B超诊断胆囊息肉样病变与病理对照分析

目的：本通过对胆囊息肉样病变的超声诊断与病理结果分析，以探讨不同类型胆囊息肉样病变的声像图特征，为早期分类诊断提供依据。方法：对75例胆囊息肉样病变患的超声图像与手术后病理诊断进行对照分析。结果：胆固醇性息肉64例，腺瘤并局部不典型增生及癌变4例，单纯性腺瘤2例，粘膜息肉样变1例，慢性胆囊炎4例。在病理诊断为胆囊息肉样病变中合并慢性胆囊炎61例，合并胆囊结石3例。超声与病理诊断符合率为94．67％。结论：应用超声图像分析，可以提高对胆囊息肉样病变的良性病变与恶性病变及病理分型的诊断率，特别是对胆囊癌前病变及早期胆囊癌的预防和早期诊断有重要价值。     

胆囊息肉样变51例分析

目的：探讨胆囊息肉样变（PLG）的诊断及手术指征。方法：对B超和病理诊断的胆囊息肉样变51例进行回顾分析。结果：胆固醇性息肉以多发为主,本组为87.8%,平均直径3～7 mm。胆囊腺瘤以单发为主占76.9%（10/13）。腺瘤癌变4例,占30.7%,直径均〉15 mm,伴轻中度不典型增生2例,重度不典型增生1例。结论：（1）B超是诊断PLG的首选方法;（2）单发,直径≥10 mm,基底宽,合并胆囊炎胆囊结石,有右上腹痛症状,息肉短期内增长较快者作为手术指征;（3）多发胆固醇性息肉可定期随访。     

胆囊息肉样病变超声显像与病理对照研究

本文分析我院手术治疗的胆囊息肉样病变３５例病理诊断结果，其中胆固醇性息肉２５例，乳头状腺瘤３例，单纯性腺瘤２例，上皮乳头样增生１例，上皮腺瘤样增生１例，粘膜腺瘤局限性癌变１例，慢性胆囊炎２例，超声与病理诊断符合率为９４．３％，探讨了不同类型胆囊息肉样病变的声像图特征。     

胆囊息肉样病变超声显像与病理对照研究

本文分析我院手术治疗的胆囊息肉样病变３５例病理诊断结果，其中胆固醇性息肉２５例，乳头状腺瘤３例，单纯性脉瘤２列，上皮乳头样增生１例，上皮腺瘤样增生１例，粘膜腺瘤局限性癌变１例，慢性胆囊炎２例，超声与病理诊断符合率的９４．３％，探讨了不同类型胆囊息肉样病变的声像图特征。     

B超诊断胆囊息肉样病变与病理对照分析

目的：分析86例B超诊断不同类型的胆囊息肉样病变（PLG）声像图特征，探讨B超的诊断价值。方法：对B超和病理诊断的PLG进行回顾性分析。结果：本组胆固醇息肉72例，乳头状腺瘤5例，单纯腺瘤6例，上皮砂样增生1例，上皮腺瘤样增生1例，粘膜腺瘤局限性癌变1例，B超诊断与病理诊断对照符合率为93．1％，结论：B超诊断各种类型的PLG，敏感性高，便于动态观察随访，对该病早期诊断和治疗提供了可靠依据。     

胆囊息肉样变42例声像图分析

目的 回顾性分析胆囊息肉样病变42例声像图特征,旨在提高超声诊断的准确性.方法 对42例经病理证实的胆囊息肉样病变的声像图与病理进行对比分析.结果 胆固醇息肉21例,占50%;炎性息肉4例,占9.5%;单纯性腺瘤8例,占19%;乳头状腺瘤8例,占19%;胆囊肌腺瘤1例,占2.3%.有4例为2种类型合并发生,伴慢性胆囊炎者9例,伴胆囊结石者4例,单发者28例,多发者14例.超声诊断与病理诊断符合率为93.6%.结论 声像图根据息肉数目、大小、形态、基底宽窄及血流情况,可初步判断其性质,为临床提供了必要的诊断信息.     

胆囊息肉样病变超声诊断与病理对照

胆囊息肉样病变系指胆囊内壁呈息肉状隆起的良性病变。以往罕见。近年B超显象的广泛应用,该病检出率日趋增多。本组64例术前经B超检查并为病理证实。其中5例腺瘤(1例为腺瘤癌变);59例胆囊瘤样增生:35例胆固醇息肉、20例炎性息肉、3例腺瘤样息肉、1例腺肌病。10/64例合并胆石。B超诊断与病理符合率为93.8％。声像图与病理对照具以下特点:(1)其声像图大多相似,表现为胆囊壁向腔内     

肿瘤性与非肿瘤性胆囊息肉样病变的超声鉴别诊断

目的探讨超声检查对胆囊肿瘤性与非肿瘤性息肉样病变的鉴别诊断价值。方法对所选患者胆囊进行多切面超声检查及病理检查,记录并分析胆囊息肉样病变的部位、大小、数目、形态及声像图特征。结果167例胆囊息肉样病变中,肿瘤性病变17例占10．18％,非肿瘤性病变150例占89．82％。结论实时超声显像有助于从胆囊息肉样病变中及早发现肿瘤性病变。对于5-10mm胆囊腺瘤恶性变和胆囊癌声像图缺乏特异性。     

胆囊息肉样病变超声显像与病理对照研究

本文分析我院手术治疗的胆囊息肉样病变35例病理诊断结果,其中胆固醇性息肉25例,乳头状腺瘤3例,单纯性腺瘤2例,上皮乳头样增生1例、上皮腺瘤样增生1例,粘膜腺瘤局限性癌变1例,慢性胆囊炎2例,超声与病理诊断符合率为94.3%。探讨了不同类型胆囊息肉样病变的声像图特征。     

胆囊息肉样变的声像图分析

胆囊息肉样变又称胆囊隆起性病变,多无症状,85％的患者在例行体检中发现。我国成年人中,胆囊息肉样病变发生率约为5％。胆囊息肉样变病理学分为：胆固醇息肉（又称胆固醇沉着症）、炎性息肉、胆囊腺瘤（包括单纯性腺瘤和乳头状腺瘤）及胆囊肌腺瘤（腺肌增生症）。本组对42例经手术病理证实的胆囊息肉患者的声像图分析报告如下。     

Acoustic artifacts and reverberation shadows in gallbladder sonograms: Their cause and clinical implications

From among more than 7000 sonographic examinations of the gallbladder performed over a period of 2 years, different types of acoustic artifacts were observed in 42 patients. Artifacts originated in the gallbladder wall in 37 cases and within the lumen in 5 cases. Eighteen patients had symptoms related to the hepatobiliary area. Twenty-four patients were fully asymptomatic although cholelithiasis was demonstrated in 8. In 21 cases (50%) some type of gallbladder pathology was associated with the presence of acoustic artifacts. Thirteen patients were cholecystectomized and the associated gallbladder pathology consisted of cholelithiasis (N=5), cholesterolosis (N=2), adenomyomatosis (N=2), emphysematous cholecystitis (N=2), and acute cholecystitis (N=2). In 3 of these patients a sonographic/pathologic correlation was established. Only 5 of the 18 symptomatic patients presented acoustic artifacts in an otherwise normal gallbladder. Recognition of those pathological conditions favorable to the appearance of artifacts and reverberation shadows is extremely useful for differentiating merely clinically irrelevant anomalies from those that require prompt management.     

胆囊息肉样病变手术切除指征临床分析

目的探讨胆囊息肉样病变（PLG）手术切除指征。方法对124例PLG病人术前B超、手术切除标本及术后病理资料进行回顾性分析。结果手术标本示PLG直径〈1 cm者共72例,≥1 cm者52例。病理示：胆固醇性息肉59例（47.6%）,胆囊腺瘤35例（28.2%）,炎性息肉18例（14.5%）,胆囊癌8例（6.5%）,其他4例（3.2%）。良性组与潜在恶性及恶性组病人年龄、息肉数目、PLG大小、PLG形态、胆囊结石、血流比较差异均有显著性（χ2=4.1~71.6,P〈0.05）。结论 PLG符合下列条件之一均应手术切除：病人年龄≥50岁的单发息肉,并存胆囊结石,息肉直径≥1 cm,广基息肉或血流信号丰富,有临床症状。     

Biliary levels of ceforanide.

Ceforanide levels in plasma, gallbladder bile, gallbladder tissue, and common bile duct were studied in 10 patients with normal biliary tracts and in 35 patients with biliary disease at various intervals after intravenous injection of 1 g of the drug. Peak blood levels were obtained within 1 h of administration (mean, 67 +/- 15 micrograms/ml). Patients with a normal bilary tract, as well as patients with chronic cholecystitis and a patent cystic duct, achieved high gallbladder bile levels of ceforanide within 2 h (mean, 76 +/- 25 micrograms/ml) and attained even higher levels by 4 h (mean, 182 +/- 51 micrograms/ml). However, all patients with chronic cholecystitis and an occluded cystic duct had very low drug concentrations in the gallbladder bile (14 +/- 7 micrograms/ml at 2 h). Despite this difference in gallbladder bile levels, ceforanide levels of 21 +/- 3 micrograms/g were achieved at 1 to 3 h in gallbladder tissue in both groups with chronic cholecystitis. The concentration of ceforanide in common bile duct was 149 +/- 59 micrograms/ml at 2 h after administration, with levels over 60 micrograms/ml present from 1 to 4 h after administration. These results indicate that ceforanide reaches high levels in the biliary tract. Its potential value in the prevention and treatment of biliary infections should be assessed.     

WWOX抑癌基因和Nrf2转录因子在胆囊癌组织中的表达及相关性研究

[目的]研究WWOX抑癌基因和Nrf2转录因子在原发性胆囊癌(PGC)组织中的表达及其与临床病理的关系,以及WWOX和Nrf2表达的相关性.[方法]收集胆囊癌标本54例、胆囊腺瘤标本20例、慢性胆囊炎标本20例.应用免疫组织化学方法检测WWOX蛋白和Nrf2蛋白的表达情况,同时收集胆囊癌患者的临床病理资料,并将结果进行分析.[结果](1)WWOX蛋白在胆囊癌、胆囊腺瘤及慢性胆囊炎组织中阳性表达率分别为48.1％ (26/54)、75.0％ (15/20)和85.0％(17/20),差异有统计学意义(P＜0.01).WWOX蛋白阳性表达与病理学分级(P＜0.01)、Nevin分期(P＜0.05)、淋巴结转移(P＜0.01)有关.(2)Nrf2蛋白在胆囊癌、胆囊腺瘤及慢性胆囊炎组的阳性表达率分别为66.7％ (36/54)、20.0％ (4/20)及5.0％(1/20),差异有统计学意义(P＜0.01).Nrf2蛋白阳性表达水平与病理学分级(P＜0.05)、Nevin分期(P＜0.01)、淋巴结 转移(P＜0.01)有关.(3)WWOX阳性表达与Nrf2阳性表达均与患者的性别、年龄、病理类型及是否伴有结石无显著关系(P＞0.05).(4) WWOX阳性表达与Nrf2阳性表达呈负相关(r=-0.420,p＜0.01).[结论]WWOX和Nrf2表达可能是反映胆囊癌发生、进展、生物学行为和预后的重要生物学标记物;WWOX和Nrf2蛋白在胆囊癌中的表达呈明显的相关性,可能在胆囊癌的发生中起协同作用.     

黄色肉芽肿性胆囊炎的临床诊断及治疗分析

目的探讨黄色肉芽肿性胆囊炎的诊断与治疗,提高对该疾病的认识及诊治水平。方法对2004年9月2009年10月确诊为黄色肉芽肿性胆囊炎的15例患者资料进行回顾性分析。结果确诊为黄色肉芽肿性胆囊炎3例,慢性胆囊炎8例,胆囊癌4例。10例行胆囊切除术,2例行胆囊切除加胆总管探查T管引流术,1例行胆囊大部切除加十二指肠瘘修补术,1例行胆囊大部切除加胃瘘修补术,1例行胆囊切除加胆囊床部肝组织切除。术后并发胆瘘1例,切口感染2例。无死亡病例。结论黄色肉芽肿性胆囊炎术前难诊断,术中冷冻切片检查和术后病理检查是诊断的关键,手术切除胆囊是主要治疗方法。     

Performance and interpretation of focused right upper quadrant ultrasound by emergency physicians

The objectives of this study were to determine the accuracy of Emergency Physicians (EP) performing focused right upper quadrant (RUQ) ultrasound, to quantify how sonographic experience affects accuracy for gallbladder pathology, and to establish the time needed to complete a focused RUQ ultrasound. A convenience sample of patients with suspected gallbladder disease received a focused RUQ ultrasound by an EP. Sonographic findings, number of previous RUQ ultrasounds performed, and time for examination completion were recorded. Each patient then had a formal RUQ ultrasound by a sonographer blinded to the focused RUQ ultrasound results. Focused RUQ and formal ultrasound findings were compared, with the exception of the sonographic Murphy sign, which was compared to pathology reports. One hundred nine patients were enrolled. Fifty-one had gallstones. Forty-nine were detected by EPs, yielding a sensitivity of 96% [95% confidence interval (CI).87-.99]. Of the 58 patients without gallstones, 51 were correctly diagnosed by EPs (specificity = 88%, 95% CI.77-.95). The sonographic Murphy sign was present during 54 emergency examinations, but in only 24 formal studies. When compared to pathology reports, the emergency sonographic Murphy sign had a sensitivity of 75% compared to the formal ultrasound sensitivity of 45% for acute cholecystitis. EPs were less accurate for other sonographic findings, and level of experience had little effect on sensitivity or specificity for detecting gallstones. Eighty-three percent of emergency studies were completed in less than 10 min. Gallstones are accurately detected by EPs in a timely fashion. Additionally, compared to the radiologist's interpretation, the EP-detected sonographic Murphy sign was more sensitive for diagnosing acute cholecystitis.     

慢性胆囊炎与胆结石形成关系的超声研究

目的 探讨慢性胆囊炎与胆结石形成的关系.方法 慢性胆囊炎、胆结石患者及正常人各20例采用超声法进行脂餐前后胆囊容积及排空率的测定.结果 结石组较对照组脂餐前、餐后各期胆囊容积增大,排空率降低(P＜0.05).慢性胆囊炎组餐后胆容积及排空率与对照组无显著性差异(P＞0.05),但空腹容积显著增大(P＜0.05).结论 慢性胆囊炎患者存在胆囊运动功能异常,这种异常可能是胆囊结石形成的原因之一.     

Sonographic findings in cases of missed gallstones

PURPOSE. We retrospectively evaluated sonographic findings in 946 cases of gallstones to determine whether the false-negative rate for gallstone detection by sonography has decreased as a result of technologic advances over the past 15 years. METHODS: We reviewed preoperative sonographic reports, operative notes, and pathologic reports for 614 women and 332 men (ages 22-78 years) seen over a 2.5-year period and compared sonographic findings with surgical pathologic findings after cholecystectomy. Sonograms for patients whose gallstones were missed on sonography were reviewed by 3 board-certified radiologists. RESULTS: Preoperative sonography of the gallbladder accurately predicted the presence of gallstones in 934 cases (98.7%). Gallstones were not identified by sonography in the remaining 12 cases. In those cases, sonography revealed polyps in 5, sludge in 5, sludge plus a polyp in 1, and neither stones nor polyps in 1. Thus, the false-negative rate was 1.3%. CONCLUSIONS: Despite improvements in sonographic technology, detection of small gallstones remains difficult in some cases. Adherent gallstones can mimic gallbladder polyps. Our false-negative rate for detection of gallstones was no different from that in earlier studies.     

Diagnostic values of gallbladder hyperperfusion and the rim sign in radionuclide angiography and hepatobiliary imaging

The diagnostic values of hyperperfusion to the gallbladder fossa and the rim sign were retrospectively evaluated in 24 histopathologically proven cases of gallbladder disease. Although 12 of 13 patients (92%) with acute cholecystitis had nonvisualization of the gallbladder, the positive predictive value with this finding was 71%. However, when the finding was associated with hyperperfusion to the gallbladder fossa or the rim sign, the positive predictive value with both (90%) was markedly increased compared to the prevalence ratio of 54%. Such a combination could be useful for preserving a high positive predictive value in the diagnosis of acute cholecystitis.     

胆囊息肉样病变134例分析

目的探讨胆囊息肉样病变(PLG)的手术适应证和手术方式。方法回顾分析我院2000年1月至2004年12月间134例手术治疗的胆囊息肉样病变的临床和病理资料。结果超声检查胆囊息肉样病变的诊断率为94.77%,年龄大于50岁、超声提示息肉直径大于1 cm和单个息肉者为癌变的高危因素。其中75例行腹腔镜胆囊切除术(LC),12例为胆囊腺瘤,其余均为胆固醇性息肉,无并发症发生。结论适当放宽手术指证,对胆囊癌高危人群施行手术治疗,能有效地预防胆囊癌变;LC是治疗胆囊息肉样病变的理想方法。