Endoscopic sonographic evaluation of the thickened gallbladder wall in patients with acute hepatitis

PURPOSE: Thickening of the gallbladder wall is often observed during abdominal sonographic examination in patients with acute hepatitis. However, there is rarely an opportunity for a histopathologic analysis of these structural changes. Endoscopic sonography (EUS) can accurately delineate the structure of the gallbladder wall and therefore may be useful for visualizing changes in the gallbladder wall in patients with acute hepatitis. Hence, we prospectively studied the ability of EUS to detect specific structural changes in the gallbladder wall in patients with acute hepatitis and examined the effect of high elevation of serum liver enzyme levels on the gallbladder wall. METHODS: A study group of patients diagnosed with acute hepatitis who had gallbladder wall thickening and a control group of patients without acute hepatitis or gallbladder disease underwent EUS between May 1, 1999, and June 1, 2002. EUS was used to measure the thickness of the gallbladder wall and to visualize each of its layers. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels of the patients with acute hepatitis were measured at the time of the EUS examination. Statistically significant differences were determined using an independent t test and the chi-squared test. A p value of less than 0.05 was considered statistically significant. RESULTS: The acute hepatitis group comprised 28 men and 24 women with a mean age of 40.8 years. The control group comprised 25 men and 25 women with a mean age of 45.1 years. The mean gallbladder wall thickness +/- standard deviation in the acute hepatitis group (6.3 +/- 2.6 mm) was significantly greater than that in the control group (1.6 +/- 0.4 mm; p < 0.01). The mean thickness of the gallbladder wall for patients in whom both the AST and the ALT levels were 500 U/l or higher (7.0 +/- 2.6 mm) was significantly greater than that for patients with levels below 500 U/l (5.4 +/- 2.3 mm; p < 0.05). In the acute hepatitis group, EUS showed thickened, well-defined muscular and serosal layers of the gallbladder wall in 24 of the patients and a diffusely thickened gallbladder wall, in which each layer was ill defined, in the other 28 patients. The mean thickness of the gallbladder wall for patients with the pattern of ill-defined layers was significantly greater than that for the patients with the pattern of well-defined layers (p < 0.05). The pattern of ill-defined layers was more common among patients in whom the serum AST and ALT levels were at least 500 U/l than among patients with levels below 500 U/l (p < 0.05). CONCLUSIONS: We propose that gallbladder wall thickening in patients with acute hepatitis is associated with prominent changes in the muscular and serosal layers. Patients with highly elevated serum liver enzyme levels are more likely to have gallbladder wall thickening and disruption of planes between the muscular and serosal layers than are patients with normal liver enzyme levels.     

Role of sonography in the diagnosis of gallbladder perforation

PURPOSE: Gallbladder perforation is a dreaded complication of acute cholecystitis that is associated with a high mortality rate. Early detection of gallbladder perforation reduces the associated mortality and morbidity rates. The purpose of this study was to highlight the role of sonography in the diagnosis of gallbladder perforation and to compare the diagnostic accuracy of sonography with that of CT. METHODS: We retrospectively evaluated the sonographic and CT findings in surgically proven cases of gallbladder perforation. RESULTS: In 18 of 23 cases, both sonography and CT had been performed; in the other 5 cases, only sonography had been performed. Sonography helped to diagnose the defect in the gallbladder wall and gallbladder perforation in 16 (70%) of 23 patients. In the 18 cases in which both sonography and CT had been performed, sonography showed the wall defect in 11 cases (61%), whereas CT was diagnostic in 14 cases (78%). The difference between sonography and CT in the ability to visualize a defect in the gallbladder wall was not statistically significant. CONCLUSIONS: Sonography is useful for diagnosing gallbladder perforation and detecting the defect in the gallbladder wall. We believe that sonography should be the first-line imaging modality for evaluating the patients in these cases.     

腹腔镜对可疑早期胆囊癌的治疗

目的 评估对可疑早期胆囊癌腹腔镜治疗的可行性.方法 前瞻性研究内蒙古医学院第三附属医院在2005年3月～2008年12月入院患者共计25例,术前CT诊断≤T2胆囊肿瘤肝脏未受侵犯,拟行腹腔镜手术.常规术前内镜超声、术中腹腔镜超声检查进一步排除肝脏受侵的可能性.术中常规送冷冻切片,如发现癌细胞,行腹腔镜淋巴清除术.结果 内镜超声检出肝脏受侵的2例患者行开腹手术.术中腹腔镜发现肝脏受侵的3例患者中转开腹.剩余20例患者选择腹腔镜手术.通过CT、内镜超声、腹腔镜超声的联合应用,肝脏未受侵犯的确诊率为100%.根据冷冻切片,9例良性患者手术就此结束;剩余11例胆囊癌患者行腹腔镜下淋巴结清除术.11例患者淋巴结清除过程中,1例由于出血中转开腹,手术中位时间185rain,中位出血量60mL;术后并发症发生率为18.2%,术后中位住院时间为5 d,随访中位时间25个月,11例腹腔镜淋巴结清除的患者均存活,未发现复发或转移明显证据.结论 腹腔镜下早期胆囊癌切术是安全可行的.     

内镜微创保胆术后结石复发患者胆囊中胆汁成分分析

目的 探讨胆囊胆汁成分与内镜微创保胆术后胆囊结石复发的关系。 方法 测定150例胆囊结石、80例非肝胆疾病患者的胆囊胆汁成分,该150例患者均行腹腔镜联合胆道镜保胆取石术,术后发现胆囊结石复发12例。测定所有患者胆汁成分。 结果 结石组和复发组胆固醇浓度均较正常组明显升高;复发组胆固醇浓度高于结石组;结石组及复发组糖蛋白含量浓度及钙离子浓度明显高于正常组,复发组糖蛋白含量浓度及钙离子浓度高于结石组;正常组PH值明显低于结石组和复发者,差异均有显著性。 结论 胆囊胆汁中胆固醇浓度升高是保胆取石术后胆囊结石复发的重要因素。糖蛋白及钙离子浓度可促使胆固醇结石的形成和发展,在保胆术后结石复发中起到一定作用。     

彩阶B超在超声内镜诊断胃胆疾病中的价值

本报道采用彩阶B超与超声内镜联机，对156例胃胆病变（胃癌64例，胃溃疡40例，胆囊结石28例，胆囊息肉20例，胆囊肌腺瘤4例）进行超声内镜检查及黑白灰阶图像的彩色显示，全部病例均有手术与病理对照，结果显示：良性胃溃疡的平均色量级高于胃癌（P＜0.01）；胆囊结石比胆囊息肉提高近2个色量级（P＜0.01）；B彩能不同程度地提高病灶的清晰度；B彩对病变的诊断准确率与黑白灰阶显示的结果相近，统计学无显差异。     

Sonographic evaluation of gallbladder volume and ejection fraction in obese women without gallstones

PURPOSE: Obese people have an increased incidence of gallstones. Although the exact pathogenic mechanisms of gallstone development are unknown, impaired gallbladder emptying has been suggested as a possible underlying mechanism. Our aim was to investigate this possibility by evaluating gallbladder motility and related factors in obese and nonobese women without gallstones. METHODS: This study included 79 obese women and 25 nonobese healthy women. Using real-time sonography, we evaluated fasting and postprandial (15th-, 30th-, 45th-, 60th-, 75th-, 90th-, 120th-, and 150th-minute) gallbladder volumes and ejection fractions. The smallest postprandial volume was considered the residual volume. RESULTS: Mean (+/- standard deviation) fasting and residual gallbladder volumes were 43.2 +/- 18.3 cm(3) and 21.4 +/- 11.2 cm(3), respectively, in the obese women and 28.1 +/- 12.3 cm(3) and 7.9 +/- 3.4 cm(3), respectively, in the nonobese women. Maximal ejection fraction was 49 +/- 19% in obese women and 63 +/- 29% in nonobese women (p = 0.001). The fasting and residual volumes and the postprandial volumes at all time points were higher in obese women than in nonobese women (p < 0.001). In addition, 15th-, 30th-, 45th-, 60th-, 75th-, and 90th-minute postprandial ejection fractions were lower in obese women than in nonobese women (p < 0.001). Positive correlations were found between fasting gallbladder volume and body mass index and body fat weight and between residual volume and body mass index, waist circumference, body fat percentage, and body fat weight (p < 0.05 for all comparisons). CONCLUSIONS: Our results show that fasting and postprandial gallbladder volumes are higher and that postprandial gallbladder motility is lower in obese than in nonobese women. There are positive correlations between fasting gallbladder volume and body weight, body mass index, and body fat weight.     

超声造影到达时间参数成像鉴别诊断胆囊病变

目的 观察超声造影到达时间参数成像鉴别诊断胆囊病变的价值。方法 回顾分析25例胆囊癌和22例胆囊良性病变胆囊患者的超声检查资料，根据到达时间参数成像评估灌注动脉模式，评价到达时间参数，包括病灶到达时间、同深度肝组织到达时间、病灶与同深度肝组织的到达时间差（△T）。结果 胆囊良恶性病变间灌注动脉模式差异有统计学意义（P<0.001）。恶性病变动脉模式多呈分支型和不规则型，良性病变多呈散在点状型和单支型，而病灶到达时间差异无统计学意义（P>0.05）。良恶性病变之间△T[造影剂到达胆囊与到达同深度肝组织的时间差，分别为（-0.21±1.37）s和（-2.69±1.37）s]差异有统计学意义（P<0.001）。取△T截断值为-1.05 s，其诊断敏感度、特异度、阳性预测值、阴性预测值和准确率分别为81.80%、92.00%、85.20%、90.00%和87.20%。结论 超声造影到达时间参数成像有助于鉴别诊断胆囊良恶性病变。     

Intraluminal papillary carcinoma of the gallbladder: Prognostic value of computed tomography and sonography

Twenty-seven consecutive cases with a prospective diagnosis of cancer of the gallbladder were analyzed to clarify the computed tomographic (CT) and ultrasonographic features, behavior, and prognosis of intraluminal papillary carcinoma (n=7) of the organ. With CT and ultrasonography, these intraluminal carcinomas were further classified into 3 subtypes: single polyp, multiple polyp, and jam-packed gallbladder. Preoperative diagnosis, evaluation of local invasiveness, and detection of metastatic lesions were reliably done. Carcinomas of this type were locally less invasive, less frequently metastasized, and resulted in a longer survival than the other massive and thickened-wall carcinomas.     

食管黏膜下肿瘤的内镜下诊断与治疗

目的基于食管黏膜下肿瘤(SMTs)内镜检查及治疗手段,分析食管SMTs的临床病理学特征,同时评价食管SMTs内镜下诊治的安全性、经济性和有效性。方法选择2012年1月-2017年12月新疆医科大学第一附属医院收治的98例食管SMTs患者,并同时完善普通胃镜和超声内镜(EUS)检查,所有患者均接受内镜下治疗,所有切除的肿瘤均行病理学检查。结果共98例患者。其中,女55例(56.12%),男43例(43.88%)。肿瘤位于食管上段27例(27.55%),中段28例(28.57%),下段43例(43.88%),56例病例行内镜黏膜下剥离术(ESD),25例行内镜黏膜下肿瘤挖除术(ESE),12例行内镜黏膜下隧道肿瘤切除术(STER),另3例行电凝电切除术,1例孤立性纤维性肿瘤因术中发现肿瘤基底部深转为外科手术,另1例平滑肌瘤因肿瘤体积太大致内镜操作困难,中途转胸腔镜下治疗。1例神经鞘瘤,ESD术后出现气胸、胸腔积液、术后瘘及食管狭窄等并发症,1例胸腔镜下行肿瘤摘除术的平滑肌瘤,术后发生气胸和胸腔积液,另外2例出现纵隔气肿和皮下气肿,均于术后2或3 d自行好转。病理学检查及免疫组化结果证实,最常见的食管SMTs为平滑肌瘤,共90例,占所有病例91.84%。结论食管SMTs以女性多见,好发于中下段食管,病理以平滑肌瘤最为常见;应用EUS技术能够对病变性质及组织学来源进行较准确的评估;内镜下治疗食管SMTs不仅能提供完整的病理学资料,而且有效安全。     

超声诊断胆囊憩室伴胆汁淤积1例

患者男,30岁,体检超声发现胆囊旁占位;既往体健.入院查体及实验室检查均未见明显异常.腹部超声:胆囊大小、形态正常,胆囊壁光滑,于胆囊前壁近肝右前叶旁见约1. 80 cm × 1. 20 cm中等回声,周边见环状无回声,动态显示病灶与胆囊腔相通(图1A ) ,CDFI未见明显血流信号(图1B );提示胆囊憩室伴胆汁淤积...     

硬质超声胆囊内镜系统在保胆取石手术中的应用价值

目的 为了准确了解胆囊结石、胆囊息肉患者胆囊、胆囊壁的病理变化,探讨硬质超声胆囊内镜系统临床应用的可行性.方法 2008年6月～11月,自主研发CHiAO(桥牌)硬质超声胆囊内镜系统(专利号:ZL200920005583.1).实施保胆取石(息肉)手术39例.术中依据硬质超声胆囊内镜系统的检查结果 ,用取石网、小结石吸取箱清除胆囊腔内结石、泥沙洋结石、胆泥;用推、挤、压、撕、撑、冲、吸7种手法清除胆囊黏膜下结石;对于息肉.根据硬质超声胆囊内镜系统检查所显示胆囊黏膜的完整性、胆囊壁各层次的变化、息肉的形态等信息,判定息肉的性质并决定治疗方案,良性者保留胆囊,切除息肉.取4mm×5mm胆囊组织、胆汁、结石、息肉送去做相关检查.结果 39倒手术成功,平均手术时间65min,术后第1天均可下床活动,平均住院时间4d.单发结石6例,多发33例,数目1～80颗,直径2～34mm.合并胆囊息肉12例,直径1～1.5mm,数目1～20粒;黏膜下结石13例438窝,占33.33%,每例3～108窝.术中超声检查结石取净率100%.随访1～6个月,无特殊不适.硬质超声胆囊内镜系统图像质量明显优于体表超声检查,与病理诊断符号率100%.结论 硬质超声胆囊内镜系统是一种新设备,为保胆取石技术及胆囊病的临床研究提供了新平台.时手术中准确了解胆囊结石(息肉)患者胆囊壁各层次的变化有重要意义.用硬质超声胆囊内镜系统进行保胆取石(息肉)是一种安全、有效、可行的新方法 .     

Differential diagnosis of gallbladder diseases with contrast-enhanced harmonic gray scale ultrasonography.

OBJECTIVES: We evaluated the usefulness of contrast-enhanced harmonic gray scale ultrasonographic findings for differential diagnosis of gallbladder diseases. METHODS: We evaluated contrast-enhanced harmonic gray scale ultrasonographic images from 33 patients with 35 polypoid gallbladder disease lesions larger than 10 mm in diameter, consisting of 12 biliary sludge lesions, 8 cholesterol polyps, 1 inflammatory polyp, 2 adenomas, and 12 carcinomas. After a galactosepalmitic acid contrast agent was injected, lesions were scanned by contrast-enhanced harmonic gray scale ultrasonography in 2 phases: early vascular and late vascular. RESULTS: None of the biliary sludge lesions (n = 12) showed either tumor vessels or tumor enhancement. Lesions showing tumor vessels and tumor enhancement on contrast-enhanced harmonic gray scale ultrasonography were diagnosed as cholesterol polyp, inflammatory polyp, adenoma, or carcinoma. Three (38%) of the 8 cholesterol polyps showed dotted-type tumor vessels. Branched-type tumor vessels were observed in 5 (62%) of the 8 cholesterol polyps, the 1 (100%) inflammatory polyp, both (100%) adenomas, and 3 (25%) of the 12 carcinomas. Tortuous-type tumor vessels were observed in 9 (75%) of the 12 carcinomas. Lesions with tumor enhancement and tortuous-type tumor vessels on contrast-enhanced harmonic gray scale ultrasonography were diagnosed as carcinomas, and the sensitivity, specificity, and accuracy of this diagnosis with the current modality were 75% (9/12), 100% (23/23), and 91% (32/35), respectively. CONCLUSIONS: Evaluation of tumor vessels on contrast-enhanced harmonic gray scale ultrasonography may be a useful modality for differentiating gallbladder carcinoma from other polypoid gallbladder disease lesions.     

Endoscopic transpapillary gallbladder drainage for management of acute cholecystitis with coagulopathy

Acute cholecystitis is a common and frequently occurring disease, and laparoscopic cholecystectomy is the preferred treatment method. Percutaneous transhepatic gallbladder drainage is regarded as the first-line palliative procedure for elderly patients with poor cardiopulmonary function who cannot tolerate general anesthesia. However, for patients with acute cholecystitis who are undergoing treatment with oral antithrombotics or who have abnormal coagulation mechanisms, endoscopic transpapillary gallbladder drainage may be a good choice. Endoscopic transpapillary gallbladder drainage is an endoscopic retrograde cholangiopancreatography-based technique that drains the gallbladder by placing a tube into the cavity of the gallbladder though the cystic gall duct. It is the application of the concept of natural orifice transluminal endoscopic surgery in the biliary system. This technique can not only achieve gallbladder drainage but can also minimize the risk of procedure-induced bleeding. In this paper, we describe a representative case to introduce the key points of this procedure and the associated clinical care, hoping to provide useful information for clinicians and nurses.     

胆囊息肉样病变的超声诊断与病理分析

目的:探讨胆囊息肉样病变的超声表现与病理改变的关系。方法:回顾性分析47例胆囊息肉样病变的实时超声表现和病理结果。结果:42例胆固醇性息肉中,36例表现为多发病灶,平均直径7.6mm,蒂窄。2例胆囊腺瘤表现为1例单发,1例多发,平均直径1.1mm,基底较宽。3例腺瘤恶变者声像图上均为单发,平均直径19mm,基底较宽。结论:B超对胆囊息肉样病变检出率高,根据息肉大小、数目、蒂宽窄等情况,在定性诊断上有一定参考价值。     

超声内镜及内镜黏膜下剥离术对直肠类癌的诊疗价值

目的探讨超声内镜(EUS)对直肠类癌治疗的指导价值,及内镜黏膜下剥离术(ESD)对直肠类癌治疗的安全性及有效性。方法对临床考虑直肠类癌的患者进行EUS检查,根据EUS结果选择适合的治疗方案。结果 45例术前病理确诊的类癌病例,42例经ESD治疗,2例累及固有肌层及1例浸透浆膜层并伴有周围淋巴结转移者,经外科手术治疗。结论 EUS能够明确直肠类癌的大小、浸润深度、有无周围淋巴结肿大,对其治疗有较高的指导价值。对于小于20 mm直肠类癌,ESD是一种安全、有效的方法。     

内镜诊断胃异位胰腺

目的探讨胃异位胰腺内镜特征，提高内镜诊断率。方法总结近6年来经电子胃镜结合超声内镜（Endoscopic Ultrasonography，EUS）及病理确诊的12例胃异位胰腺的临床资料。结果胃异位胰腺无特异临床症状。好发于胃窭，多见于大弯侧。胃镜下异位胰腺多为隆起性病变，表面黏膜光滑，形态及大小差异很大，顶端可见导管开口，多单个；超声内镜可见黏膜下层或肌层低回声、等回声或混合回声团。结论内镜检查是诊断胃异位胰腺的有效方法，并可进一步选择相应的治疗措施。     

超声内镜对结直肠黏膜下病变的诊断价值

目的探讨超声内镜(EUS)在结直肠黏膜下病变诊断和治疗中的作用。方法对结直肠黏膜下病变进行EUS检查。根据黏膜下病灶的起源层次,部分患者接受深挖活检、超声内镜引导下细针穿刺吸取活检术(EUS-FNA)、内镜下治疗或外科手术。回顾性分析EUS诊断结果与临床病理的相关性。结果 EUS检查的74例患者中,诊断神经内分泌肿瘤28例(均位于直肠);脂肪瘤15例(其中位于回盲部4例、横结肠1例、升结肠8例、乙状结肠2例);直肠间质瘤2例(固有肌层和黏膜肌层各1例);外压性改变14例(卵巢肿瘤9例,淋巴结2例,盆腔肿瘤3例);囊肿5例(横结肠4例、升结肠1例);气囊肿1例;乙状结肠子宫内膜异位3例;直肠周边恶性肿瘤侵犯4例;肠道淋巴瘤2例。所有病灶均接受深挖活检、EUS-FNA、内镜下治疗或外科手术。最终病理和EUS诊断符合率为68/74(91.9%),其中2例EUS考虑直肠类癌最后病理确诊为黏膜肌层来源的平滑肌瘤。1例考虑脂肪瘤最终确诊为肠道淋巴瘤。2例考虑直肠周边恶性肿瘤最终为炎性包块,1例考虑子宫内膜异位症最终诊断为直肠癌。结论 EUS能清晰地显示消化道各层结构,能清楚显示结直肠黏膜下病变的大小、起源及其与相邻结构的关系,并且能较精确地判断各种病变的性质,进而指导结直肠黏膜下病变的治疗。     

超声胃镜对早期胃癌的诊断价值

应用超声胃镜（ＥＵＳ）检查了早期胃癌８例，判断完全准确２例，基本准确３例；判断失误３例，其中２例为溃疡癌变。表明ＥＵＳ对早期胃癌的判断优于胃镜，但尚难区分低回声病灶是肿瘤还是炎症或纤维化。