胆囊腺肌增生症15例临床分析

1998-2002年，我院共收治经病理证实胆囊腺肌增生症15例。现报告如下。     

超声诊断胆囊腺肌增生症1例

病人女，30岁，无明显不适，健康体检时发现胆囊壁回声不均。查体：腹平软，肝脾肋下未及，无压痛、反跳痛，Murphy征阴性。实验室相关检查均正常。超声检查示：肝脏大小形态正常，包膜光滑，实质回声均匀，门静脉主干不宽，肝内外胆管不扩张，肝内未见占位病变。胆囊大小尚可，胆囊体部壁不均匀增厚，最厚处达0．4cm，累及长度2．2cm，其内可见多发小液性囊腔(使用高频探头探查显示更为清晰)，胆囊底部及颈部壁未见异常，腔内未见明显异常回声，脂餐试验示病变处胆囊壁收缩功能亢进。超声诊断：胆囊壁体部异常所见，符合胆囊腺肌增生症声像图改变。病人要求手术治疗而行胆囊切除术。病理检查：胆囊腺肌样增生。     

高频超声检查对胆囊腺肌增生症的临床诊断价值

目的探讨胆囊腺肌症患者采用高频超声检查的诊断价值和临床体会。方法将2017年1月—2018年10月疑诊为胆囊腺肌增生症的24例患者分别采用低频和高频彩色多普勒超声检查,观察胆囊腺肌增生症的超声典型表现,比较两种检查方法的效果。结果胆囊腺肌增生症的声像图特征为胆囊壁厚、毛糙,囊腔缩小,囊壁内见多发性、大小不等的罗-阿氏窦,多为局限型。高频超声检查的病灶定位率、罗-阿氏窦显示率、诊断符合率和分型符合率等相关指标明显高于低频超声检查组,差异有统计学意义(P0.05)。结论临床超声诊断胆囊腺肌增生症应以高频探头检测为主,辅以低频探头补充,具有较高的临床诊断价值。     

18例胆囊腺肌增生症患者二维灰阶超声与超声造影检查结果分析

目的探讨超声造影对胆囊腺肌增生症的诊断价值。方法分析经病理证实的18例胆囊腺肌增生症患者二维灰阶超声及超声造影图像特点。结果二维灰阶超声检查10例、超声造影检查17例发现罗—阿氏窦（胆囊黏膜及肌层过度增生,胆囊壁增厚,腺体样增生的黏膜上皮伸入肌层,形成多数小囊状突出）;术前诊断率分别为55.6%、94.4%;与病理诊断的符合率分别为55.6%、94.4%;P均〈0.05。结论胆囊造影更有助于胆囊腺肌增生症的诊断。     

超声和CT对胆囊腺肌增生症诊断价值的对照分析

目的分析超声和CT检查对胆囊腺肌增生症的诊断价值。方法回顾性分析广州医科大学附属第二医院28例经病理证实的胆囊腺肌增生症患者超声和CT表现,分析其影像学特点,并以病理诊断为金标准,分析两种影像方法对胆囊腺肌增生症的诊断价值。率的比较采用χ2检验,P0.05为差异有统计学意义;率的多重比较采用卡方分割,P0.0125为差异具有统计学意义。结果 28例患者中,术前超声诊断胆囊腺肌增生症15例,CT诊断9例,CT诊断率为32.14%,超声诊断率为53.57%,χ2检验表明,超声与CT对胆囊腺肌症的诊断率差异无统计学意义(χ2=2.63,P=0.10);卡方分割分析CT及超声诊断不同类型胆囊腺肌症准确率的差异,结果表明,超声与CT对各种类型胆囊腺肌症的诊断率差异均无统计学意义(节段型:χ2=0,P=0.11;弥漫型:χ2=2.57,P=1.00;局灶型:χ2=1.42,P=0.23)。结论 CT及超声是诊断胆囊腺肌增生症的重要影像学方法;凸阵探头与线阵探头联合应用,可能提高超声对胆囊腺肌增生症的检出率。     

胆囊腺肌症一例

患者,男性,19岁.因"呕吐伴上腹疼痛半个月"就诊.无腹胀、腹泻,无反酸、嗳气,无恶心、畏寒、发热,无厌油感,皮肤黏膜及巩膜无黄染.体格检查:腹平坦,腹壁软,右上腹轻压痛,无反跳痛,肝脾肋下未触及,移动性浊音(-),肠鸣音正常,双下肢无水肿.肝功能未见异常.腹部超声检查提示胆囊大小、形态正常,内膜面粗糙,胆囊颈、体部囊壁局部非均匀性增厚,范围约1.9 cm ×0.6 cm,最厚处约0.5 cm,增厚囊壁处有多个微小类圆形液性回声区,并可见多个强回声斑,其后方伴彗星尾征,胆总管未见扩张.腹部CT增强扫描检查显示胆囊大小正常,壁稍增厚,内未见异常密度影.诊断为胆囊腺肌症.     

胆囊腺肌增生症15例

１材料和方法我院自１９７５／１９９７收治１５例经手术和病理证实的胆囊腺肌增生症中男６例,女９例年龄２１岁～７３岁,病程９ｄ—３５ａ,术中证实１２例（８０％）合并胆囊结石,１３例（８１％）合并胆囊炎,２例（１３％）合并胆总管结石,１例（７％）合并先天性胆总管囊肿和１例（７％）合并胆囊癌．１５例患者均有不同程度的消化不良,上腹饱胀,疼痛,发作时伴绞痛的症状其中件恶心,呕吐１１例,畏寒,发热３例,莫非征阳性４例,黄痊或有黄疸史２例,在胆囊区触及包块１例９例行口服胆囊造影,其中５例胆囊显影不良,浅淡或浓…     

14例胆囊腺肌瘤病病理诊断分析

胆囊腺肌瘤病又称“胆囊憩室病”及“腺肌瘤性增生”,是一种获得性疾病。1临床资料共观察14例,男性10例,女性4例,平均年龄53.2岁,均为胆囊切除术后活检时发现,多数发生于胆囊底部。病理观察:大体所见胆囊明显增大,平均为(8.5×3.4×2.5)cm,胆囊切开见粘膜呈绒状,壁增厚(0.3～1.     

CT检查对诊断胆囊腺肌症的效能分析*

目的 总结胆囊腺肌症与胆囊癌患者多层螺旋CT(MSCT)表现特征。方法 2015年9月～2020年9月我院诊治的胆囊腺肌症患者113例和胆囊癌患者78例,均接受MSCT和超声检查,外科手术治疗后行组织病理学检查。结果 MSCT检查结果与术后组织病理学检查结果的一致性(Kappa=0.749)显著高于超声检查(Kappa=0.577);MSCT诊断胆囊腺肌症的准确度为88.0%,显著高于超声检查的79.6%(P<0.05);MSCT对局限型胆囊腺肌症的检出率为97.1%,显著高于超声检查的82.9%(P<0.05);在CT检查上,胆囊腺肌症表现为胆囊壁光滑、RAS窦和肝胆交界清楚显示率分别为36.3%、36.3%和69.0%,显著高于胆囊癌组的9.0%、6.4%和38.5%(P<0.05)。结论 MSCT检查诊断胆囊腺肌症有较高的正确率,其特征有助于与胆囊癌鉴别。     

孕三烯酮治疗子宫腺肌症合并不孕12例临床分析

近年来,我们采用孕三酮治疗12例子宫肌腺症合并不孕患者,效果满意。现报告如下。     

Segmental adenomyomatosis of the gallbladder predisposes to cholecystolithiasis

Background/Purpose

The aim of the present study was to clarify the association between adenomyomatosis of the gallbladder and cholecystolithiasis.

Methods

A cholecystectomy was performed for cholelithiasis or various other conditions in 1099 patients, of whom 608 had cholecystolithiasis. Adenomyomatosis of the gallbladder was classified as one of three variants: segmental, fundal, and diffuse. Segmental adenomyomatosis has an annular stricture dividing the gallbladder lumen into the “neck compartment” and the “fundal compartment”. Bile lipid analysis was performed in 8 patients with segmental adenomyomatosis.

Results

Adenomyomatosis of the gallbladder was observed in 156 patients (14.2%), of whom 99 had segmental adenomyomatosis, 54 had fundal adenomyomatosis, and 3 had diffuse adenomyomatosis. The prevalence of cholecystolithiasis was higher in patients with segmental adenomyomatosis (88.9%) than in those without adenomyomatosis (52.3%; P < 0.001). Gallstones were detected earlier in patients with segmental adenomyomatosis than in those without (P < 0.001) and were located predominantly in the fundal compartment. Bile in the fundal compartment had lower concentrations of total bile acids (P = 0.012), with an increased cholesterol saturation index (P = 0.012), compared to bile in the neck compartment.

Conclusions

Segmental adenomyomatosis is a condition predisposing to cholecystolithiasis, probably due to the lithogenic environment in the fundal compartment. Fundal or diffuse adenomyomatosis appears to be unrelated to cholecystolithiasis.

     

胆囊息肉样病变612例临床分析

目的分析总结胆囊息肉样病变的临床、病理、诊断等特征．方法我院及中华医学会第七届全国胆道外科学术会议资料共报道胆囊息肉样病变６１２例进行分析和总结．结果胆囊息肉样病变６１２例占同期胆囊切除术的４２％；３０岁～５０岁占７８５％；结石合并率２８５％；病理类型中以胆固醇息肉最多，占５３７％；腺瘤性息肉恶变率极高，达２８５％；临床表现无特异性，Ｂ超的诊断率最高，达９２５％．结论胆囊息肉样病变患者相对年轻；病理类型以胆固醇类多见，腺瘤性息肉易恶变，特别是合并结石的息肉；临床诊断以Ｂ超为首选     

进一步提高胆囊癌诊治的总体水平

原发性胆囊癌是胆道系统最常见的恶性肿瘤,女性多于男性。该病发病隐匿,临床症状不典型,早期诊断率低,恶性程度高,预后极差,病理类型以腺癌为主。虽然外科手术技术不断进步,但手术切除率仍低。所以努力提高胆囊癌早期诊断率,开展以手术为主的综合治疗措施,把握手术适应证,选择合理术式,是进一步提高胆囊癌诊治总体水平的重要措施。     

Successful treatment of gallbladder carcinoma producing alpha-fetoprotein with segmental adenomyomatosis

The successful treatment of hepatoid adenocarcinoma of the gallbladder with elevated serum alpha-fetoprotein (1243 ng/ml) and segmental adenomyomatosis in a 58-year-old woman is described. The woman had alpha-fetoprotein (AFP)-producing carcinoma of the gallbladder with regional lymph node metastasis and was treated by extended radical resection and postoperative adjuvant chemotherapy. She is alive, showing normal serum AFP concentration and no recurrence, 57 months after surgery. The tumor cells were stained immunohistochemically for AFP by the peroxidase anti-peroxidase method. Serum AFP reactivity to concanavalin A and lentil lectin was similar to the pattern shown in hepatocellular carcinoma. Only a few cases of AFP-producing gallbladder carcinoma have been reported and there have been no reports of long-term survivors. The combination of aggressive radical resection and chemotherapy seems to have been effective for achieving long-term survival without liver metastasis.     

胆囊癌诊断和治疗指南(2015版)

正胆囊癌是指发生于胆囊(包括胆囊底部、体部、颈部以及胆囊管)的恶性肿瘤。我国胆囊癌发病率占同期胆道疾病的0.4%~3.8%,位列消化道肿瘤发病率第6位,患者5年总生存率仅为5%[1-3]。胆囊癌疗效的提高主要取决于对其主要高危因素的认识、准确的临床分期和根治性手术切除方法的应用。由于长期缺乏符合我国国情的诊断与治疗规范,目前对于胆囊癌诊断与治疗方法的认识和应用仍较为混乱。为此,中华     

急性呼吸窘迫综合征23例临床分析

目的探讨急性呼吸窘迫综合征（ARDS）的诊断和治疗。方法对23例ARDS患者的临床资料进行回顾性分析。结果23例患者死亡14例（死亡率60．9％）。结论多种危重病都有可能发生ARDS。监测患者的呼吸频率（RR）、经皮血氧饱和度（SpO2）、动脉血气（SaO2、PaO2）和PaO2／FiO2有利于ARDS的早期诊断;ARDS的治疗以机械通气为主,实施保护性肺通气策略,兼顾其他支持性治疗。     

意外胆囊癌18例报告

意外胆囊癌(unexpected gallbladder carcinoma,UGC)是指术前未有明确诊断,因"良性"疾病行胆囊切除术中或术后由病理切片确诊的胆囊癌,又称为偶发胆囊癌、亚临床胆囊癌、机遇性胆囊癌。UGC在所有诊断的胆囊癌中所占比例较高,但各家报道不一。随着目前腹腔镜胆囊切除术和小切口胆囊切除术的普及,UGC的数量也有逐年增多趋势。尽管超声、CT及核磁等影像学检查技术在不断进步,但胆囊癌的早     

Benign gallbladder lesions mimicking cancer infiltrating the liver

Considering the current improved resectability of advanced gallbladder cancers, differentiation from benign gallbladder lesions mimicking advanced cancer is now a significant problem to be overcome so that unnecessary extended operations can be avoided. During the 4 years from January 1989 to December 1992, we experienced 63 patients with elevated lesions of the gallbladder, including cancer. Among the 59 patients who underwent resection, preoperative imaging diagnostic procedures were suggestive of cancer in 27. In particular, the lesions of 14 patients appeared to be cancerous with hepatic infiltration. Frozen section histological examinations were performed on the specimens of 4 of these patients in whom the findings were inconsistent; all of them were shown non-cancerous. The final diagnoses in these 4 patients were: hyperplastic polyp with foreign body granuloma, xanthofibromatous granulation, localized type adenomyomatosis, and chronic cholecystitis. Resections were performed on the remaining 10 patients who had lesions suspected to be cancerous with infiltration to the liver. Nine lesions were confirmed as cancer by histological examination of the resected specimen. However, the lesion of the remaining patient, who underwent hepatopancreatoduodenectomy, proved after operation, to be a hamartoma with foreign body granuloma. Of the imaging diagnostic procedures, a combination of endoscopic or intraoperative ultrasonography and computerized tomography was most valuable for making the differential diagnosis between gallbladder cancer and benign gallbladder lesions mimicking cancer infiltrating the liver. However, frozen section histological examination should not be omitted before the extended operations are performed, even though en bloc resection is preferable because the procedures used to obtain the specimens have the potential to disseminate viable cancer cells.     

Imaging-based algorithmic approach to gallbladder wall thickening

Gallbladder(GB) wall thickening is a frequent finding caused by a spectrum of conditions. It is observed in many extracholecystic as well as intrinsic GB conditions. GB wall thickening can either be diffuse or focal. Diffuse wall thickening is a secondary occurrence in both extrinsic and intrinsic pathologies of GB, whereas, focal wall thickening is mostly associated with intrinsic GB pathologies. In the absence of specific clinical features, accurate etiological diagnosis can be challenging. The survival rate in GB carcinoma(GBC) can be improved if it is diagnosed at an early stage, especially when the tumor is confined to the wall. The pattern of wall thickening in GBC is often confused with benign diseases, especially chronic cholecystitis, xanthogranulomatous cholecystitis, and adenomyomatosis. Early recognition and differentiation of these conditions can improve the prognosis. In this minireview, the authors describe the patterns of abnormalities on various imaging modalities(conventional as well as advanced) for the diagnosis of GB wall thickening. This paper also illustrates an algorithmic approach for the etiological diagnosis of GB wall thickening and suggests a formatted reporting for GB wall abnormalities.