B超对原发性胆囊癌的诊断价值

目的探讨B超在胆囊癌早期诊断中的应用价值。方法随机选取洛阳市石化医院特检科3 0例已经病理确诊的胆囊癌患者,对比分析患者之前的B超表现特征及诊断结果,以分析B超对胆囊癌早期诊断的准确性。结果 3 0例胆囊癌患者中,1 8例患者经腹部B超明确诊断且与术后病理相符合;6例患者首次腹部B超检查怀疑胆囊癌,建议复查;6例患者首次腹部B超未发现异常。与病理诊断结果呈正相关,且相关关系密切。结论 B超在胆囊癌中的诊断价值较高,准确率较高,是现阶段胆囊癌最方便、快捷的诊断方式。在筛查诊断胆囊癌时应当首选B超检查。     

胆囊癌22例诊治探讨

目的探讨原发性胆囊癌的诊断与治疗。方法对手术和病理确诊的22例胆囊癌病例的临床资料进行回顾性分析,并随访生存状况。结果B超和CT等影像诊断技术和腹腔镜技术的普及,有助于胆囊癌的早期诊断,但目前临床上仍以中晚期胆囊癌占绝大多数,提高早期诊断率是关键。结论胆囊癌早期诊断是提高生存率的关键,手术切除仍是最有效的治疗方法,胆囊癌晚期疗效差。     

早期胆囊癌与胆囊息肉样病变B超的鉴别诊断

目的：探讨分析早期胆囊癌与胆囊息肉样病变B超的鉴别诊断。方法：回顾分析2012年2月至2014年2月到我院就诊的56例早期胆囊癌与胆囊息肉样病变患者的影像资料,探讨B超对早期胆囊癌与胆囊息肉样病变的诊断方法及应用价值。结果：56例患者中,有25例患者被诊断为胆囊息肉,其中女性20例（80％）,平均年龄（45．1±13．2）岁;患者胆囊腺瘤13例,女性患者9例（69．2％）,平均年龄（54．1±13．5）岁;胆囊癌18例,女性患者13例（72．2％）,平均年龄〈62．1±6．9）岁。结论：B超在早期胆囊癌与胆囊息肉样病变B超的鉴别诊断中灵敏度较好、特异性较高,有重要的-临床价值。     

原发性胆囊癌29例临床分析

目的　探讨如何提高原发性胆囊癌的早期诊断和有效治疗的方法。方法　对 2 9例原发性胆囊癌一般情况、诊断、治疗、病理分型、临床分期和治疗效果等进行分析。结果　首发症状和体征多为腹痛、黄疸及腹块伴腹痛的性质和节律不同程度的改变 ,诊断主要依靠B超和CT ,手术切除率为 51 .7% ,治疗效果满意。结论　提高警惕、尽早期地作出胆囊癌的诊断是提高治愈率的关键 ,手术治疗是胆囊癌治疗的惟一有效方法。     

原发性胆囊癌误诊原因探讨

原发性胆囊癌由于没有特征性的临床表现,同时又缺乏特异性的检查手段,在临床上往往容易误诊,以致胆囊癌的治疗效果不佳。目前如何提高原发性胆囊癌术后5年存活率,关键在于早期正确诊断。本文就我     

B超对胆囊癌诊断价值探讨

胆囊癌临床上并不少见,但由于胆囊癌起病隐匿,早期诊断不易。我们自1980年以来经手术病理证实胆囊癌32例,其中术前行B超检查27例。现结合临床对B超对胆囊癌的诊断价值作一探讨。 1.临床资料 1.1 一般资料 本组男性12例,女性15例。年龄34～88岁,平均57.96岁,大于50岁者17例占62.96％。 1.2 临床表现 右上腹痛20例占74.07％,发热6例占22.22％,恶心呕吐10例占37.04％,黄疸4例占14.81％,腹部包块1例占3.7％。无症状1例占3.7％。 1.3 胆囊癌B超诊断依据:①胆囊自然形态失常:②     

原发性胆囊癌15例临床分析

原发性胆囊癌是胆道系统常见的恶性肿瘤,本院自1989年7月至1996年6月共收治原发性胆囊癌15例。为提高其诊治水平,现结合文献分析报告如下。临床资料1．一般资料:男性5例,女性10例,男女之比1:2。年龄50岁至79岁,平均63.5岁,其中60岁以上11例(73.3%)。2．临床表现:全组均有胆道病史。多数病例有近期发作史。阻塞性黄疸3例。术前全部行B超检查。4例行CT检查。B超检查中5例、CT检查中3例初诊为胆囊癌。其余分别诊断胆囊炎、胆石症或胆囊息肉。     

原发性胆囊癌22例误诊分析

目的分析原发性胆囊癌误诊的原因。方法回顾性分析25例原发性胆囊癌患者的临床资料。结果在25例原发性胆囊癌患者中,误诊22例,误诊率为88%。误诊原因主要是将胆囊癌误诊为胆囊炎或胆结石等。结论为了减少胆囊癌的误诊,对>50岁有胆囊炎或胆结石的患者,其中尤以女性患者,除了B超和CT检查外,必要时在B超或CT引导下,应进行胆囊穿刺作细胞学检查,尽早确诊,以免延误治疗。     

胆囊癌误诊分析

胆囊癌为胆道系统常见恶性肿瘤,胆囊癌的症状与胆囊炎性病变或其他胆道疾病的症状无特异性差别,主要表现为腹痛与黄疸,仅靠临床表现难以做出正确的诊断.目前超声检查及CT是诊断胆囊癌的最常用方法.由于B超及CT的诊断正确率仅为50%～60%.而临床诊断率更低.因而分析胆囊癌的误诊原因,对提高诊断正确率很有必要.本文就胆囊癌的误诊进行分析讨论.     

黄色肉芽肿性胆囊炎与胆囊癌的鉴别诊断

目的探讨黄色肉芽肿性胆囊炎（XGC）和胆囊癌的临床特点及鉴别要点,以减少黄色肉芽肿性胆囊炎的误诊率。方法收集经病理确诊为黄色肉芽肿性胆囊炎（23例）和胆囊癌（51例）患者的临床资料并进行统计分析。结果23例黄色肉芽肿性胆囊炎临床表现类似一般的胆囊炎,术前B超32％（7／22）胆囊癌不能排除,术前MRI或CT检查52％（12／23）误诊为胆囊癌,4％（1／23）误诊为胆囊腺肌症。术中冷冻病理检查7例XGC均排除胆囊癌,术后病RI胆囊癌诊断正确性为7例,检查23例黄色肉芽肿性胆囊炎均确诊。51例胆囊癌临床表现无特异性,术前B超胆囊癌诊断正确性为73％（33／45）,术前CT及MRI诊断正确性为78％（35／44）,术后病理检查51例胆囊癌均得以确诊。结论黄色肉芽肿性胆囊炎无特异性症状和体征,影像学检查的特征性表现不明显,极易误诊为胆囊癌。术中冰冻切片检查可明确病变性质,指导手术方式的选择。确诊黄色肉芽肿性胆囊炎需依赖病理检查。     

原发性胆囊癌的外科治疗(附59例分析)

目的 总结原发性胆囊癌的治疗经验，探讨提高原发性胆囊癌的诊断和治疗效率。方法 回归性分析本院1985-01～1999-12收治的59例原发性胆囊癌且行手术治疗患者的临床资料。结果 本组患者中男22例，女37例，男女之比为l：1.68，59％(35／S9)的病例合并有胆囊结石。最常见的临床症状和体征依次是右上腹疼痛、黄疸和右上腹包块。本组胆囊切除率56％(33／59)。病理检查示胆囊腺癌占94％(53／56)。术后总的1、3、5年生存率分别为36％(21／59)、20％(12／59)和10％(6／59)，但早期患者与晚期患者术后1、3、5年生存率有明显的差别，根治术与非根治术后1、3年生存率亦有明显的差别。结论 重视胆囊癌的诊断，早期发现和根治性切除是提高手术疗效的关键，对有高危因素胆囊结石患者，应行预防性胆囊切除。     

产前超声诊断用于检测胎儿胆囊异常的临床应用价值

目的分析并评价早期常规超声检查配合使用高频探头对孕妇实施动态监测的方法对检出胎儿胆囊异常的临床应用价值。方法对我院自2009年12月至2012年1月期间收治的产前检查孕妇5400例,采用常规超声检查配合使用高频探头实施动态监测胎儿的胆囊状况。结果经早期常规超声检查,全部5400例孕妇中共查出8例胎儿胆囊异常者,再使用高频探头对其实施动态监测,其中5例胆囊未显示,2例为胆囊内强回声,1例为双胆囊。5例胆囊未显示者中有4例通过产前复查以及产后证实胆囊无异常,余者1例通过产前复查均未见胆囊,通过产后证实为先天胆囊缺如;2例胆囊强回声者通过产前复查及产后证实为胆囊结石,但在胎儿出生后半年内结石均消失;1例双胆囊者通过产后复查证实为先天胆总管囊状扩张疾病。结论采用超声检查可以较好地检查胎儿胆囊异常,再使用高频探头对其实施动态监测,可以对胎儿胆囊异常做出进一步的明确诊断。     

胆囊癌诊治中腹腔镜技术的应用进展

胆囊癌是临床常见病症,在胆囊恶性肿瘤中占首位,原发性胆囊癌在临床较为少见,发病率约1％左右,且常与胆囊良性疾病同时存在,以合并胆囊结石最为常见,结石的慢性刺激是引起胆囊癌的高危因素.胆囊癌早期常见症状为右上腹疼痛、消化不良、嗳气和发热等,晚期可出现黄疸、乏力、皮肤瘙痒和消瘦等症状,由于缺乏特异性临床表现,多数患者就诊时...     

肝硬化伴或不伴胆结石胆囊排空的比较

目的观察肝硬化患者伴或不伴有胆囊结石时胆囊的排空功能,以探讨胆囊的排空是否与胆囊结石的形成有关。方法24位肝硬化并胆囊结石患者纳入研究,作为试验组,ChildA、B、C级各8例;另24例不伴胆囊结石的肝硬化患者为对照组,每级均有8位患者。利用超声波检查测量空腹胆囊体积,后嘱受试者摄入脂餐计箅胆囊体积,估测胆囊最小体积、胆囊排空分数。统计分析使用Students’t检验和Pearson’S相关性分析。结果对照组中空腹胆囊体积和胆囊最小体积均增大,但胆囊排空分数并无明显变化。试验组中,与Child A级比较,Child C级胆囊排空分数显著降低,并且也比对照组中Child C级的胆囊排空分数显著下降。结论肝硬化患者的胆囊收缩功能明显下降,胆囊的运动减弱则与肝脏病变的严重程度呈平等趋势,胆囊的运动减弱是肝硬化晚期患者胆囊结石形成的主要原因,胆囊结石的数量和大小及胆囊壁的厚度与胆囊排空并无明显的相关性。     

超声在原发性胆囊癌早期诊断中的应用价值

目的:分析早期胆囊癌的超声特征及临床应用价值。方法:对经手术病理证实的20例早期胆囊癌与超声结果进行了回顾性分析。结果:早期胆囊癌超声图像分为三型:小结节型、厚壁型及混合型。结论:超声并结合彩色多普勒检查对早期胆囊癌的诊断有较高敏感性,可以作为首选诊断方法之一。     

Tumors in the gallbladder: a possible differentiation between malignant and benign tumours

In a 59-year-old woman with pain in the right upper abdomen, echography and CT-scan revealed adenomatosis of the gallbladder. Her symptoms did not disappear after cholecystectomy, even though echography showed no further abnormality. In a 46-year-old man with fever and weight loss, echography revealed two polyps in the gallbladder. Following cholecystectomy, histopathology revealed cholesterol polyps and an infection with Entamoeba coli. In a 63-year-old man with systemic symptoms, a biopsy of the echographically diagnosed tumour of the gallbladder revealed that he had actually had cholecystitis. The management was wait-and-see and the patient recovered completely. In a 68-year-old woman with jaundice and attacks of abdominal pain, a CT-scan revealed gallstones. The symptoms recurred following an ERCP. Following cholecystectomy, an adenocarcinoma of the gallbladder was found. One year later, a contact metastasis developed forwhich she received radiotherapy. After 4 years she was in good condition. Patients with a tumour in the gallbladder are often diagnosed with gallbladder cancer, which has a poor prognosis. Other diseases should also be considered, since the treatment and prognosis differ greatly. It is important to differentiate at an early stage. Ultrasound, CT and MRI have improved the possibility of differentiating and choosing the correct treatment.     

Fair, and still a sun lover: risk of gallstone formation.

STUDY OBJECTIVE--The aim was to evaluate the hypothesis that sunlight exposure leads to the development of gallstones in people with a sun sensitive skin. DESIGN AND SETTING--This was a case-control study among 206 white patients referred for an ultrasound examination of the gallbladder. Sunlight exposure and skin sensitivity were retrospectively assessed by a structured questionnaire. The questionnaire was taken before the outcome of the ultrasound examination was known, so that the patients and the interviewers were blind to the outcome. The main outcome measure was gallstones in the gallbladder detected by ultrasound. MAIN RESULTS--87 patients had gallstones (cases), 119 had none (controls). In subjects with a skin sensitive for sun (Fitzpatrick skin type I) a positive attitude to sunbathing was associated with a higher risk of gallstones than a negative attitude. In subjects with an insensitive skin (skin type IV) no association was found. CONCLUSIONS--This study confirms a hypothesis which was based upon metabolic research. However it is too early to upgrade the first "F" in the traditional adage that gallstone patients are "fair, fat, female, fertile and forty". Since both epidemiological and pathobiological evidence is scarce, the role of sun and/or (ultraviolet) light exposure and skin sensitivity in the aetiology of gallstones should be confirmed by further research.     

Increased cholecystectomy rates among medicare patients after the introduction of laparoscopic cholecystectomy

A study was undertaken of Medicare claims coded for cholecystectomy and those coded for laparoscopic cholecystectomy for the four year period 1990–1993 in New York State. During this time period there was a 28.12% increase in total cholecystectomies performed and an increase in the proportion of laparoscopic cholecystectomies from 15.86% to 50.0%. The increase in total cholecystectomies appears to be driven by a dramatic increase in laparoscopic procedures. Possible reasons for this increase include the performance of laparoscopy on patients previously assessed as too risky to undergo the conventional procedure, laparoscopy on mildly symptomatic patients who had previously put off a perceived higher risk open procedure and a possible broadening of indications for gallbladder surgery.The dramatic increase in the numbers of cholecystectomies performed in the early 1990s may be due in part to procedures performed on a large pool of procrastinating mildly symptomatic patients. If this is the case, then these increased rates should decline to baseline levels as soon as this pool of patients is exhausted. However, if surgeons are performing laparoscopy on asymptomatic patients with gallstones, then these rates may well be sustained. Such a broadening of indications for gallbladder surgery is of concern to many and has prompted the issuance of guidelines concerning the treatment of gallstones. Any broadening of indications for gallbladder surgery also has significant implications for health care costs and the use of health care resources.