外伤后应用头孢曲松钠所致胆囊假性结石的临床及CT表现

目的探讨外伤患者经静脉应用头孢曲松钠后导致胆囊假性结石的临床特征及CT表现。方法回顾性分析因外伤住院的30例经静脉应用头孢曲松钠后胆囊出现假性结石患者的临床与CT影像资料,并结合文献复习。结果头孢曲松钠导致胆囊假性结石形成最早出现在用药后1天,最迟24天,给药2～7天发生率较高;假性结石在停用头孢曲松钠后均自行消失。消失时间最早为停药后第3天,最迟2个月。30例中表现为泥沙样假性结石23例,其中1例患者合并膀胱结石,表现为团块状假性结石7例。结论经静脉应用头孢曲松钠后所致胆囊假性结石,停药后短期内可自行消失,充分认识此影像表现,以减少此类不良反应带来的危害。     

头孢曲松钠导致假性胆石症二例

例1女，24岁。骑车摔伤腰部就诊。体检：胸部压痛，以右侧明显。CT检查扫描示右侧多发肋骨骨折并胸腔积液，肝右叶挫裂伤；胆囊、双肾未见异常。患者入院后给予保守治疗，头孢曲松钠静脉点滴4．0g／d，共14d，同时应用外伤常规用药。治疗第4天CT复查示：紧贴胆囊内壁见条带样高密度影，以低位处明显（图1）。治疗第13天CT复查示：胆囊体积缩小，囊内充盈结石密度影（图2）。患者症状逐渐减轻。出院20d后复查CT示：胆囊内高密度影完全消失，胆囊影像表现正常。     

头孢菌素相关性胆囊假性结石的声像图特征分析

目的:分析头孢菌素所致胆囊假性结石的声像图特征。方法:应用彩色多普勒超声诊断仪,对62例头孢菌素所致胆囊假性结石的患者进行扫查,观察结石形态、回声强度、后方声影及变换体位后结石移动和变形情况,停药后随访结石的变化,同时询问患者有无伴随症状。结果:62例患者中,胆囊沉积物4例(6.5%),泥沙样结石23例(37.1%),团块状结石35例(56.4%);大部分结石具有质地疏松、伴弱声影、移动缓慢和变形的特征。停药后所有结石均自行消失,以停药后1～2周内消失者最多。62例患者中,仅5例(8.1%)出现临床症状。结论:应用头孢菌素后会产生胆囊假性结石,与一般胆囊结石相比,具有特征性的声像图表现,停药后短期内可恢复正常。临床及影像医生对此应有充分的认识,以免造成误诊、误治。     

头孢曲松钠致胆囊可逆性结石32例声像图分析

头孢曲松钠致胆囊可逆性结石,临床时有发生,但报道尚少,现总结我院2008—06～2009—02,超声诊断并随访观察的32例因头孢曲松钠致胆囊可逆性结石患者,对其超声声像图特征进行分析总结,并与真性结石进行鉴别,现报告如下。     

X线及CT联合应用对胆石性肠梗阻的诊断价值

目的：探讨X线及CT联合应用对胆石性肠梗的阻诊断价值。方法：回顾性分析10例胆石性肠梗阻患者的X线及CT表现。结果：10例患者中2例胆结石位于十二指肠,4例胆结石位于空肠,3例胆结石位于回肠,1例胆结石位于横结肠,结石直径2．5～6．5cn2,平均3．5cm;4例出现胆囊一十二指肠瘘,1例出现胆囊一结肠瘘,1例出现胆囊一十二指肠一结肠复合瘘,瘘口平均直径约1．5cm,其影像学表现包括肠管扩张积气积液、梗阻段肠腔内环形高密度结石影、胆囊积气及消化道造影剂外漏。结论：X线及CT联合应用可明确诊断胆石性肠梗阻,为临床治疗提供重要信息。     

黄色肉芽肿性胆囊炎的诊断及鉴别诊断

目的 探讨黄色肉芽肿性胆囊炎（XGC）的临床表现、实验室检查情况、影像学检查表现特点,旨在提高XGC的术前诊断率.方法 回顾性分析12例经手术病理证实XGC患者的临床表现、实验室指标及病变的超声、CT及MRI表现特点,例如,胆囊壁内结节、黏膜线、胆囊壁增厚情况及强化方式、是否合并结石、胆囊周围脂肪及肝实质是否受累以及胆道梗阻情况.结果 12例患者均出现右上腹痛,11例白细胞及粒细胞不同程度升高;7例CA 199轻度升高但低于正常值5倍,CEA轻度升高1例;超声、CT、MRI表现为胆囊壁增厚,其中弥漫性增厚9例,8例见多发壁内结节,部分结节超声表现为低回声（带）、CT为低密度、MRI呈较长T1长T2.CT及MRI增强结节未见明显强化,6例增强CT、MRI粘膜线完整强化,11例病例合并胆囊结石,仅1例出现胆道梗阻,1例邻近肝实质受累.结论 综合分析患者临床表现、实验室指标及影像学检查结果,能明显提高XGC诊断准确率,为手术方案选择提供有力依据.     

急性胆囊炎腹腔镜手术指征及技巧

目的 研究急性胆囊炎腹腔镜手术指征及技巧.方法 随机选择2010年1月-2016年9月收治的100例急性胆囊炎腹腔镜手术患者,采用分析法,观察、记录患者手术指征特征、处理效果.结果 100例患者,手术指征为有症状的胆囊结石31例、胆囊泥沙样结石20例、充满型或多发结石并胆囊萎缩15例、胆囊结石伴糖尿病34例,处置有效率91％.结论 急性胆囊炎腹腔镜手术指征表现种类较多,一般危险性不大,处理高效.     

肠易激综合征及其亚型与胆囊结石的相关性分析

目的 分析肠易激综合征(IBS)及其亚型与胆囊结石的相关性。方法 选取2019年1月-2023年3月于解放军总医院第六医学中心消化内科就诊的患者556例,其中IBS组161例,非IBS组395例。对研究对象进行问卷调查、体格检查及血液检查,比较两组性别、年龄、身高、体重、血压、血生化指标等资料。采用logistic回归分析IBS与胆囊结石的关系。结果 556例患者中胆囊结石90例(16.2%),其中IBS组胆囊结石37例(23.0%),非IBS组胆囊结石53例(13.4%),IBS组胆囊结石患病率高于非IBS组(P<0.05)。IBS组胆囊泥沙样结石6例(3.7%),非IBS组胆囊泥沙样结石3例(0.8%),IBS组患者胆囊泥沙样结石患病率高于非IBS组(P<0.05)。Logistic回归分析发现,年龄、BMI、总胆汁酸(TBA)、总胆固醇(TC)及合并IBS是胆囊结石的独立影响因素(P<0.05)。161例IBS患者中,腹泻型IBS 114例,其中胆囊结石26例(22.8%);便秘型IBS47例,其中胆囊结石11例(23.4%);395例非IBS患者中胆囊结石53...     

肺内淋巴瘤的影像诊断

目的 探讨肺内淋巴瘤的影像学特征及表现.方法 选择2016年3月-2020年6月收治的30例肺内淋巴瘤患者为研究对象,均行CT、腹部超声检查,其中行气管分叉和肺内病灶薄层扫描检查12例,其余行常规胸部CT检查18例,回顾性分析临床资料.结果 所有患者均顺利完成检查,可见多发或单发肺肿块、结节,其中可见空洞4例,可见空气支气管征8例,病灶边缘表现为磨玻璃样或者棉絮状25例;合并双肺多发栗粒结节6例,合并双肺磨玻璃样变或细网状结构20例;同时,肺假性淋巴瘤8例,主要以空气支气管征为主的双肺多发大片浸润为主要表现,无肺门及纵隔淋巴结肿大.结论 肺淋巴结影像表现呈现出多样化的特点,往往合并肺间质变、肺内斑片影,应该及时行病理检查,减少漏诊或误诊.     

腹腔镜联合胆道镜微创保胆取石术治疗胆囊结石

目的评价腹腔镜联合胆道镜微创保胆取石术治疗胆囊结石的临床应用价值。方法收集我院2006年1月～2010年12月收治的胆囊结石患者120例,均采取经腹腔镜下切开胆囊底部应用纤维胆道镜进行取石,保留功能良好的胆囊。术后第2 w B超复查结石取尽率,术后1年复查胆囊收缩功能、胆囊壁厚度及胆囊结石复发。结果全部病例成功实现了保胆取石术,平均手术时间55 min,平均住院时间4.2 d。术后第2 w B超检查结石取净率100%,术后1年复查胆囊收缩功能和胆囊壁厚比术前明显改善,术后随访1年胆结石复发6例。结论经腹腔镜微创保胆取石术具有安全性高、创伤小、痛苦少、恢复快、复发率低等特点,且可保留有功能的胆囊,具有临床推广价值。     

Ultrasonographic findings in ceftriaxone: associated biliary sludge and pseudolithiasis in children

PURPOSE: To prospectively evaluate the incidence of biliary sludge and pseudolithiasis in children treated with ceftriaxone. MATERIAL AND METHODS: Thirty-three children (14 girls, 19 boys) treated with ceftriaxone for prophylaxis (n=13) or for an infection (n=20) were included in this study. The incidences of biliary sludge and pseudolithiasis were investigated using ultrasonography. The ultrasonographic evaluations were performed prior to and on the 4th-5th days and on the 8th-10th days of treatment. The patients who had biliary sludge or pseudolithiasis were followed up with ultrasonographic evaluation periodically until these pathological phenomena disappeared. RESULTS: Ceftriaxone was administrated intravenously at a dosage of 100 mg kg(-1) day(-1). Serial gallbladder sonograms were performed before treatment and on the 4th-5th and 8th-10th days of therapy. Nineteen children developed pseudolithiasis and sludge in the gallbladder, and all were asymptomatic. No significant differences were found between the patients with normal versus abnormal sonographic findings in regard to gender, age, duration of the therapy, oral restriction except the presence of surgery (P< 0.005). CONCLUSION: The combination of oral restriction and surgical procedures may be a causal factor in ceftriaxone-associated biliary pseudolithiasis. It is emphasized that when gallstone and/or sludge are detected in the gallbladder in children by ultrasonographic examination, the administration of ceftriaxone must be sought beyond other causative factors.     

胆囊颈部结石超声诊断影像学分析

目的探讨超声在胆囊颈部结石诊断中的应用价值。 方法对我院2011年至2019年彩超诊断为胆囊颈部结石的201例患者的超声声像图特征进行回顾性分析。所有患者均在我院普外科接受保胆取石手术时得以证实。 结果201例胆囊颈部结石中有96例出现胆囊体积增大并积液,占47%;176例出现胆囊壁增厚,占87%;47例出现胆泥团,占23%;35例出现胆囊缩小,占17%;145例出现胆绞痛发作史,占72%。 结论在胆囊颈部结石的诊断中,当超声检查出现以下几点应高度提示胆囊颈部结石的可能性：（1）胆囊体积增大合并积液;（2）胆囊壁明显增厚,胆汁暗区呈云雾状改变;（3）胆囊腔内有多个胆泥团;（4）胆囊缩小,胆囊内仅见极少许胆汁;（5）有反复发作的胆绞痛病史。要重点观察胆囊颈部情况,以提高胆囊颈部结石的检出率,减少漏诊。     

Gallbladder ejection fraction: correlation of scintigraphic and ultrasonographic techniques

PURPOSE: The assessment of gallbladder function and ejection fraction using sincalide-enhanced biliary scintigraphy is a useful way to evaluate patients with recurrent right upper quadrant pain but no gallstones. MATERIALS AND METHODS: We wanted to determine whether gallbladder contraction measured by ultrasonography could be used in place of biliary scintigraphy. Biliary scans with an infusion of sincalide and concurrent ultrasonography were performed in 17 patients with histories of recurrent abdominal pain and no evidence of gallstones by ultrasound. RESULTS: Gallbladder ejection fractions calculated by ultrasound and scintigraphy using standard techniques showed only a weak correlation. The poor performance of ultrasound appears to arise because the variable shape of the gallbladder invalidates the calculation of its volume by the formula for a prolate spheroid. When gallbladders that were ellipsoidal were subselected, correlation was improved. The level of training of the sonologist did not have a significant effect on the results. CONCLUSION: Gallbladder ejection fraction calculated by ultrasonography cannot be used routinely as a substitute for biliary scintigraphy.     

Ultrasonic detection of gallstone ileus

A woman of 60 years of age with acute abdominal pain, vomiting, constipation and radiological signs of small bowel obstruction was subjected to sonographic examination. Careful examination of the entire abdomen demonstrated a hyperechoic object within the distended terminal ileum with an intensive acoustic shadow. The gallbladder was not visible. This strongly suggested gallstone ileus, especially since the patient had a history of gallbladder disease. She was treated immediately by enterotomy and extraction of a noncalcified obstructing stone. The value of ultrasound in detecting gallstones causing small bowel obstruction is discussed.     

A sign of symptomatic chronic cholecystitis on biliary scintigraphy

Five hundred patients with acute right-upper-quadrant pain underwent biliary scintigraphy with 99mTc paraisopropyliminodiacetic acid. One hundred and thirty-four studies were reported normal (both gallbladder and activity in bowel are noted in 1 hr). Of the 134 studies reported as normal, 32 showed intestinal activity before gallbladder visualization during the first hour of the study. Sonography and/or oral cholecystography revealed that 24 patients had gallstones, and eight patients had no demonstrable pathology in the biliary system. Of the 134 studies, 102 showed visualization of the gallbladder before intestinal activity during the first hour of the study. Sonography and/or oral cholecystography showed that 73 patients had normal biliary system. The remaining 29 patients had gallstones. The overall sensitivity of this finding is 45%, the specificity is 90%, and the accuracy is 73%. In this group of symptomatic patients, the appearance of intestinal activity before gallbladder activity on biliary scintigraphy warrants further evaluation of these patients by sonography and/or oral cholecystography.     

医源性胆囊结石的超声诊断价值

目的：探讨某些患者在治疗非胆道系统疾病期间,胆囊内形成结石的超声诊断价值。方法：分析55例非胆道系统疾病患者,在常规治疗原发病期间胆囊内形成的结石,患者在治疗原发病期间须禁食≥48h,并全部使用了头孢曲松钠抗生素。结果：55例患者中40例胆囊腔内出现直径〉5mm的团状强回声,11例胆囊腔内出现直径〈4mm的点状强回声,4例胆囊腔内出现细密的泥样等回声。结论：患者在禁食、使用头孢曲松钠等诱因下,胆囊内可以快速形成结石,此类结石超声检查时可提示为医源性胆囊结石。     

飞行人员胆囊结石的空中B超观察

旨在观察飞行中胆囊结石有无位移及能否诱发空中突然失能。采用日本SDL－32型B超诊断仪，对16名飞行人员胆囊结石患者进行了地面及空中观察。结果表明，地面观察未见胆囊结石有明显位移；跟班飞行观察，从飞机爬升经巡航到下滑几个阶段内，胆囊结石保持原位不动者9例（共有块状结石7枚，泥沙状结石3堆），其中结石位于胆囊颈部3例、胆囊体部6例，为滞留型；结石发生了位移者7例（共有块状结石13枚），其中结石由胆囊颈部降到胆囊体部者4例、由胆囊体部落到胆囊底部者2例，在胆囊体部前后壁间横向移位者1例，为游移型。游移型结石有可能速入胆道，引起突然失能，危及飞行安全，应密切观察。     

The importance of appropriate frequency selection in sonographic gallstone detection

A prospective study was performed on 161 patients referred for gallbladder ultrasound to determine whether routine use of a 5 MHz probe in addition to a standard 3.5 MHz probe provided useful additional information. Seventy-two patients were found to have gallstones. In 26.4% of these patients (19 cases) a confident diagnosis of gallstones was possible only when the 5 MHz probe was used. These results confirm theoretical assertions on the value of high-frequency probes in the evaluation of superficially located organs such as the gallbladder. Our findings lend support to their routine use in cholecystosonography.     

Gallbladder stones: imaging and intervention.

Imaging of the gallbladder for cholelithiasis and its complications has changed dramatically in recent decades along with expansion of interventional techniques related to the disease. Ultrasonography (US) is the method of choice for detection of gallstones. The characteristic US findings of gallstones are a highly reflective echo from the anterior surface of the gallstone, mobility of the gallstone on repositioning the patient, and marked posterior acoustic shadowing. Oral cholecystography remains an excellent method of gallstone detection, but its role has been limited due to the advantages of US. Most people with cholelithiasis will not experience symptoms or complications related to gallstones. When biliary colic does occur, it is typically caused by transient obstruction of the cystic duct by a stone. The primary imaging modality in suspected acute calculous cholecystitis is usually US or cholescintigraphy. Detection of gallstones alone does not permit a diagnosis of acute cholecystitis; however, secondary US findings provide more specific information. In detection of choledocholithiasis, endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography are superior to US. In certain clinical settings, interventional radiologic procedures have become an important alternative to surgery in the treatment of gallstones and their complications; techniques include percutaneous cholecystostomy and gallstone removal.