A double or bilobar gallbladder as a cause of severe complications after (laparoscopic) cholecystectomy

A double or bilobar gallbladder is a rare congenital anomaly. If not recognized during preoperative evaluation or operation, it can cause severe complications. We describe two cases in which a second operation had to be performed because of the presence of a second or bilobar gallbladder that was not recognized in the preoperative evaluation and during (laparoscopic) cholecystectomy. The types of anomalies, the concomitant pathology, and treatment are discussed.     

腹腔镜意外胆囊癌外科治疗体会

目的总结意外胆囊癌腹腔镜胆囊切除的经验。方法回顾性分析连续1037例腹腔镜胆囊切除术中的4例意外胆囊癌患者的临床特征、病理分期、手术及术后处理措施。结果术后病理分期2例为T1aNM,1例为00T1bNM,1例为TisNM,其中3例肿瘤位于体部,1例位于胆囊颈部息肉癌变。术后随访1～3年,无切口种植,腹腔0000及远处转移。结论LC只要注意技术操作,勿分破胆囊,并不会增加肿瘤扩散的机会;术后应根据PTNM分期及肿瘤部位决定是否行淋巴清扫。     

胆囊小隆起性病变的诊断及治疗

报告37例胆囊小隆起性病变，其中良性颈变34例，胆囊癌3例。结果：本组23例有临床症状，多表现为反复发作的右上腹疼痛或不适；病灶部位，大小，多少，有无合并胆石及病变性质与临床症状有关；B-us,OCG,CT的诊断符合率例如辚33／37，9／24和5／10（x^2=18.75,P<0.005)。认为对胆囊小隆起性病变的病灶≥10mm，有增大趋势，呈恶性图像，合并胆石或血清CEA升高的病例应及早手术治疗。     

Asymptomatic metachronous metastatic renal cell adenocarcinoma to the gallbladder

Summary A case of asymptomatic metachronous metastatic unilateral renal cell adenocarcinoma to the gallbladder detected five years after resection of the primary renal neoplasm is reported here. The lesion was diagnosed by contrast enhancement of a gallbladder mass on abdominal computerized tomography scan and by color Doppler sonographic study of the gallbladder, both of which demonstrated the vascular supply to the intraluminal gallbladder mass. The biological behavior of renal cell adenocarcinoma is reviewed. Guidelines for the evaluation of intraluminal gallbladder masses are suggested.     

胆道穿孔的诊治体会

目的探讨胆道穿孔的病因、诊断及处理措施。方法对1985-2003年收治的41例胆道穿孔病例进行回顾性分析。结果41例均行手术治疗，2例死亡，其余均治愈。结论胆道在感染和梗阻情况下容易发生胆道穿孔，胆囊疾病合并胆管疾病并发感染时易发生胆囊穿孔，治疗胆道穿孔应根据病变和其并发症采用不同的手术治疗措施。     

Localized wall thickening of the gallbladder mimicking a neoplasm

Clinical diagnosis of chronic cholecystitis is made based on diffuse hyperechoic thickening of the gallbladder wall as shown by ultrasonographic examination. We herein report three cases of chronic cholecystitis showing localized hypoechoic thickening of the gallbladder wall that mimicked gallbladder cancer by ultrasonography. Histologically, hypertrophy of the muscularis propria was a common characteristic finding in these three patients. A smooth surface of the inner hypoechoic layer of the thickened wall was considered to be a reliable finding in the differential diagnosis between this type of chronic cholecystitis and gallbladder cancer.     

皮下通道型胆囊肝胆管成形术治疗区域性肝胆管结石的中远期疗效观察

目的 观察皮下通道型胆囊肝胆管成形术(STHG)治疗区域性肝胆管结石的中远期疗效。方法 对我院1994年12月-2000年8月期间行STHG手术的31例患者术后并发症进行统计分析。结果 STHG术后并发症发生率低,且并发症种类少。结论 STHG保留了胆囊及Oddi括约肌功能,维持了正常的胃肠道生理结构,能有效防止返流性胆管炎及术后的消化功能紊乱,是一种较为理想的治疗区域性肝胆管结石的术式。     

胆汁对豚鼠离体胆囊肌条收缩影响的实验研究

目的：观察不同浓度的胆汁对胆囊平滑肌运动的影响并初步探讨其作用机理。方法：将肌条置于离体平滑肌灌流肌槽内，用生理记录仪记录肌条的收缩活动。结果：(1)胆汁可降低离体胆囊肌条张力，减慢收缩频率，减小收缩波平均振幅。(2)心得安、L—NNA、六烃季胺可部分阻断胆汁对脂囊肌条的作用。结论：胆汁对豚鼠胆囊肌条的作用与肾上腺素能β受体、胆碱能N受体和N0有关。     

人胎儿胃液、胆汁及胃粘膜、胆囊组织胃动素水平及其相关性

作者采用特异性胃动素(MTL)抗体,通过放射免疫法,对8例16～40周龄的人胎儿胃液、胆汁及胃粘膜、胆囊组织MTL含量进行探测。结果显示:MTL含量胃液为46.00±12.87pmol/L,胆汁为29.89±15.45Pmol/L;胃粘膜为1.34±0.45pmol/g,胆囊为0.87±0.32pmol/g.胃液、胃粘膜MTL含量分别高于胆汁及胆囊MTL水平(P<0.05)。相关分析显示:胃液与胃粘膜MTL含量,胆汁与胆囊MTL含量均呈显著正相关(N=8,r=0.8933,P<0.01;N=8,r=0.9016,P<0.01)。胃粘膜MTL含量与胎龄增长也呈显著正相关(N=8,r=0.7321,P<0.05)。     

Systemic chemotherapy using cisplatin plus 5-fluorouracil for inoperable gallbladder cancer

We report a case of advanced gallbladder cancer in a 37-year-old man who presented in June 1993 with malignant obstructive jaundice. After percutaneous transhepatic biliary drainage and several diagnostic imaging examinations, the patient underwent laparotomy under a diagnosis of extremely advanced gallbladder cancer involving the confluence of the hepatic ducts. The tumor, however, was judged to be unresectable because of its massive spread into the liver along Glisson's sheath, and because of histologically proven peritoneal dissemination. After exploratory laparotomy, one course of anticancer chemotherapy (cisplatin, 100 mg/body IV, on day 1, and 5-fluorouracil, 1000 mg/body, on days 1–5, by continuous infusion) was administered and the completely obstructed hepatic duct was dramatically re-canalized. Four courses of chemotherapy were administered over a 16-month period until jaundice recurred. For these 16 months, the patient's quality of life was well maintained without biliary drainage. He died of increased peritoneal dissemination approximately 2 years after the first course of anticancer chemotherapy.