Laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis in a patient with a left ventricle assist device: A case report and brief review of the literature (with video)

For acute cholecystitis in patients with left ventricular assist devices, the use of percutaneous transhepatic gallbladder drainage to calm inflammation before planned laparoscopic cholecystectomy may be helpful in safely adjusting anticoagulation and in performing safe laparoscopic cholecystectomy, as demonstrated in this case.     

Multiseptate gallbladder with acute acalculous cholecystitis

Multiseptate gallbladder is a rare congenital malformation of the gallbladder. In some cases, right upper quadrant pain, recurrent abdominal pain, and gallstones were present. We present the sonographic findings in a case of multiseptate gallbladder with acute cholecystitis, which (to our knowledge) has not been reported before. We hypothesize that bile sludge accumulated and subsequent cholecystitis developed as a result of bile stasis in our case because the classic predisposing factors that have been described were absent.     

Gallbladder aspiration for acute cholecystitis in average-surgical-risk patients

We conducted a retrospective case note review to assess whether or not gallbladder aspiration can be applied as a temporary measure for the treatment of acute cholecystitis in average-surgical-risk patients. Gallbladder aspiration was performed in 79 consecutive average-surgical-risk patients with acute cholecystitis, who had no indications of emergent surgery and who complained of severe colicky pain. Elective surgery became possible in 92% of patients by gallbladder aspiration. The percentage reached 97 when percutaneous cholecystostomy was added (four patients). Emergent surgery was needed in one patient suffering bile leakage following gallbladder aspiration. Colicky pain was controlled soon after the procedure in most cases. Neither major complications nor mortalities were observed in the following surgical therapies. It is suggested that gallbladder aspiration might be applied as a temporary measure for acute cholecystitis in average-surgical-risk patients, although early surgery should remain the primary choice of therapy in such patients.     

进展期急性胆囊炎的手术时机

目的探讨进展期急性胆囊炎(AAC)患者经皮经肝胆囊穿刺引流术(PTGBD)后行腹腔镜胆囊切除术(LC)的手术时机。方法回顾分析某院近3年收治的AAC患者的临床资料(共242例),其中85例患者于PTGBD后接受LC治疗,85例患者中54例患者于PTGBD后5~12 d内接受LC(平均时间7 d),为早期手术组;31例患者于66~100 d内行LC(平均时间79 d),为延期手术组。比较两组患者手术操作时间、术中出血量、中转开腹率、手术并发症发生率、人均住院日、人均住院费用、PTGBD引流管相关并发症的差异。结果早期手术组患者的手术操作时间(46.9±9.3)min较延期手术组(75.6±9.0)min短(P<0.01);早期手术组患者的术中出血量(21.1±9.3)mL较延期手术组(12.5±6.4)mL多(P<0.01);两组患者均无中转开腹情况;早期手术组患者无手术并发症,延期手术组术后胆漏1例、术后腹腔出血1例(P=0.13);早期手术组患者的人均住院日(13.6±2.7)d短于延期手术组的(16.7±2.7)d(P<0.01);早期手术组人均住院费用为(2.6±0.49)万元,明显少于延期手术组的(3.2±0.65)万元(P<0.01);早期手术组无PTGBD引流管相关并发症,延期手术组脱管3例,堵塞1例(P=0.016)。结论AAC患者PTGBD后早期行LC安全可行,符合快速康复外科理念。     

经皮经肝胆囊穿刺引流联合腹腔镜下左侧入路胆囊切除治疗急性重症胆囊炎老年患者的临床疗效

目的 探讨经皮经肝胆囊穿刺引流(PTGD)联合腹腔镜下左侧入路胆囊切除治疗急性重症胆囊炎老年患者的临床疗效.方法 选择2016年10月-2019年12月于该院住院并接受治疗的急性重症胆囊炎老年患者80例,均行彩超引导下PTGD联合腹腔镜下左侧入路胆囊切除治疗.观察患者术中情况、术后恢复和并发症发生情况.结果 80例患者...     

B超引导下经皮经肝胆囊穿刺引流术治疗急性胆囊炎的临床疗效

目的探讨B超引导下肝胆囊穿刺引流手术(PTGD)治疗急性胆囊炎的临床疗效。方法选择2010年2月至2012年11月收治的140例急性胆囊炎患者,随机分为两组,观察组70例采用PTGD治疗,对照组70例采用传统的胆囊切除术治疗,比较两组的临床疗效。结果治疗后,观察组的治愈率为100%,明显高于对照组(95.71%),而病死率和并发症的发生率明显低于对照组患者,且差异具有统计学意义(P<0.05)。此外,观察组的住院时间和抗生素使用时间也明显短于对照组(P<0.05),而两组治疗费用基本相当,差异无统计学意义。结论采用PTGD治疗急性胆囊炎具有十分显著的疗效,有利于患者术后早期恢复,且引流效果好,值得临床推广和应用。     

经皮经肝胆囊穿刺置管引流在老年急性胆囊炎患者中的应用

目的：总结B超引导下经皮经肝胆囊穿刺引流(UPTGD)对老年急性胆囊炎患者的治疗经验。方法：对1990年1月至2001年12月期间接受UPTGD治疗的113例老年急性胆囊炎患者的临床资料进行回顾性分析：结果：所有患者均穿刺置管成功。110例(97．3％)获得有效的胆囊引流,108例(95．6％)治愈。91例于急性胆囊炎治愈后2周至3月行择期胆囊切除术,3例行胆囊的“化学性切除。”1例发生胆囊出血,2例出现胆汁腹腔漏。全组无1人因急性胆囊炎及相关的治疗而死亡。3例行胆囊化学性切除的患者随访分别达1．5、2及3年,患者无症状出现,并且B超证实胆囊腔完全闭锁。结论：UPTGD是治疗老年性胆囊炎患者的一项安全、简便、有效的方法。     

Torsion of the gallbladder: a rare cause of acute cholecystitis

We present a case of acute torsion of the gallbladder in a young woman. Approximately 400 cases have been reported since 1898, mostly in elderly women, and the incidence appears to be increasing. The anatomy and pathophysiology that predispose patients to this rare surgical emergency are discussed. Several clinical and imaging findings can be used to distinguish gallbladder torsion from typical acute cholecystitis. By recognizing and treating gallbladder torsion early in its course, a low surgical morbidity and mortality can be achieved. The case presented highlights for emergency physicians some of the considerations in identification of patients with acute cholecystitis who are at highest risk of gangrene and perforation, their emergency treatment, and the timing of surgery.     

超声引导下经皮肝穿置管引流治疗急性重症胆囊炎

目的探讨彩超引导下经皮经肝穿刺胆囊置管引流术（PTGD）在急性重症胆囊炎治疗中的应用价值。方法回顾性分析2005年6月-2008年6月97例行超声引导下经皮经肝穿刺胆囊置管引流术的急性重症胆囊炎患者的临床资料。结果行超声引导下经皮经肝穿刺胆囊置管引流术的97例患者中,96例炎症均得到有效的控制（1例于术后第2天死于全身脏器衰竭）。76例患者于置管3～6周后择期行胆囊切除术,痊愈出院;4例急性非结石性胆囊炎患者于症状及体征缓解后拔管出院16例因合并有其它脏器疾病不能耐受手术而带管随访,带管最长者已达1年。结论彩超引导下经皮经肝穿刺胆囊置管引流术在急性重症胆囊炎治疗中的具有极大的应用价值。     

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.     

腹腔镜治疗急性胆囊炎并发胆囊颈部结石嵌顿的体会（附92例分析）

目的：探讨腹腔镜胆囊切除术（LC）治疗急性胆囊炎并发胆囊颈部结石嵌顿的可行性、安全性和手术时机。方法：回顾性分析2006-01-2012-07我院收治的92例LC治疗胆囊颈部结石嵌顿所致的急性胆囊炎患者的临床资料。结果：术前影像学检查诊断为胆囊颈部结石嵌顿所致的急性胆囊炎患者92例,全部行腹腔镜探查,完成LC手术77例（占83.7%）、中转开腹手术15例（占16.3%）,全部治愈,无死亡病例。结论：应用LC是治疗急性胆囊炎并发胆囊颈部结石嵌顿的可选择术式,尤其是在有多年LC应用经验的医院是安全的。     

Infusion tomography and ultrasonography of the gallbladder in the diagnosis of acute cholecystitis

Sixty-three patients with the clinical suspicion of acute cholecystitis were examined with infusion tomography of the gallbladder. Ultrasonography was performed in 51 of these cases. The technique and diagnostic principles of both methods are discussed. The diagnostic value of the two methods when used in combination is stressed. Thus in a case of gangrenous cholecystitis when opacification of the gallbladder wall may not appear at infusion tomography, ultrasonography may demonstrate signs of gallbladder disease. Infusion tomography, on the other hand, may be of great value if ultrasonography is not informative.     

Diagnosis of gallbladder perforation in acute acalculous cholecystitis in critically ill patients

In the presence of ascites ultrasound is not appropriate to distinguish between gallbladder perforation and acute acalculous cholecystitis. However, the correct and early diagnosis of gallbladder perforation is important for the treatment and prognosis. We report 4 critically ill patients with ascites. All patients had evidence of gallbladder perforation by ultrasound and underwent cholecystectomy: 2 patients had gallbladder perforation, but 2 had acalculous cholecystitis without perforation. markedly elevated serum alkaline phosphatase was the only discriminating finding indicating gallbladder perforation.     

急性胆囊炎早期治疗及推迟行腹腔镜胆囊切除的比较

目的：比较急性胆囊炎症状早期行腹腔镜胆囊切除和待急性期后再行手术的安全性及可行性。方法：将有症状的急性胆囊炎患者随机分为两组,一组在入院72h内行腹腔镜胆囊切除,另一组则行保守治疗待症状缓解消失后3个月返院行手术治疗。结果：并未发现早期行胆囊切除术组相对推迟后手术组的中转开腹率、术后疼痛处理技术后并发症有显著区别,但在手术时间相对增加,而住院时间则缩短。结论：在出现症状72h内急诊行腹腔镜胆囊切除在医疗及社会经济效益上具有较大优势,但手术需要更有经验的医师执行。     

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.     

老年急性胆囊炎患者早期行腹腔镜胆囊切除术围术期处理分析

目的 探讨老年急性胆囊炎患者早期行腹腔镜胆囊切除术(LC)围术期处理的方法.方法 以60岁以上老年急性胆囊炎患者76例为治疗组,以同期收治的60岁以上老年非急性胆囊炎患者42例为对照组,均给予LC术,比较2组疗效.结果 治疗组手术时间较对照组长,差异具有统计学意义(P<0.05);2组术后肛门排气时间、术后住院时间差异无统计学意义(P>0.05).2组术后并发症发生率,差异无统计学意义(P>0.05).结论 只要充分围术期处理,掌握手术适应证,老年人早期行腹镜胆囊切除术是安全可行的.