老年急性重症胆囊炎56例临床治疗分析

目的回顾分析老年患者急性重症胆囊炎的治疗效果。方法我中心2009年6月～2011年12月对56例老年急性重症胆囊炎患者均应用B超引导下经皮经肝胆囊穿刺引流（PTGD）治疗，现对其临床资料进行分析。结果56例老年急性重症胆囊炎患者通过PTGD治疗，穿刺置管全部成功，成功率达100％。患者在穿刺引流术后24。48h内其畏寒、高热、右上腹疼痛等症状明显得到缓解，感染症状得到控制。经过外引流胆汁2周后54例患者在拔除引流管时其临床症状体征消失，治愈率达96．4％，无死亡病例。结论PTGD用于治疗老年急性重症胆囊炎，不仅可以迅速缓解其临床症状、控制感染，而且能够有效避免行急诊手术引起的相关并发症。     

射频刀在腹腔镜手术中的临床应用

目的探讨射频刀在腹腔镜手术中的临床应用价值。方法应用射频刀对38例病人进行了腹腔镜手术。其中胆囊切除术21例、早期胆囊癌根治术1例、甲状腺腺瘤切除术4例、肝囊肿开窗引流术3例、胃底折叠术1例、十二指肠肿物切除术1例、阑尾切除术1例、肠粘连松解术1例、腹腔镜探查活检术2例、卵巢囊肿切除术1例、直肠癌根治术2例等。结果手术均获成功，术后6-12h拔胃管、8-24h下床活动、进流食，1-3d拔除引流管，2-5d出院，无手术并发症。结论射频刀可以在较低温度下进行组织消融、切割及止血，而且对周边组织损伤极小，具有独特的临床实用价值。     

COVID-19: Focus on the lungs but do not forget the gastrointestinal tract

The coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was declared in the last weeks as global pandemic. Currently affecting more than 5 000 000 individuals worldwide, COVID-19 is most commonly associated with symptoms caused by the acute respiratory distress syndrome (ARDS). As the number of infected individuals increases, we are learning that not only lungs, but also other organs can be affected by the virus. The gastrointestinal symptoms, for example diarrhoea, vomiting, nausea or abdominal pain, are frequent in patients with COVID-19. Moreover, alimentary tract symptoms may precede the respiratory presentation of SARS-CoV-2 infection. This can lead to delayed diagnosis and inappropriate management of infected patients. In addition, SARS-CoV-2 nucleic acid can be detected in faeces of infected patients and rectal swabs are even reported to remain positive for a longer period of time than nasopharyngeal swabs. Here, we aim to provide an update on the gastrointestinal involvement of COVID-19 presenting the symptoms that can be encountered in infected patients. We address the role of angiotensin-converting enzyme 2 (ACE2), as a functional receptor for SARS-CoV-2, which also was found in the gastrointestinal tract. Finally, we briefly discuss faecal shedding of SARS-CoV-2 and its potential role in the pathogenesis of the disease.     

Squamous variant of gallbladder cancer: is it different from adenocarcinoma?

Background

Literature on squamous variants of gallbladder cancer (GBC) is limited.

Methods

This was a retrospective analysis of GBC patients operated on between August 2009 and March 2012. Patients with adenosquamous carcinoma or squamous cell carcinoma were compared with adenocarcinoma for clinicopathologic features and surgical outcomes.

Results

Of the primary GBC patients resected with curative intent, 14 had adenosquamous carcinoma (10) or squamous cell carcinoma (4) (group A), whereas 122 had adenocarcinoma (group B). Abdominal pain was the most common symptom in both groups; however, presentation with vomiting and an abdominal lump was more common in group A (P = .04 and <.01, respectively). Group A had a significantly larger tumor size (7.9 vs 4.8 cm, P = .01) and a higher incidence of adjacent organ involvement requiring extended resections (85.7% vs 26.2%, P < .01). Despite the higher T stage, node-negative disease was significantly higher in group A (42.9% vs 17.2%, P = .03). There was no significant difference in the median survival after curative resection between the 2 groups (28 vs 31 months, P = .24).

Conclusions

The squamous variant of GBC presented at an advanced T stage; however, nodal involvement and distant metastasis were less common. Despite the higher T stage, curative resection could be achieved in the majority with a comparable survival.     

Lipid peroxidation and mucin secretagogue activity in bile of gallstone patients

Background Chronic inflammation of the gallbladder wall and mucin hypersecretion are considered to be important factors in the pathogenesis of cholesterol gallstone disease. The aim of the study was to compare mucin concentration and mucin secretagogue activity with lipid peroxidation in gallbladder bile of patients with cholesterol or pigment stones. Material and methods We studied mucin concentration and, as a marker of lipid peroxidation, malondialdehyde concentration in 11 rapid (1 to 3 days) and eight non‐nucleating (> 21 days) gallbladder biles of patients with cholesterol or pigment stones. Furthermore, the mucin secretagogue activity of rapid and non‐nucleating gallbladder biles, as well as 1–5 µmol L⁻¹ malondialdehyde on cultured gallbladder epithelial cells, was determined. Results Our data show an increased malondialdehyde (7·2 ± 1·8 vs. 3·8 ± 0·5 µmol L⁻¹, P = 0·01) and mucin concentration (0·9 ± 0·09 vs. 0·41 ± 0·03 mg mL⁻¹, P = 0·01) and an increased mucin secretagogue activity (2·0 ± 0·5 vs. 1·1 ± 0·3 mucin secretion/control, P = 0·04) and cholesterol saturation index (1·2 ± 0·1 vs. 08 ± 0·1, P = 0·04) in rapid as compared to non‐nucleating gallbladder biles. Malondialdehyde stimulated mucin secretion of cultured gallbladder epithelial cells in a concentration dependent manner. Conclusions Our results support a promoting effect of gallbladder mucin hypersecretion by lipid peroxidation leading to rapid formation of cholesterol crystals in gallbladder bile. These findings suggest that besides hypersecretion of cholesterol in bile, chronic inflammation of the gallbladder wall is implicated in the pathogenesis of cholesterol gallstone disease.     

残余胆囊的诊断和治疗

随着影像学、内镜技术的发展及其在胆道外科领域的广泛运用,残余胆囊的临床诊断率也日趋增高[1-2].残余胆囊可伴有或不伴有结石残余,可出现类似胆囊炎的症状,更有部分患者继发癌变[3-4].本研究回顾性分析2000年1月至2010年12月解放军第四五五医院收治的48例残余胆囊患者的临床资料,探讨该病的诊断和治疗. 1资料与方法 1.1一般资料 本组残余胆囊患者48例,男22例,女26例;年龄38～70岁,平均年龄54岁.其中43例在外院行手术治疗,5例在本院行手术治疗.开腹胆囊切除术所致35例,LC所致13例;择期手术18例(其中12例为LC),急诊手术30例(其中25例为单纯胆囊切除术、5例为胆囊切除+胆总管探查术).48例患者行胆囊切除术后14 d至3年出现恶心、呕吐、腹胀、纳差及腰背部放射痛等,部分出现黄疸和发热,且均与饮食无因果联系.所有患者行彩色多普勒超声检查,必要时追加MRI、MRCP及ERCP检查.     

超声造影在原发性胆囊癌的应用探讨

目的探讨超声造影对原发性胆囊癌的诊断价值。 方法13例原发性胆囊癌患者接受了超声造影检查。采用对比脉冲序列（CPS）成像技术,造影剂为SonoVue。 结果注射造影剂后13例原发性胆囊癌均见造影增强,各病灶较常规超声显示更清晰。2例常规超声漏诊的胆囊癌造影后癌灶增强而胆泥不增强得以确诊。2例胆囊癌伴肝转移造影后检出更多的转移病灶。 结论超声造影是常规超声的重要补充,有助于提高原发性胆囊癌的诊断水平。     

进展期急性胆囊炎的手术时机

目的探讨进展期急性胆囊炎(AAC)患者经皮经肝胆囊穿刺引流术(PTGBD)后行腹腔镜胆囊切除术(LC)的手术时机。方法回顾分析某院近3年收治的AAC患者的临床资料(共242例),其中85例患者于PTGBD后接受LC治疗,85例患者中54例患者于PTGBD后5~12 d内接受LC(平均时间7 d),为早期手术组;31例患者于66~100 d内行LC(平均时间79 d),为延期手术组。比较两组患者手术操作时间、术中出血量、中转开腹率、手术并发症发生率、人均住院日、人均住院费用、PTGBD引流管相关并发症的差异。结果早期手术组患者的手术操作时间(46.9±9.3)min较延期手术组(75.6±9.0)min短(P<0.01);早期手术组患者的术中出血量(21.1±9.3)mL较延期手术组(12.5±6.4)mL多(P<0.01);两组患者均无中转开腹情况;早期手术组患者无手术并发症,延期手术组术后胆漏1例、术后腹腔出血1例(P=0.13);早期手术组患者的人均住院日(13.6±2.7)d短于延期手术组的(16.7±2.7)d(P<0.01);早期手术组人均住院费用为(2.6±0.49)万元,明显少于延期手术组的(3.2±0.65)万元(P<0.01);早期手术组无PTGBD引流管相关并发症,延期手术组脱管3例,堵塞1例(P=0.016)。结论AAC患者PTGBD后早期行LC安全可行,符合快速康复外科理念。     

胆囊息肉样病变的超声诊断与病理分析

目的:探讨胆囊息肉样病变的超声表现与病理改变的关系。方法:回顾性分析47例胆囊息肉样病变的实时超声表现和病理结果。结果:42例胆固醇性息肉中,36例表现为多发病灶,平均直径7.6mm,蒂窄。2例胆囊腺瘤表现为1例单发,1例多发,平均直径1.1mm,基底较宽。3例腺瘤恶变者声像图上均为单发,平均直径19mm,基底较宽。结论:B超对胆囊息肉样病变检出率高,根据息肉大小、数目、蒂宽窄等情况,在定性诊断上有一定参考价值。