胆囊结石并发急性胰腺炎的超声诊断及价值

目的：探讨胆囊结石并发急性胰腺炎的超声诊断及价值。方法：采用超声检查32例胆囊结石并发急性胰腺炎患者,观察胆囊内结石大小与数量并进行比较,同时观察胰腺大小、形态、实质回声及周围情况。结果：胆囊结石中81.1%（26/32）为多发性结石,其中81%（21/26）为直径〈0.9cm的小结石。结论：多发性且直径小的的胆囊结石患者并发急性胰腺炎的发病率明显增高。超声检查胆囊结石可为临床提供急性胰腺炎的可能病因,并为胆囊结石患者选择性地施行胆囊切除术提供影像学诊断依据。     

彩色多普勒超声诊断胆囊结石并发急性胰腺炎的效果体会

目的:观察彩色多普勒超声诊断胆囊结石并发急性胰腺炎的效果。方法:选择2019年1月-2019年12月间我院收治的68例胆囊结石并发急性胰腺炎患者,利用彩色多普勒超声观察胆囊内结石和胰腺表现。结果:胆囊结石以多发性结石居多,占比为88.24%(60/68);结石直径小于0.9cm的患者有62例,占比为91.18%(62/68);结石直径为0.9cm及以上的患者有6例,占比为8.82%(6/68)。结论:多发性、小直径结石易引发急性胰腺炎,彩色多普勒超声检查可清晰观察胆囊和胰腺情况,判断胆囊结石并发急性胰腺炎的病因,为选择性实施胆囊切除术提供影像学依据。     

胆囊结石并发急性胰腺炎患者行超声诊断的临床应用

目的:探究胆囊结石并发急性胰腺炎患者采用超声诊断的价值.方法:选取2020年1月—2021年6月绵阳市中心医院收治的49例疑似胆囊结石合并急性胰腺炎患者作为研究对象,所有患者均接受超声检查,对比病理检查结果,分析超声诊断效果.结果:超声诊断灵敏度为93.02％、特异度50.00％、准确率87.76％;单发性结石和多发性...     

超声检查在腹腔镜胆囊切除术前后的诊断价值

目的探讨超声检查在腹腔镜胆囊切除术（Laparoscopic cholecystectomy，LC）前后的价值及临床应用意义。方法 对超声检查胆囊疾病，进行回顾性分析，并与手术、病理对照。结果 314例胆囊疾病．经超声检查，符合率9.7%，（313/311）．其中胆囊结石293例．占93．31%（293／311）、急性胆囊炎10例．占3．18%（10／311）、慢性胆囊炎6例．占1．91%（6／311）、胆囊小隆起性病变5例．占1．6%（5／311）。结论 超声检查在腹腔镜胆囊切除术已成为重要的诊断工具，为临床诊断提供了有办依据。     

胆囊癌合并胆囊结石的超声研究

目的 探讨易合并胆囊癌的高危胆囊结石声像图特征，为胆囊结石患者选择预防性胆囊切除提供影像学依据。方法 分析37例胆囊癌合并胆囊结石术前超声检查的声像图特点。结果 26例（71％）同时合并慢性胆囊炎。29例（78％）为单发结石且结石大小超过1cm。扫查时27例（73％）结石不移动。胆固醇性和混合性结石共33例（89％）。结论 单发、体积较大且移动性差的胆固醇性或混合性结石更倾向于合并胆囊癌，当超声检查发现上述特点，尤其是同时存在慢性胆囊炎时，提示有较强的预防性胆囊切除指征。     

超声诊断胆囊结石的应用及影像学特征

目的:分析对胆囊结石患者实施超声诊断及影像学特征。方法:从2018年1月至2020年1月择取120例疑似胆囊结石患者,所选患者均实施超声诊断,并对照手术病理诊断结果,分析超声诊断结果及影像学特征。结果:从诊断结果来看,手术病理诊断中118例患者确诊为胆囊结石,确诊率为98.33%(118/120),其中典型胆囊结石63例、充满型胆囊结石34例、胆囊颈结石13例、泥沙样型结石8例,超声诊断中114例患者确诊为胆囊结石,其中典型胆囊结石61例、充满型胆囊结石33例、胆囊颈结石12例、泥沙样型结石8例,诊断符合率为96.61%(114/118)。从超声影像学特征来看,典型胆囊结石可见胆壁粗糙,而且毛糙度高,腔内形态稳定,边界清晰,有强回声团,检查期间若移动体位,则后方声影、回声团随之改变。充满型胆囊结石可见胆囊壁增厚,大部分病例胆囊内无明显液性透声腔,胆囊后半部分以及后壁未完全显示,囊壁、结石、声影三合征(即WES症)清晰。胆囊颈结石可见在胆汁衬托下横切面上部分胆囊颈、结石嵌顿明显,结石具体位置无法确定,胆囊肿大,需要改变体位为左前倾位,以更好地暴露结石。泥沙样型结石中,结石大小差异,胆囊结石特征不同,沉积厚、颗粒大的结石声影有移动性,且有沉积状强回声带,颗粒小的结石胆囊后壁粗糙,毛糙感高,相比于前壁、侧壁,后壁回声更强,回声随体位变化出现细小发丝状强回声。结论:对胆囊结石患者实施超声诊断可以对具体疾病状况进行明确,医学影像清晰,临床价值显著。     

彩色多普勒超声对肾小结石的诊断价值

目的 评价彩色多普勒超声对肾小结石的诊断价值.方法 对100例肾小结石（直径2～6 mm）患者,135枚小结石,行二维超声和彩色多普勒超声检查.彩色多普勒观察结石后方快闪伪像确定结石的存在,对比分析二维超声和彩色多普勒超声对肾小结石的检出率.通过增加回声差异强化值,观察结石边界情况.结果 135枚小结石,二维超声检出92枚（68.2%,92/135）,彩色多普勒通过观察快闪伪像检出128枚 （94.8%,128/135）,两者比较差异有统计学意义（P〈0.05）.结石直径2～3 mm小结石74枚,二维超声检出39枚（52.3%,39/74）,彩色多普勒超声检出72枚（97 3%,72/74）,两者比较差异有统计学意义（P〈0.05）.135枚小结石通过增加回声差异强化值（△=4～5）观察,边界均清晰显示.结论 ①彩色多普勒超声对肾小结石的检出和诊断有重要价值.②回声差异强化可清晰显示肾小结石边界情况,有助于准确测量结石大小.     

MRCP联合MRI在胆系结石术前检查中的价值

目的:探讨MRI结合磁共振胰胆管水成像(MRCP)技术在胆系结石术前诊断中的价值。材料与方法:115例超声诊断为胆结石的患者均行MRI和MRCP检查。结果:115例患者中,单纯性胆囊结石85例,单纯性肝管结石8例,胆囊结石伴胆管结石19例,胆总管囊肿伴结石1例,先天性无胆囊1例,急性单纯性胰腺炎1例。结论:MRI结合MRCP对胆系的先天发育异常是重要适应症,对于胆系结石的有无、大小、形态、数目、梗阻部位和胆管扩张的程度提供了可靠的诊断依据。     

超声在头孢曲松钠诱发可逆性胆囊结石诊断中的价值

目的 分析头孢曲松钠所诱发可逆性胆囊结石的超声图像,提高对头孢曲松钠所致的可逆性胆囊结石的鉴别诊断能力.方法 选择385例需接受头孢曲松钠治疗的患者,其中55例患者出现可逆性胆囊结石超声图像,与同期50例急性非结石性胆囊炎、52例功能性胆囊内沉积物、63例典型胆囊结石超声图像进行对比分析.结果 55例使用头孢曲松钠患者,在用药4~5 d后,出现假性结石,胆囊大小无明显改变,胆囊壁增厚,超声随访2~7周后恢复正常.50例急性非结石性胆囊炎,胆囊体积明显增大,张力高,胆囊壁增厚5~10 mm,呈多边回声,胆囊内无结石光团.42例功能性胆囊内沉积物,恢复正常正常饮食3天后复查,胆囊大小正常.63例典型胆囊结石,胆囊内可见形态固定的强回声团,后方伴有明显的声影.结论 超声在对头孢曲松钠诱发的可逆性胆囊结石的鉴别诊断中具有较高的应用价值,可避免因头孢曲松钠诱发的可逆性胆囊结石造成的过度医疗.     

胆石性胰腺炎的超声探讨

胆石性胰腺炎的超声探讨山西太原市中心医院超声科吴志霞，马义前，杨军山西太原市中心医院外科刘扬邮政编码０３０００９本文报告５４４例胆囊结石的胰腺超声测值，发现胆囊内多发性微结石患者胰头明显大于胆囊内大结石患者，Ｐ＜０．０１。说明胆囊内微结石患者在其慢性...     

Management of gallstones

Many patients with gallstones can be managed expectantly. Generally, only persons with symptoms related to the presence of gallstones (e.g., steady, nonparoxysmal pain lasting four to six hours located in the upper abdomen) or complications (such as acute cholecystitis or gallstone pancreatitis) warrant surgical intervention. Biliary pain is alleviated by cholecystectomy in the majority of cases. Laparoscopic cholecystectomy is considered the most cost-effective management strategy in the treatment of symptomatic gallstones. Medical management strategies are mostly palliative and are not widely supported. Patients with longer-lasting biliary pain, in combination with abdominal tenderness, fever, and/or leukocytosis, require an ultrasound evaluation to help establish a diagnosis of acute cholecystitis. Once a patient is diagnosed, having cholecystectomy early in the course of the disease can significantly reduce the hospital stay.     

Acute pancreatitis in the postpartum period: a population-based case-control study

OBJECTIVE: To determine relationships among pregnancy (during and postpartum), acute pancreatitis, and gallstones. PATIENTS AND METHODS: In this retrospective population-based case-control study, we identified all 12- to 50-year-old Rochester, Minn, females diagnosed between 1976 and 1991 as having acute pancreatitis (cases). For each case, we matched 4 women of the same age (+/- 6 years) with no history of acute pancreatitis (controls). Acute pancreatitis was defined as associated with pregnancy if it occurred from 10 months prior to delivery to delivery and with the postpartum period if it occurred within 10 months of the date of delivery. Logistic regression was used to assess associations between pregnancy-related acute pancreatitis, age, gallstone occurrence, and alcohol use. RESULTS: In a cohort of 61 women who developed acute pancreatitis and 244 controls, the relative risk for acute pancreatitis associated with pregnancy was 1.43 (95% confidence interval, 0.61-3.40). All 10 cases of acute pancreatitis associated with pregnancy occurred in the postpartum period. Gallstones were present in 6 of them compared with 13 of 51 women with non-pregnancy-related acute pancreatitis (P < .05). Women with postpartum-related pancreatitis were younger than those with non-pregnancy-related pancreatitis (mean, 28 vs 36 years; P < .05). Alcohol was not associated with pregnancy-related pancreatitis. CONCLUSIONS: Acute pancreatitis during the postpartum period is not directly related to pregnancy but is associated with gallstones and occurs in younger women.     

Gallstones and biliary disease

Gallstones are common in the US and western countries. This article describes the pathogenesis of gallstone formation and the clinical manifestations and current approaches to diagnosis and treatment of the most common clinical conditions caused by gallstones: biliary colic, acute cholecystitis, choledocholithiasis, and acute gallstone pancreatitis. The role of widely used imaging techniques (transabdominal ultrasound, CT scan, MR imaging, and MRCP) and diagnostic and therapeutic endoscopy (endoscopic ultrasound, ERCP) is emphasized. This article is intended mainly for general practitioners, primary care physicians, and other specialists providing medical care to patients with gallstones and their complications.     

十二指肠镜治疗高龄急性胆源性胰腺炎的临床应用

目的探讨应用十二指肠镜治疗高龄急性胆源性胰腺炎患者的可行性、有效性和安全性。方法该院2002年5月-2005年10月收治的18例高龄急性胆源性胰腺炎患者首先行内镜下乳头括约肌切开取石，同时置入鼻胆管引流；合并胆囊结石者，待胰腺炎恢复后，施行腹腔胆囊切除术等。结果全组18例病人均行鼻胆管引流（ENBD），11例胆管结石行内镜下乳头括约肌切开取石（EST）取出，胰腺炎顺利治愈17例，治愈率94．4％：6例取石失败。二次内镜治疗行胆道支架引流术、三镜联合胆总管探查术，中转开腹手术治疗，无严重术后并发症发生。结论早期ENBD＋EST，解除胆道梗阻，降低胰管压力，避免急诊手术，为择期手术创造条件，该微创技术尤为适合高龄、合并有多脏器功能不全、难以耐受手术的患者。     

胰腺炎的超声表现:中日两组病例的比较

目的比较中国和日本两组胰腺炎病例的超声表现.方法分析我院慢性胰腺炎59例、急性胰腺炎84例(A组)和日本杏林大学的慢性胰腺炎128例、急性胰腺炎95例(B组)的超声表现.结果①慢性胰腺炎:A组胰管扩张、胰腺钙化的检出率明显低于B组,分别为23.7% vs 53.0%,13.6% vs 27.3% (均P<0.01).A、B两组胰腺结石合并率分别为18.6%和54.7% (P<0.01), 胆结石合并率分别为52.5%和7.0% (P<0.01).②急性胰腺炎:A、B两组超声表现差别不明显.胰腺结石合并率分别为0.0%和8.4%(P<0.01),胆结石合并率分别为42.9%和7.4% (P<0.01).结论日本组慢性胰腺炎超声主要特点为胰管扩张和胰腺钙化.中日两组急、慢性胰腺炎则分别以胆结石或胰腺结石合并率高为特征.     

Recurrent Gallstone Ileus

Mechanical small bowel obstructions caused by gallstones account for 1% to 3% of cases. In these patients, 80% to 90% of residual gallstones in these patients will pass through a remaining fistula without consequence. Recurrent gallstone ileus has been reported in 5% of patients. We report the case of a woman, aged 72 years, who presented with mechanical small bowel obstruction caused by gallstone ileus. After successful surgical therapy for gallstone ileus, the patient''s symptoms recurred, and she was diagnosed with recurrent gallstone ileus requiring a repeat operation. While management of gallstone ileus can be achieved through a single-stage operation including enterolithotomy and cholecystectomy with repair of biliary-enteric fistula or by enterolithotomy alone, the literature supports enterolithotomy alone as the treatment of choice for gallstone ileus due to decreased mortality and morbidity. However, the latter approach does not obviate potential recurrence. We present this case of recurrent gallstone ileus to elucidate and review the pathogenesis, presentation, diagnosis, and consensus recommendations regarding management of this disorder.     

复发性胰腺炎139例病因分析

目的 探讨急性胰腺炎反复发作的诱发因素及复发性胰腺炎的预后.方法 对昆明医学院第一附属医院消化内科收集的832例急性胰腺炎患者根据发作次数分为单发组和复发组,对两组的病史特点、临床表现及预后分别进行比较.结果 单发组693例(83.3%),复发组139例(16.7%),两组患者年龄比较差异无统计学意义(P>0.05);而在复发组中男性比例明显高于女性(P<0.01),年龄相对集中在31~59岁,通过单因素分析显示:饮酒、胆结石病史、胆囊切除术后、高脂血症病史、血清高三酰甘油及高脂饮食病史等与复发性急性胰腺炎(RAP)相关;逐步Logistic回归分析发现:胆囊切除术后及胆结石病史为急性胰腺炎反复发作的最有可能的潜在危险因素.结论 胆囊切除术及胆结石病史是急性胰腺炎反复发作的高危因素,饮酒、高脂血症病史及高脂饮食也是RAP不容忽视的危险因素.     

Cholecystectomy for asymptomatic gallstones: Markov decision tree analysis

Gallstones are a common public health problem, especially in developed countries. There are an increasing number of patients who are diagnosed with gallstones due to increasing awareness and liberal use of imaging, with 22.6%-80% of gallstone patients being asymptomatic at the time of diagnosis. Despite being asymptomatic, this group of patients are still at life-long risk of developing symptoms and complications such as acute cholangitis and acute biliary pancreatitis. Hence, while early prophylactic cholecystectomy may have some benefits in selected groups of patients, the current standard practice is to recommend cholecystectomy only after symptoms or complications occur. After reviewing the current evidence about the natural course of asymptomatic gallstones, complications of cholecystectomy, quality of life outcomes, and economic outcomes, we recommend that the option of cholecystectomy should be discussed with all asymptomatic gallstone patients. Disclosure of material information is essential for patients to make an informed choice for prophylactic cholecystectomy. It is for the patient to decide on watchful waiting or prophylactic cholecystectomy, and not for the medical community to make a blanket policy of watchful waiting for asymptomatic gallstone patients. For patients with high-risk profiles, it is clinically justifiable to advocate cholecystectomy to minimize the likelihood of morbidity due to complications.     

急性胰腺炎合并浆膜腔积液临床意义分析

目的 评价急性胰腺炎合并胸腔积液和/或腹腔积液临床意义及对预后的影响.方法 回顾性分析312例因急性胰腺炎入院合并胸腔积液和/或腹腔积液患者临床资料.结果 312例急性胰腺炎合并胸腔积液47例、腹腔积液18例.47例胸腔积液病例中,31例(66.0%)为重症胰腺炎(P＜0.01),27例(57.4%)合并胰腺假囊肿(P＜0.01).18例腹腔积液病例中,14例(77.8%)为重症胰腺炎(P＜0.01).死亡6例.其中合并胸腔积液死亡2例,合并腹腔积液死亡1例,合并胸、腹腔积液死亡3例;死因主要为体克.结论 急性胰腺炎合并胸腔积液和/或腹腔积液与重症胰腺炎有密切关系.