects of morphine administration. The second pattern consists of a continuous decrease in BD activity that parallels the activity in the liver parenchyma (BD decrease), representing lower or no physiologic effects of morphine administration. The authors hypothesize that gallbladder nonvisualization associated with a continuous decrease in BD activity after morphine administration will have a lower positive predictive value (PPV) for acute cholecystitis than gallbladder nonvisualization associated with an increase in BD activity. METHODS: Thirty-six patients who had morphine-augmented cholescintigraphy were divided into two groups: 19 with BD increase after morphine administration and 17 with BD decrease. RESULTS: Of the 36 patients, 22 had acute cholecystitis. The positive predictive value (PPV) of gallbladder nonvisualization was 61%. All of the remaining 14 had chronic cholecystitis. Of 19 patients with BD increase, 15 had acute cholecystitis (PPV = 79%), whereas only 7 of 17 patients with BD increase (PPV = 41 %) had acute cholecystitis (P = 0.023 by the one-tailed and 0.038 by the two-tailed Fisher exact tests). CONCLUSIONS: Gallbladder nonvisualization after morphine administration with the pattern of BD decrease is not as reliable (intermediate probability in this series) for the diagnosis of acute cholecystitis as is nonvisualization of the gallbladder in patients with a pattern of BD increase (high probability).     

Association between false negative hepatobiliary scans and initial gallbladder visualization after 30 min

We have reviewed the experience of our institution and the literature concerning the use of hepatobiliary scintigraphy for the diagnosis of acute cholecystitis. The aim of this study was to assess whether the hepatobiliary scintigraphic finding of initial gallbladder visualization within 30 min is a more reliable criterion for excluding acute cholecystitis than gallbladder visualization within 1 h after tracer injection. In our institution's consecutive series, 113 of 211 hepatobiliary studies had gallbladder visualization within 1 h. Gallbladder visualization time in this group had a log normal distribution, with gallbladder visualization occurring within 30 min in 107 of 113 (95%). Gallbladder visualization occurred between 31 and 60 min in only 6 (5%); nevertheless, our one false negative study came from this small subgroup of patient studies (P = 0.05). Review of the literature (1645 patients with iminodiacetic acid [99mTc-IDA] derivative studies) revealed 6 further timed false negative results with gallbladder visualization within 1 h. Of these studies, in 4 (67%) the gallbladder was visualized between 31 and 60 min and in only 2 before 30 min. One of these latter 2 patients had a rare anatomy. Analysis of the pooled institutional and literature data gave an estimated false negative rate of 21% if the gallbladder was visualized between 31 and 60 min. This was significantly higher (P less than 0.001) than the 0.5% false negative rate when the gallbladder was seen prior to 30 min, but similar to the false negative rate of 16% reported by Weissmann et al. for studies with initial visualization after 1 h.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ultrasound changes of the gallbladder wall in cholecystitis: a sonographic-pathological correlation

To assess the pathological basis of the changes seen on ultrasound examination of the gallbladder wall in cholecystitis, the appearances of the gallbladder wall were analysed in 17 patients with acute cholecystitis and 27 patients with chronic cholecystitis, and correlated with the pathological specimens removed at surgery. A thin echo reduced layer within the echogenic gallbladder wall corresponds to a complex of subserosal oedema, haemorrhage and inflammatory cell infiltration, or to muscular hypertrophy. Indistinctness or a low echogenicity rind along the inner margin represents mucosal sloughing or obliteration of the mucosal folds. Uniformly decreased echogenicity of the wall is caused by severe inflammatory change with sloughing of the mucosa or obliteration of the mucosal folds. These ultrasound signs are considered to be valuable signs of cholecystitis.