急性非结石性胆囊炎的诊断治疗分析

目的总结急性非结石性胆囊炎的诊断和治疗经验。方法对我院1999年3月—2010年11月收治的19例急性非结石性胆囊炎患者的临床资料进行回顾性分析。结果 19例患者均行手术治疗,其中胆囊切除12例,胆囊大部切除2例,胆囊造瘘3例,胆总管探查、T管引流2例。术前误诊7例,误诊率36.8%。除2例死于术后多脏器功能衰竭外,其余病例均治愈出院。结论急性非结石性胆囊炎病情急、进展快、临床表现不典型。早期诊断和及时手术治疗是提高其治愈率和降低死亡率的关键。     

急性结石性胆囊炎腹腔镜胆囊切除术148例临床探讨

目的:总结急性结石性胆囊炎LC手术的应用.方法:总结2009-10~2012-01本院收治的148例急性结石性胆囊患者行腹腔镜胆囊切除手术的经验.结果:148例中有143例完成腹腔镜手术,5例中转开腹,无胆管损伤,患者恢复快,无并发症发生.结论:具备熟练腹腔镜操作技术前提下,急性结石性胆囊炎早期行腹腔镜胆囊切除术在基层医院大有前景.     

急性非结石性胆囊炎临床特点及治疗方法探讨

目的探讨急性非结石性胆囊炎的病因、临床特点及诊治经验。方法对我院2000年～2007年间收治的25例急性非结石性胆囊炎患者的临床资料进行回顾性分析。结果24例行手术治疗，其中胆囊切除18例，胆囊造瘘3例，胆囊大部分切除2例，胆囊切除＋胆总管探查T管引流术1例。治愈23例，死亡1例，放弃治疗1例（其家属放弃治疗，追踪结果，病人回家后24小时内死亡）。结论急性非结石性胆囊炎起病急、进展快，病因复杂。提高对该病的认识有重要的临床意义，早期诊断和及时治疗是提高其治愈率和降低病死率的关键。     

CT引导下经皮胆囊造瘘术治疗高龄、危重急性胆囊炎患者

目的 评估CT引导下经皮胆囊造瘘术治疗高龄、危重急性胆囊炎患者的临床价值并对并发症等问题进行探讨。方法 对16例不能进行急诊胆囊切除手术的高龄、危重急性胆囊炎患者行CT引导下经皮经肝穿刺胆囊造瘘术，在胆囊内置放直径为7～8．5F猪尾引流管引流潴留胆汁，观察胆囊造瘘前后患者临床症状、体征及血白细胞计数的变化情况。结果 16例患者CT引导下经皮胆囊造瘘均获得成功。15例术后12～48h临床症状、体征缓解；1例术后无缓解。5例非结石性胆囊炎术后21～28d拔管后康复；10例结石性胆囊炎30～60d行胆囊切除手术。无严重并发症。结论 CT引导下经皮胆囊造瘘术是1种操作简便、安全有效的胆囊造瘘方法，对于治疗高龄、危重的急性胆囊炎患者具有较为重要的临床价值。     

腹腔镜胆囊切除术与开腹胆囊切除术在急性结石性胆囊炎中的对比

目的比较腹腔镜胆囊切除术与开腹胆囊切除术在急性结石性胆囊炎中的效果。方法将185例急性结石性胆囊炎手术患者随机分成两组,A组93例腹腔镜胆囊切除术,B组92例采用开腹胆囊切除术,比较两组手术时间、成功率、术后整体疼痛程度、并发症、术后平均住院时间以及切口美容效果。结果两组在手术时间、成功率、并发症无明显差异;A组整体疼痛程度、切口美容效果及术后平均住院时间方面明显优于B组。结论腹腔镜胆囊切除术对于急性结石性胆囊炎同样安全,有效,切口局部疼痛程度轻,美容效果更好,恢复快值得推广。     

42例老年急性结石性胆囊炎护理体会

急性结石性胆囊炎是普外科常见的急腹症,随着人口的老龄化,老年人急性结石性胆囊炎日益增多[1]。我院自2004～2011年共施行老年人急性结石性胆囊炎手术42例,均给予全程护理,取得满意疗效,现将护理体会报告如下。1临床资料1.1一般资料42例病例中男12例,女30例,年龄60～70岁32例,70～80岁10例。全部均有胆囊结石、慢性胆囊炎病     

胆囊炎及结石性胆囊炎99Tcm-EHIDA

目的　探讨胆囊炎及结石性胆囊炎胆囊显像特点。方法　对 14例无肝胆疾病的正常对照者和均经手术病理检查证实的包括胆囊炎患者 2 7例、结石性胆囊炎患者 38例 2个疾病组进行了99Tcm 二乙基乙酰苯胺基亚氨二乙酸 (EHIDA)肝胆显像及半定量分析。结果　与对照组比较 ,2个疾病组潜伏期 (LP)延长 ,胆囊排胆分数 (EF)及排胆率 (ER)均明显降低 ,差异均有高度显著性 (P均 <0 0 1)。胆囊平均排空曲线示 2个疾病组脂餐后胆囊排空潜伏期延长 ,呈“再充盈”现象。急性胆囊炎及慢性胆囊炎急性发作 6例、慢性胆囊炎 8例以及结石性胆囊炎 2 0例胆囊未见显影。结论　核素肝胆显像可早期预测胆囊疾病的发生并指导治疗     

47例阑尾切除术同时胆囊切除术治疗体会

目的 探讨阑尾炎合并结石性胆囊炎或胆囊息肉手术治疗体会.方法 对手术治疗的47例急慢性阑尾炎合并结石性胆囊炎或胆囊息肉患者进行回顾性分析.结果 阑尾炎合并结石性胆囊炎35例,合并胆囊息肉12例,其中急性阑尾炎37例,慢性阑尾炎10例 开腹手术31例,腹腔镜手术16例.开腹手术后切口感染2例 腹腔镜手术后发生胆漏1例,发生阑尾残端瘘1例.结论 单纯急慢性阑尾炎合并结石性胆囊炎或胆囊息肉患者可以选择性同时进行胆囊切除术和阑尾切除术.     

超声介入联合胆道镜对改善急性结石性胆囊炎患者胃肠功能的效果

急性结石性胆囊炎不仅发病急促,而且病情十分严重,直接影响患者健康,及时进行治疗是改善患者病情的关键性措施[1]。临床治疗急性结石性胆囊炎时,多以腹腔镜胆囊切除手术进行,较之开腹手术,该术式安全性高,操作时间短,而且创伤非常小,然而却存在医源性损伤风险,在治疗高危病情患者时,还可能会有并发症出现,导致该手术应用效果受到影响[2]。近年来,本院采取超声介入以及胆道镜联合治疗的方法对急性结石性胆囊炎患者进行治疗,而为了分析该疗法的效果,随机抽取2017年1月至2018年5月本院收治的70例急性结石性胆囊炎患者作对象展开分组观察,现回顾性分析如下。     

腹腔镜胆囊切除术2000例手术体会

我科于1991年10月～1994年9月，施行腹腔镜下胆囊切除术[LC]2000例，现就手术操作体会与几种困难情况的处理报告如下：临床资料一、一堆资料本组男‘’3例，女“‘’例，年龄”’～76岁，平均46．7岁。其中慢性结石性胆囊炎1769例，急性胆囊炎或胆囊积脓185例，胆囊息肉样病变41例，慢性非结石性胆囊炎5例。口服法胆囊造影不显影186例，有腹部手术史306例，195例逆行法切除胆囊。全组病例经手术和病理确定诊断。H、结果手术后平均3．gd出院，同期中转剖腹胆囊切除术58例，手术成功率971％，严重并发症10例[0·5％]，其中服漏致弥漫性腹膜…     

老年上消化道急性穿孔21例临床分析

目的探讨老年人上消化道急性穿孔的临床特点及治疗方法。方法回顾分析21例60岁以上上消化道急性穿孔患者的临床资料。结果21例中胃溃疡穿孔10例,十二指肠球部溃疡穿孔8例,胃癌穿孔3例,单纯穿孔修补术17例,胃大部分切除术3例,死亡2例。结论老年人上消化道穿孔病情发展快,病死率高,一旦确诊,合理选择术式,应尽早手术治疗。     

Gallbladder bile in cholecystitis: in vitro MR evaluation

Fifty-three samples of gallbladder bile were obtained at the time of cholecystectomy from patients with the clinical diagnosis of acute or chronic cholecystitis. Five bile samples from patients with clinically normal gallbladders also were obtained. Proton magnetic resonance (MR) relaxation times, protein content, and water content were determined for the bile samples, and the data were grouped according to pathologic diagnosis, which disclosed 11 cases of acute cholecystitis, 41 cases of chronic cholecystitis, and six normal gallbladders. There was no significant difference in the mean T1 and T2 values between the groups with acute and chronic cholecystitis. Patients with chronic cholecystitis were found to have more concentrated bile than those with acute cholecystitis. Protein content varied widely within both groups of patients. We conclude that T1 and T2 relaxation times do not reliably differentiate acute from chronic cholecystitis.     

腹腔镜胆囊切除术治疗急性胆囊炎90例效果分析

目的探讨腹腔镜胆囊切除术（laparoscopie cholecystectomy,Lc）治疗急性胆囊炎的临床应用。方法对我院2008年9月～2013年9月行腹腔镜胆囊切除术治疗急性胆囊炎的90例临床病例进行回顾性分析。结果90例临床病例中顺利完成LC84例,中转开腹6例。并发症发生2例。结论把握好手术时机、做好术前综合评估、熟练掌握手术操作技巧、掌握好中转开腹指征,LC术用于治疗急性胆囊炎是可以选择的治疗方案,能够减少并发症的发生。     

老年急性重症胆管炎的外科处理

目的探讨老年急性重症胆管炎外科治疗方式。方法回顾性分析58例老年急性重症胆管炎患者的外科治疗及预后情况。结果急诊手术44例,治愈40例,死亡4例;择期手术4例,全部治愈;非手术治疗10例,仅2例好转,死亡8例。结论老年急性重症胆管炎的诊断,在应用“急性重症胆管炎诊断标准”的同时,应以全身感染症候群和本病的局部体征为主要依据,结合过去胆道感染病史、B超检查等综合判定,明确诊断后及早手术,积极的围手术处理,是提高治愈率、降低并发症和死亡率的关键。     

Acute cholecystitis: ultrasonographic staging and percutaneous cholecystostomy.

Experience in the treatment of acute cholecystitis with percutaneous cholecystostomy in 29 high-risk and elderly patients is reported. The treatment group included 14 men and 15 women, 21 of whom were over 70 years of age. The suspected clinical diagnosis of acute cholecystitis was confirmed in all cases by ultrasonography (accuracy: 95.6%). The percutaneous cholecystostomy was successful in 27 of 29 cases and these patients had a sudden improvement in their clinical condition; failure of the procedure was due in one patient to dislodgement of the catheter and in another patient to the guide-wire slipping out of the gallbladder. Six patients complained of pain radiating to the right shoulder which disappeared within 30-60 minutes after the procedure. Twenty-three of the 27 patients subsequently underwent elective cholecystectomy. In 22 patients the ultrasonographic findings were compared with the histology; thus enabling us to establish an ultrasonographic staging of acute cholecystitis related to the seriousness of the disease. Percutaneous cholecystostomy is the treatment of choice in high-risk patients, in the elderly, as well as in young patients with impending perforation.     

腹腔镜胆囊切除术治疗急性结石性胆囊炎的临床研究

目的分析探讨腹腔镜胆囊切除术治疗急性结石性胆囊炎的临床疗效。方法回顾性分析2003年6月～2009年6月间入住我院的214例急性结石性胆囊炎患者临床资料,其中104例采用腹腔镜手术切除术,45例采用小切口胆囊切除术,65例采用传统胆囊切除术,比较其治愈率、住院时间及术后并发症,并对结果进行统计学分析。结果三种手术方式均获成功。传统胆囊切除术平均住院时间长（13.2±3.5）d,小切口胆囊切除术术后恢复快但并发症发生率较高（28.9%）,显著高于其他两组（P〈0.05或P〈0.01）;腹腔镜手术兼有术后恢复快（5.2±1.4）d,并发症少等特点。结论腹腔镜胆囊切除术创伤小,术后恢复快,并发症少,适合进一步推广。     

Chronic acalculous gallbladder disease: multiimaging evaluation with clinical-pathologic correlation

Despite the recent advances in hepatobiliary imaging, the diagnosis of chronic acalculous gallbladder disease remains difficult. A retrospective study was undertaken to assess the value of a multiimaging approach in detecting chronic acalculous gallbladder disease and in predicting which patients would obtain symptomatic relief after cholecystectomy. Of 199 patients with chronic cholecystitis, 26 (13%) had no gallstones. Of these 26, only 17 (65%) had symptoms related to chronic cholecystitis; in the remainder, the histologic diagnosis was made incidentally. After cholecystectomy, 13 (76%) of the 17 symptomatic patients obtained long-term symptomatic relief, while in four, the symptoms recurred. Among patients with histologic changes of chronic cholecystitis, biliary scintigraphy was the most sensitive technique (sensitivity, 89%). The sensitivity of sonography and oral cholecystography was 61.5% and 66%, respectively. However, for identifying symptomatic patients who may obtain long-term symptomatic relief after cholecystectomy, the accuracy of sonography, oral cholecystography, and biliary scintigraphy was 82%, 86%, and 38%, respectively. When two tests were in agreement the accuracy was 88%. For chronic acalculous cholecystitis, more than one study must be performed in order to make the correct diagnosis and to predict good results from cholecystectomy.     

老年人急性胆囊炎不同治疗方法的效果比较

目的 探讨老年人急性胆囊炎的最佳治疗方法。方法 回顾性分析2000年3月～2002年2月期间接受胆囊切除术18例，胆囊造瘘术8例，经皮经肝胆囊穿刺置管引流术12例，治疗的38例老年急性胆囊炎病人的临床资料。结果 胆囊切除术，胆囊造瘘术的并发症率和死亡率分别为38．9％、12．5％和11．1％、12．5％；经皮经肝胆囊穿刺置管引流术的并发症率和死亡率均为0。结论 经皮经肝胆囊穿刺置管引流术是治疗老年人急性胆囊炎的简便、有效而安全的方法。