慢性胰腺炎150例病因学分析

目的 探讨我国慢性胰腺炎的病因。方法 回顾性分析1990-2004年我院共收治的150例慢性胰腺炎患者病因。结果 150例慢性胰腺炎患者的病因中胆道系统疾病占36．0％，酒精中毒占25．3％，特发性占17．3％，其他病因包括自身免疫疾病、急性胰腺炎、遗传等。胆系统疾病中以胆囊结石为最多见，其次为胆管结石和胆囊炎。结论 我国慢性胰腺疾病的病因，以胆道系统疾病为主，而酒精性因素有上升趋势。自身免疫系统疾病作为胰腺疾病的病因正逐渐受到重视。     

急性胰腺炎患者649例发病原因分析及对策探讨

目的探讨急性胰腺炎患者的发病原因，提高对急性胰腺炎的认识，并对其防治措施进行探讨。方法对我科2003年1～12月收治的649例急性胰腺炎患者发病因素进行回顾性分析。结果649例患者发病与9种因素有关，主要因素有饮食因素、胆道疾病、高脂血症、酗酒等，其中与1种因素有关者占65．9％，与2种及以上因素有关者占34．1％。结论急性胰腺炎患者发病因素多而复杂，轻症和重症急性胰腺炎发病因素无差异。部分患者发病原因仍不明确。对于这部分患者应该尽可能寻找原因，以便采取相应防治措施，提高其治愈率，降低复发率。     

磁共振胆胰成像评估不明原因急性胰腺炎病因的价值

目的：评估磁共振胆胰成像（MRCP）在不明原因急性胰腺炎（AP）病因诊断中的价值。方法：选取2006年10月-2008年10月住院治疗的45例不明原因急性胰腺炎患者．进行MRCP检查。结果：在所有45例AP患者中,MRCP检查发现有异常者15例,占33％。病因有胆胰管汇合部异常、胰腺肿瘤、胰腺钙化、胰管结石和胰腺分裂等。结论：MRCP对不明原因AP患者病因诊断有一定价值。     

妊娠合并急性胰腺炎61例报告及文献复习

目的探讨妊娠合并急性胰腺炎的病因、临床特点及防治措施。方法回顾性分析我院收治的61例妊娠期急性胰腺炎患者的临床资料，并结合1989至2004年中文科技期刊全文数据库关于妊娠合并急性胰腺炎298例的文献资料进行综合性分析。结果359例中重症急性胰腺炎（SAP）占35．4％。误诊率为8．6％；病死率10．8％（SAP占29．1％），新生儿及胎儿病死率22．8％；多发生在妊娠的中晚期（80．7％）；病因依次为：胆道疾病（47．4％）和高脂血症（39．8％）。结论对于妊娠合并急性胰腺炎患者治疗胆道疾病、高脂血症是预防的关键；早期诊断、积极中西医结合治疗是治疗的重要环节；正确掌握终止妊娠时机及手术指征同样重要。     

急性胆源性胰腺炎39例外科治疗体会

急性胰腺炎的发病因素有急性胆道感染、胆道梗阻、高脂饮食、酒精中毒、外伤等。虽发病机理尚不完全清楚 ,但它与胆道疾病 ,特别是与胆石的关系已确认。国内外文献一致认为 :胆道疾病 (含胆结石 )占胰腺炎全部发病因素的 5 5 %～ 6 5 % [1] 。我科 1990年 5月～ 2 0 0 0年 4月共收治急性胆源性胰腺炎 39例 ,分析如下 :1　临床资料1 1　一般资料　急性胆源性胰腺炎 39例 ,其中水肿性 30例 ,坏死性 9例。男 17例、女 2 2例 ,年龄 2 9～ 80岁 ,平均 49 5岁。合并胆囊结石 38例(92 3% ) ,35例 (90 % )为胆囊多发细小结石 ;Ｂ超显示 30例 (76 % …     

老年急性胰腺炎118例临床特点分析

现就我院2000-01～2006-07收治的急性胰腺炎（AP）118例临床特点分析如下。 1 临床资料 1．1 一般资料 本组男63例，女55例，年龄60～91（平均67．2）岁。病因：胆源性105例，占89．0％；饮食因素9例，占7．6％；手术因素2例（阑尾切除、胆管切开取石术后各1例），占1．7％；余为特发因素。临床表现：腹痛116例，占98．3％；呕吐78例，占66．1％；腹膜刺激征45例，占38．1％；发热57例，占48．3％。     

急性胰腺炎的诊断与治疗(附66例分析)

本文收集1985～1995年共收治急性胰腺炎66例,现报告如下。 1 临床资料 1.1 一般资料:男性48例,女18例,年龄20～61岁,平均38.4岁,年龄分布20～29岁15例,30～39岁26例,40～49岁15例,50岁以上8例,男女之比2.7:1,男多于女。 1.2 病因:胆道疾病21例,占31.8％,暴饮暴食24例,占36.3％,酗酒8例占12.1％,原因不明13例占19.6％。 1.3 临床表现:腹痛66例(100％),恶心呕吐54例(81.8％),发热34例(51.5％),腹泻8例     

一例重症坏死性胰腺炎合并胰腺假性囊肿患儿的护理

<正>急性胰腺炎是多种病因引起的胰腺分泌各种消化溶解酶引起胰腺及周围组织自身消化的病理演变过程。小儿急性胰腺炎的病因有别于成人,成人最常见的原因是胆道疾病和饮酒,而在儿童,特发性胰腺炎、胰腺创伤、先天性胆道异常、胆道结石及药物副作用为主要发病原因[1]。小儿急性胰腺炎以4岁以上儿童为多见,发病急、病势危重,救治不当死亡率高[2]。胰腺假性囊肿是急慢性胰腺炎的并发症之一。我科2013年11月收治1例急性坏死性胰腺炎     

胎盘早剥27例临床分析

【目的】探讨胎盘早剥的病因、临床表现及诊治。【方法】对27例胎盘早剥的临床资料进行回顾性分析。【结果】胎盘早剥的发生率为0.41％,病因以妊娠高血压综合征为首位,占37．04％;其次为外伤,占22．22％,第三为不明原因,占18．52％。临床表现以腹痛、阴道流血多见,分别占62．96％、48．15％,体征主要为子宫敏感性增高及胎心改变,均占59．26％。产前诊断符合率为55．56％,易误诊为早产或先兆临产。分娩方式以剖宫产为主,占92．59％。围产儿病死率33．33％。【结论】加强孕期保健宣教,减少发病的高危因素,对胎盘早剥进行早期诊断和治疗,有望减低胎盘早剥的发生率和围产儿死亡率。     

重症急性胰腺炎66例分析

现将我院1998／2006年治疗的重症急性胰腺炎（SAP）66例分析如下。 1临床资料 1．1一般资料本组均符合1997年全国胰腺炎外科学术会议关于重症腋腺炎诊断标准。男45例，女21例，年龄20～75（平均46）岁。发病原因：胆道疾病38例，暴食10例，饮酒9例，高脂血症5例，原因不明4例。保守治疗48例，手术治疗18例。     

急性胆囊炎的临床、病理与影像学对照研究(附39例报告)

目的:探讨急性胆囊炎的临床、病理、影像学特征,以便提高对本病的认识。材料与方法:对39例典型病例的临床表现、病理与影像学征象的回顾分析。结果:CT表现为胆囊壁增厚39例(100%),胆囊与肝脏间隙模糊30例(78%),胆囊扩张25例(64%),胆囊周围黏连和积液20例(51%)。39例急性胆囊炎的CT和B超的确诊率分别为92.3%(36/39)、100%(39/39)。结论:熟悉和掌握急性囊炎的影像表现特征,对急性胆囊炎早期诊断、及时治疗有重要意义,B超确诊率高,可用于检查随访。     

731例老年人胆囊疾病临床分析

目的为更好地诊治老年人胆囊疾病。方法对731例体格检查发现的老年期和老年前期胆囊疾病患者进行了随访,观察其症状、并发症及手术情况。结果老年期胆囊结石的患病率明显高于老年前期,在60—69岁组为20．2％,70～79岁组为32．9％,80岁及以上组为48．0％;而在老年前期为9．5％。胆囊息肉则与年龄关系不如胆囊结石明显。70．0％的胆囊疾病患者无症状,典型发作随增龄而减少;胆囊疾病合并冠心病在老年期随增龄而增加,部分患者胆囊切除后心脏症状缓解。结论老年人胆囊疾病症状多样,与心脏疾病关系密切,应该密切随访．适时手术。     

Possibilities of laparoscopic decompression of the gallbladder in middle-aged and elderly patients with diseases of the biliary tract]

It is established that laparoscopic cholecystostomy presents the most acceptable method of gall bladder decompression in acute cholecystitis patients of advanced age comprising a high-risk group for surgery. Cholecystostomy efficiency reaches 97.2%. In case the procedure is not feasible in acute cholecystitis patients with intrahepatic position of the gall bladder or perivesicular adhesions the preference should be given to transhepatic drainage of the gall bladder whose effectiveness is 88.5%. An expedient method of laparoscopic decompression of the biliary tracts in mechanical jaundice due to tumor obstruction of the terminal part of the common bile duct is the formation of an external biliary fistula and "continuous" direct drainage of the gall bladder warranting satisfactory results in 93.3 and 100% of cases, respectively. Patients with a 1.5-week history of mechanical jaundice are not recommended transhepatic drainage, in longer duration of the jaundice (more than 1 month) it becomes contraindicated.     

Cefoperazone concentrations in bile and gall bladder wall after intravenous administration.

Cefoperazone concentrations in the common duct bile, gall bladder bile, and gall bladder wall were determined in four patients with cholelithiasis and one patient with carcinoma of the head of the pancreas, all of whom had normal renal functions. Within 65 min after a 1-g intravenous administration, maximum concentrations ranged from 373.4 to 3,100 micrograms/ml in common duct bile and from 6.8 to 680 micrograms/ml in gall bladder bile. Cefoperazone concentrations per gram of the gall bladder wall ranged from 16.8 to 48.0 micrograms.     

经腹腔镜逆行胆囊切除术在临床中的应用分析

目的探讨经腹腔镜胆囊切除术中采取逆行胆囊切除在临床中的应用。方法回顾总结我院100例手术，均采取腹腔镜下逆行切除胆囊。结果经采取该术式均无胆瘘、胆管损伤等并发症的发生。结论经采取腹腔镜逆行胆囊切除术对于复杂性胆囊是一种行之有效的方法，降低了胆管损伤及中转开腹率。     

Paradoxical gall bladder function in hepatitis

A new sonographic gall bladder finding associated with viral hepatitis is described. Five patients were referred for abdominal sonography. Their gall bladder showed thickened walls (> 3mm) and virtually complete contraction despite prolonged fasting. After a full breakfast, the patients underwent postprandial re-examination. This re-examination, 1–3 h later, showed well-defined fluid-filled gall bladder lumen in all cases. The final diagnosis of all patients was acute viral hepatitis. It was concluded that the gall bladder may be contracted after fasting, and undergo postprandial distension in cases of viral hepatitis.     

Intraabdominal tissue concentration of ertapenem

OBJECTIVES: Ertapenem, a class I carbapenem, is approved for the treatment of mild to severe intraabdominal infections, but its in vivo concentrations in intraabdominal tissues are unknown. The purpose of this study was to determine the concentration of ertapenem in intraabdominal tissue. PATIENTS AND METHODS: After informed consent 48 patients, 23 female and 25 male with a median age of 58 years (34-81), requiring surgical intervention at intraabdominal organs were enrolled. Patients received 1 g of ertapenem intravenously for perioperative prophylaxis. Tissue samples were taken after resection of parts of the organs. Plasma samples were taken when tissue samples were taken. Drug concentrations were determined by liquid chromatography/mass spectrometry. An ANCOVA test (analysis of covariance) was performed to assess organ-specific differences in ertapenem concentration and penetration ratios. RESULTS: Mean+/-SD ertapenem tissue concentration (mg/kg) was 16.0+/-8.8 in the gall bladder, 12.1+/-5.3 in the colon, 7.0+/-5.7 in the small bowel, 4.5+/-2.3 in the liver and 3.4+/-2.9 in the pancreas. The mean tissue/plasma ratio was 0.19 (colon), 0.17 (small bowel), 0.17 (gall bladder), 0.088 (liver) and 0.095 (pancreas). The ANCOVA test revealed statistically significant organ-specific differences in ertapenem tissue concentration in the gall bladder versus liver/pancreas and in tissue penetration for the colon versus liver/pancreas. CONCLUSIONS: These pharmacokinetic results support the assumption that ertapenem is suitable for the treatment of intraabdominal infections.     

Unusual echographic appearance of a Courvoisier gall bladder.

A patient who had been jaundice for more than four months was examined with diagnostic ultrasound. Ultrasound examination revealed that the patient had a solid-appearing mass in the region of the gall bladder, in addition to findings diagnostic of obstructive jaundice. A probable mass was also noted in the head of the pancreas. The clinical data and representative echographic pictures are presented to emphasize the point that sludge within the gall bladder is echogenic and appears more solid than cystic on a standard echographic examination.     

胆囊炎声象图改变在超声诊断中的价值

目的 :揭示胆囊炎声像图特征 ,为胆囊炎诊断和治疗提供依据。方法 :分析 48例非萎缩性胆囊炎超声图象改变 ,经上腹部常规行纵切、斜切、横切扫描 ,重点观察胆囊壁、胆囊腔的回声情况。结果 :对 48例胆囊炎声象图进行统计 ,以胆囊壁回声改变为主 2 9例 ,以胆囊腔回声改变为主 19     

Spontaneous Perforation of Acalculous Gall Bladder Presenting as Acute Abdomen

Background

Acute abdominal pain is commonly encountered in the emergency department (ED), but a diagnosis of gall bladder perforation (GBP) is rarely considered in the absence of predisposing factors.

Objectives

This article will highlight the risk factors, diagnosis, and management of GBP, a rare but potentially life-threatening biliary pathology.

Case Report

A 73-year-old diabetic man presented to the ED with a 12-h history of severe upper abdominal pain. He was hemodynamically stable, but abdominal examination showed distention, guarding, and diffuse tenderness. Abdominal X-ray study showed mildly distended small bowel loops without any air-fluid levels. Abdominal sonography revealed mild ascites and pericholecystic fluid collection but no gall bladder calculi. Laboratory reports documented a white blood cell count of 13,700/mm³ and elevated serum amylase of 484 IU/L. A contrast-enhanced computed tomography (CT) scan of the abdomen suggested discontinuity of the gall bladder wall along with fluid accumulation in the pericholecystic, perihepatic, right subphrenic, and right paracolic spaces. In view of the possibility of spontaneous GBP developing as a complication of acute acalculous cholecystitis, laparotomy was planned. At surgery, several liters of bile-stained peritoneal fluid were aspirated and inspection of the gall bladder revealed a perforation at the fundus. After cholecystectomy, the patient had an uneventful recovery.

Conclusion

The diagnosis of spontaneous gall bladder perforation should be considered in elderly patients presenting to the ED with symptoms and signs of peritonitis even in the absence of pre-existing gall bladder disease. Abdominal CT scan is an invaluable tool for the diagnosis, and early surgical intervention is usually life-saving.