胆囊息肉样病变23例分析

我院自1969年7月至1990年7月,收治各种类型的胆道系统疾病共2018例,施行胆囊切除和胆总管切开取石以及其他各种胆道手术等共1821例,其中发现胆囊息肉样病变23例,术后经病理检查证实,其发病率占1.14%.23例胆囊息肉样病变同时并发急性胆囊炎、慢性胆囊炎、胆囊炎合并结石、胆囊出血、胆囊息肉癌变等并发症.本文着重讨论了并发症的原因,诊断方法以及如何治疗等问题.作者认为该病在胆道系统疾病中占有重要的地位,也是胆道系统中一种特殊的疾病.     

Effects of cholestyramine on gallbladder and gastric emptying in obese and lean subjects

Abstract. Gallbladder stasis is frequent in obese subjects and may contribute to their increased risk for gallstone formation. The bile salt sequestrant cholestyramine acutely enhances postprandial gallbladder emptying in lean subjects, through dis-inhibition of a negative feedback between intraluminal bile salts and CCK release. In this study the effect of cholestyramine on both gallbladder and gastric antrum dynamics were studied by realtime ultrasonography in 12 obese and 15 lean subjects. For the acute study, on different days, subjects ingested a liquid meal (two egg yolks plus water 200 mL, 50 kJ) or a meal with 4g cholestyramine. Gallbladder emptying was impaired in obese patients who had significantly larger fasting gallbladder volume (39.4 ± 6.9 vs. 21.6 ± l.7mL, P <0.02), larger residual volume (12.3 ± 1.8 vs. 4.0 ± 0.5ml, P < 0.0006) and slower emptying time ( T /2: 33 ± 2 vs. 21 ± 2 min, P < 0.05) than lean subjects. Integrated antral emptying was also less in obese than lean subjects (5521 ± 578 vs. 7908 ± 491 % 120min^-1, P <0.02). Cholestyramine enhanced postprandial gallbladder emptying in both obese and lean subjects. Gastric emptying was delayed with cholestyramine in lean but not obese subjects. For the chronic study, after 1 month therapy with cholestyramine (4 g every 2 days), the motility tests were repeated in nine obese subjects. Gallbladder and gastric responses to a test meal, with or without cholestyramine, were preserved. We conclude that both gallbladder and antral emptying of a liquid test meal are impaired in obese subjects. Gallbladder emptying improves after acute administration of a low dose cholestyramine with test meal. This effect is sustained after 1 month treatment with a low dose of cholestyramine and does not interfere with gastric emptying of obese patients. Cholestyramine may improve gallbladder hypomotility in obese people.     

胆囊息肉样病变56例临床诊治体会

目的 探讨胆囊息肉样痛变的诊断及治疗。方法 回顾性总结分析胆囊息肉样病变56例的临床资料。结果 胆固醇性息肉多为多发且直径小于10mm。结论 B超诊断胆囊息肉是最有效的方法，同时胆固醇性息肉的治疗应注意调节和控制胆固醇代谢，对单发息肉直径大于10mm以上，伴有胆囊结石病人，应该采取手术治疗。     

胆囊鳞癌6例报告

目的：探讨胆囊鳞癌的发病情况、特点、诊断、治疗、预后及预防。方法：结合有关文献复习分析6例胆囊鳞癌的病例。结果：5例行手术治疗，术后两月内死亡3例，另两例至今存活，分别为术后8个月，3个月。1例行B超引导穿刺活检，入院后两周死亡。结论：胆囊鳞癌早期无特异症状，诊断时多已属晚期，手术效果较差。早期诊断、根治性手术有助于胆囊鳞癌的预后。     

Incomplete excision of the gallbladder during laparoscopic cholecystectomy

Dissection and transection of the cystic duct close to the gallbladder has been advocated as a means of avoiding common bile injury during laparoscopic cholecystectomy (LC). We present three cases in which inadequate identification of the gallbladder—cystic duct junction resulted in incomplete cholecystectomy. In two patients an unsecured gallbladder infundibulum presented as cystic duct leaks and one patient developed recurrent symptomatic cholelithiasis. These cases emphasize the need for complete dissection and visualization of the cystic duct at the gallbladder prior its division and secure ligation during LC.     

人胆囊类器官培养体系的建立与鉴定

目的 构建人胆囊上皮细胞类器官的培养体系,实现人胆囊类器官体外稳定快速扩增,并鉴定其具有的特性。 方法 分离人来源胆囊组织上皮细胞,运用三维培养体系,将细胞嵌入基质胶中进行3D培养。观察胆囊类器官生长过程中球囊样结构的面积、周长与形态。利用免疫细胞荧光染色技术检测胆囊类器官的干性指标和胆管上皮细胞标志物表达情况。使用BrdU摄入实验,检测小分子CHIR-99021和Blebbistatin对类器官的增殖特性的影响。 结果 胆囊类器官在体外培养过程中,类器官形成的球囊面积逐渐增大,第1天为（1.15±0.12）×10^4μm2,第7天为（18.97±1.64）×10^4μm2,（P<0.01）,第7天时其形状因子增高至（0.83±0.003）,表明类器官在体外稳定生长（P<0.01）,且形状逐渐趋于一个完美的圆。免疫荧光染色可见类器官表达胆管上皮细胞标志物。在培养基中加入小分子CHIR-99021和Blebbistatin后,BrdU检测其增殖特性明显增高（P<0.01）。 结论 在体外能够成功培养获得了具有增殖能力的人胆囊类器官,其具有胆管上皮细胞的特性,可用于胆管疾病的研究与建模。     

Gallbladder adenocarcinoma arising in Rokitansky–Aschoff sinus

Carcinoma arising from Rokitansky–Aschoff sinus (RAS) is extremely rare; only eight cases have been reported in the literature. Herein is reported a case of minute adenocarcinoma arising in RAS. A 77‐year‐old Japanese man with gallbladder stones underwent cholecystectomy. A tiny submucosal tumor (1 cm × 1 cm) was incidentally recognized. Histologically, the submucosal tumor was located in the subserosa and, to a lesser extent, in the fibromuscular layer. It was adenocarcinoma. RAS were recognized within the tumor, and there was a gradual transition between RAS and the adenocarcinoma. Mucin histochemistry indicated neutral and acidic mucins in the cytoplasm and lumens of the adenocarcinoma cells. Immunohistochemistry showed that the adenocarcinoma cells were positive for cytokeratin, epithelial membrane antigen, carbohydrate antigen 19‐9, K‐i67 (labeling = 80%), MUC1, MUC5AC and MUC6. In contrast, the adenocarcinoma cells were negative for CEA, c‐erbB2, p53 protein, MUC2 and CD10. In summary, minute subserosal adenocarcinoma, which arose in RAS, was found incidentally; therefore careful examination of resected gallbladders is necessary.     

Cystic duct and Heister's "valves"

The anatomy and physiology of the cystic duct have been relatively neglected by anatomists and the function of the spiral mucosal folds or "valves" of Heister, first described in 1732, remains obscure. The gross and microscopic anatomy of the cystic duct is reviewed together with results from laboratory investigations into the function of the cystic duct and its spirally arranged folds. The duct and spiral folds contain muscle fibers responsive to pharmacologic, hormonal, and neural stimuli. There is, however, no convincing evidence of a discrete muscular sphincter within the duct. Although the cystic duct is unlikely to play a major role in gallbladder filling and emptying, it appears to function as more than a passive conduit. Coordinated, graded muscular activity in the cystic duct in response to hormonal and neural stimuli may facilitate gallbladder emptying. The principal function of the internal spiral folds that are found in man and other animals may be to preserve patency of this narrow, tortuous tube rather than to regulate bile flow.     

原发性胆囊癌CT诊断与鉴别诊断

目的 探讨原发性胆囊癌的CT诊断与鉴别诊断要点。方法 回顾性分析23例原发性胆囊癌CT征象，并与手术和病理对照。结果 本组23例胆囊癌术前CT正确诊断18例，5例误诊，根据CT表现可分为：腔内型8例、厚壁型5例、肿块型10例；其中共8例并肝门和腹膜后淋巴结转移；3例肝内转移；病理结果：腺癌20例，鳞癌3例。结论 原发性胆囊癌CT的诊断价值较高，但仍容易误诊，早期的诊断仍有一定困难，掌握其CT征象，注意鉴别诊断可以提高本病的诊断水平。     

Steinfeld syndrome: Report of a second family and further delineation of a rare autosomal dominant disorder

We report on a fetus with alobar holoprosencephaly, microphthalmia, midline cleft lip and palate, absent nose, dysplastic ears, radial defects, pentalogy of Fallot, unilateral renal aplasia, absent gallbladder, vertebral anomalies, and absence of ribs. The father had a cleft palate, bilateral colobomas of the iris and retina, a bifid uvula, vertebral anomalies, and unilateral congential hearing loss. His sister had a cleft lip. On the basis of this family and the family reported by Steinfeld [1982], this malformation syndrome can be defined as a rare autosomal dominant syndrome whose main component manifestations are holoprosencephaly, predominantly radial limb deficiency, heart defects, kidney malformations, absence of gallbladder, and vertebral anomalies. © 1993 Wiley-Liss, Inc.