胆囊切除术后残余胆囊19例分析

目的 提高对胆囊切除术后残余胆囊的认识,做出正确诊断和治疗。方法回顾分析19例胆囊切除术后残余胆囊的临床表现、影像学和病理学检查,以及外科治疗。结果大多数病例获得正确的临床诊断。19例均获得手术切除,术后恢复良好。结论根据临床表现和影像学检查,该病能获得正确诊断。再次手术切除是治愈该病的唯一手段。     

残余胆囊合并胆系结石13例分析

目的 提高对胆囊切除术后残余胆囊合并胆系结石的认识,做出正确诊断和治疗.方法 回顾分析13例残余胆囊合并胆系结石的临床表现、影像学和病理学检查,以及外科治疗情况.结果 大多数病例获得正确的临床诊断.13例均获得手术切除,术后恢复良好.结论 根据临床表现和影像学检查,该病能获得正确诊断.再次手术切除是治愈该病的惟一手段.     

胆囊切除术后残余胆囊结石28例诊治分析

目的探讨胆囊切除术后残余胆囊结石的原因、诊治及预防方法。方法回顾性分析我院28例残余胆囊结石再次手术的病例。28例中初次手术行经典胆囊切除术18例，小切口胆囊切除术6例，腹腔镜胆囊切除术4例；急诊手术15例，择期手术13例。结果大多数病例术前获得正确的临床诊断，28例均行再次手术治疗，切除残留胆囊及结石后，症状均消失，疗效满意。结论根据临床表现和影像学检查，该病能获得正确诊断。再次手术是唯一治疗手段。首次手术中认清胆囊管、肝总管、胆总管三者的解剖关系是预防的关键。     

胆囊切除术后残余胆囊结石的诊断与治疗

[摘 要] 目的 探讨胆囊切除术后残余胆囊结石的原因、诊治及预防方法。方法 回顾性分析扬州大学附属医院2015年1月至2017年6月收治的23例残余胆囊结石患者的临床资料。结果 23例患者术前均明确诊断,均予行残余胆囊切除术,术后恢复良好,效果满意。结论 根据患者的临床表现及影像学检查,残余胆囊结石能获得准确的诊断,再次手术是治愈疾病的有效手段,腹腔镜手术治疗残余胆囊结石是安全、有效的。     

12例残余胆囊结石诊治分析

目的 提高对胆囊切除术后残余胆囊合并结石的认识,做出正确的诊断和治疗.方法 回顾性分析我院收治的12例残余胆囊合并结石的临床资料.结果 本组12例术前获得正确的临床诊断,均行残余胆囊手术切除,术后恢复良好.结论 根据临床表现和影像学检查,残余胆囊结石能获得正确的诊断,再次手术切除是治愈该病的有效手段.     

残余胆囊合并胆系结石的诊治和预防

目的探讨残余胆囊合并胆系结石的病因、诊治及预防,以减少此并发症的发生。方法回顾性分析本院收治的17例残余胆囊合并胆系结石的临床资料。结果大多数病例术前获得正确的临床诊断;17例均行再次手术治疗,术后症状消失,疗效满意。结论根据临床表现和影像学检查,该病能获得正确诊断;再次手术是惟一治疗手段;首次手术中认清胆囊管、肝总管、胆总管三者的解剖关系是预防的关键。     

腹腔镜胆囊切除术后残余胆囊管结石23例诊治分析

目的探讨腹腔镜胆囊切除术(LC)后残余胆囊管结石诊治体会。方法回顾性分析我院收治的23例LC术后残余胆囊管结石患者的临床资料。结果本组23例术前均获得正确的临床诊断,均行残余胆囊切除治疗,术后恢复良好,疗效满意。结论根据患者临床表现结合影像学检查,残余胆囊结石可获得准确诊断,再次手术治疗是治愈该病的有效手段。     

腹腔镜胆囊切除术后残余小胆囊的诊治和预防

目的 探讨腹腔镜胆囊切除术后残余小胆囊的诊治经验和预防措施.方法 回顾性分析新疆克拉玛依市中心医院自1994年12月至2007年12月收治的12例腹腔镜胆囊切除术后残余小胆囊的临床资料.结果 该组12例,腹腔镜胆囊切除术后残余小胆囊发生率为0.46%(12/2609),均经再次手术证实,其中伴结石者3例;经再次手术切除胆囊管残株、清除残余结石而治愈,效果良好.结论 腹腔镜胆日囊切除术后残余小胆囊首选B超或MRI检查,确诊后再次手术切除残株是治疗该病的有效方法.严格把握腹腔镜胆囊切除术的适应证,强调手术操作规范,是预防本病发生的关键.     

腹腔镜胆囊切除术后残余小胆囊的诊治和预防

目的 探讨腹腔镜胆囊切除术后残余小胆囊的诊治经验和预防措施.方法 回顾性分析新疆克拉玛依市中心医院自1994年12月至2007年12月收治的12例腹腔镜胆囊切除术后残余小胆囊的临床资料.结果 该组12例,腹腔镜胆囊切除术后残余小胆囊发生率为0.46%(12/2609),均经再次手术证实,其中伴结石者3例;经再次手术切除胆囊管残株、清除残余结石而治愈,效果良好.结论 腹腔镜胆日囊切除术后残余小胆囊首选B超或MRI检查,确诊后再次手术切除残株是治疗该病的有效方法.严格把握腹腔镜胆囊切除术的适应证,强调手术操作规范,是预防本病发生的关键.     

腹腔镜胆囊切除术后残余小胆囊的诊治和预防

目的 探讨腹腔镜胆囊切除术后残余小胆囊的诊治经验和预防措施.方法 回顾性分析新疆克拉玛依市中心医院自1994年12月至2007年12月收治的12例腹腔镜胆囊切除术后残余小胆囊的临床资料.结果 该组12例,腹腔镜胆囊切除术后残余小胆囊发生率为0.46%(12/2609),均经再次手术证实,其中伴结石者3例;经再次手术切除胆囊管残株、清除残余结石而治愈,效果良好.结论 腹腔镜胆日囊切除术后残余小胆囊首选B超或MRI检查,确诊后再次手术切除残株是治疗该病的有效方法.严格把握腹腔镜胆囊切除术的适应证,强调手术操作规范,是预防本病发生的关键.     

残留胆囊的处理和预防:附56例报告

目的 探讨残留胆囊的处理与预防方法.方法 对56例残留胆囊病人处理的临床资料进行回顾性分析.结果 56例均经临床及影像学检查确定诊断,择期手术切除残留胆囊后均获痊愈.结论 (1)根据既往有胆囊切除术后反复发作的胆道症状及现代影像学可确定残留胆囊诊断;(2)残留胆囊切除是治愈本病的有效方法.     

Gallbladder Metastasis of Renal Cell Carcinoma: Report of Two Cases

We report two extremely rare cases of metastasis to the gallbladder from renal cell carcinoma. In both men, aged 63 and 80 years, a pedunculated polypoid gallbladder tumor was incidentally found 27 and 8 years after surgery for renal cell carcinoma, respectively. The tumors showed hypervascularity on diagnostic imaging. A histopathological examination showed no tumor cells in the gallbladder mucosa, but clear cell carcinoma was predominantly observed below the mucosal layer. Furthermore, based on various specific and immunohistochemical studies as well as the electron-microscopic findings, the patients were pathologically diagnosed to have gallbladder metastasis of renal cell carcinoma. Received: February 16, 2001 / Accepted: September 11, 2001     

Agenesis of the gallbladder: lessons to learn.

BACKGROUND: Congenital absence of the gallbladder is a rare, usually asymptomatic, anatomical variation. Some affected individuals may present with a clinical picture suggestive of gallbladder disease. This presentation, coupled with the inability of standard abdominal ultrasonography to convincingly diagnose agenesis of the gallbladder, can put the surgeon in a diagnostic and intraoperative dilemma. CASE REPORT: A 30-year-old lady presenting with clinical features of cholecystitis and diagnosed with shrunken gallbladder on ultrasonography was scheduled for laparoscopic cholecystectomy. Intraoperatively, the gallbladder could not be seen even after thorough dissection in the region of the porta hepatis. The procedure was terminated at this stage, and further imaging of the extrahepatic biliary system by magnetic resonance cholangiopancreatography and endoscopic ultrasound confirmed the diagnosis of congenital absence of the gallbladder. CONCLUSION: Nonvisualization of the gallbladder at laparoscopy, in the absence of any other diagnosed biliary disorder, need not prompt conversion to open exploration of the extrahepatic biliary system. Newer imaging modalities are relatively noninvasive and can provide good delineation of biliary anatomy. This allows wellplanned treatment and at the same time prevents the added morbidity of a diagnostic laparotomy performed solely to confirm the absence of the gallbladder.     

Floating gallbladder strangulation caused by the lesser omentum: report of a case

Strangulation of the gallbladder by the omentum is extremely rare. We report what to our knowledge is only the second documented case of strangulation of a floating gallbladder by the lesser omentum. A 61-year-old Japanese woman presented to a local hospital after the sudden onset right upper quadrant pain. Her clinical features suggested a gallbladder volvulus, and the patient was referred to our hospital for investigation and treatment. Ultrasonography and computed tomography showed no cholecystolithiasis, but the fundus and body of the gallbladder were markedly swollen without wall thickening, whereas the neck of the gallbladder was normal. A narrowed, twisted area was seen between the body and neck of the gallbladder. Based on these findings, gallbladder volvulus was diagnosed and she underwent emergency laparoscopic cholecystectomy. The fundus and body of the gallbladder were grossly necrotic. The narrowest part of the gallbladder was tightly strangulated by the lesser omentum, but the gallbladder neck was normal. Histopathologic examination of the resected gallbladder showed ischemic changes in the wall of the fundus and body. This case highlights that the clinical features and imaging findings of a gallbladder strangulated by the lesser omentum are similar to those of gallbladder volvulus and that a positive outcome is dependent on a correct diagnosis and prompt surgical management.     

残余胆囊的病因与处理

目的：探讨残余胆囊的发病原因、诊治及预防,以减少或根除残余胆囊的发生。方法：回顾性总结本院收治的３６例残余胆囊的临床资料,分析与致病有关的因素。３４例为开腹胆囊切除,另２例为腹腔镜胆囊切除术所引起。主要临床表现为类似胆囊炎表现,Ｂ型超声是主要影像学诊断方法。主要治疗方法为手术切除残余胆囊。结果：全组均行残余胆囊切除,近远期疗效佳。结论：提高医生对残余胆囊的警觉性,在胆囊切除术中认清胆囊三角区解剖关系,是预防残余胆囊的关键。     

十二指肠镜、腹腔镜序贯治疗胆石症2 248例分析

目的探讨十二指肠镜、腹腔镜序贯性诊治胆石症的价值. 方法回顾性分析2000年1月～2004年12月采用十二指肠镜、腹腔镜序贯性诊治方案治疗胆石症2 248例的临床资料. 结果确诊胆囊结石1 817例,胆囊结石合并胆总管结石431例.B超诊断为胆囊结石2 021例中,行术前ERCP 690例,发现胆总管结石213例;术中胆道造影(IOC)85例,发现胆总管结石10例;腹腔镜胆囊切除(LC)术后胆总管残余结石6例,并经EST治愈.B超诊断胆囊结石合并胆总管结石227例中,ERCP证实胆总管结石202例.行LC 1 817例,EST LC 395例,LBDE 36例(其中胆管一期缝合26例,T管引流10例).全组中转开腹28例(1.2%),并发症52例(2.3%). 结论十二指肠镜、腹腔镜序贯性诊治方案治疗胆石症,体现了内镜、腔镜联合应用的优势,术后残余结石率低,微创治疗成功率高.     

Mixed Adenoneuroendocrine Carcinoma of the Gallbladder

Mixed adenoneuroendocrine carcinoma rarely occurs in the gallbladder. Most cases of cholecystic mixed adenoneuroendocrine carcinoma have been reported from Asia, North American, and Europe; however, there is scarce literature available on this tumor in other populations. Here, we report a case of mixed adenoneuroendocrine carcinoma in a Melanoderm woman who was initially suspected to have gallbladder cancer. No specific symptoms or abnormal blood test results were observed preoperatively. Magnetic resonance imaging revealed a 7-cm hypointense mass in the gallbladder fossa, which invaded the surrounding liver segments. Radical cholecystectomy, partial liver resection, and regional lymphadenectomy were performed. Finally, she was diagnosed as mixed adenoneuroendocrine carcinoma of the gallbladder upon postoperative pathological examination and immunohistochemical staining. She received six cycles of systemic chemotherapy and somatostatin treatment and survived 21 months after surgery. Our case highlights the fact that mixed adenoneuroendocrine carcinoma of the gallbladder can occur in African populations as well. Surgical approach combined with adjuvant chemotherapy and somatostatin treatment may contribute a relatively good survival outcome.     

Acute noncalculous cholecystitis following gastrectomy for gastric cancer--study by ultrasonic examination

In 190 patients who were operated for gastric cancer, incidence of post-operative noncalculous acute cholecystitis was studied. Twenty four patients was diagnosed as postoperative acute cholecystitis mainly by ultrasonic examination. As the sonographic appearance of 24 diagnosed cases, gallbladder distention was observed in 6 cases (25%), a thickened gallbladder wall in 19 cases (79%), intraluminal echoes within the gallbladder in 20 cases (83%) and sonolucent layer around the gallbladder in 14 cases (58%). In many cases clinical symptoms were so mild that without ultrasound they might be dealt with fever of unknown origin. With regard to treatment, conservative therapy by antibiotics was performed in 18 cases and ultrasonically guided percutaneous transhepatic gallbladder drainage in 6 cases. In many cases, sludge demonstrated during the initial stage of acute cholecystitis remained for long period. In 6 cases, intraluminal echoes gradually changed into gallstones. Frequency of postoperative acute cholecystitis was 12.6% (24/190)--Subtotal gastrectomy: 8.4% (11/131), total gastrectomy: 23.0% (11/48) and proximal gastrectomy: 18.2% (2/11). In cases of Appleby operation, incidence was especially high--27.0% (10/37). Acute cholecystitis after gastrectomy for gastric cancer is not so rate complication as considered previously.     

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??ERCP combined with SpyGlass system for the treatment of concomitant gallbladder stones and secondary common bile duct stones in high-risky surgical patients ZHANG Hang*, LIU Dan-qing, XIAO Le,et al.* Department of Clinical Medical College, Southwest Medical University, Luzhou 646000, China
Corresponding author:LIU Wei-hui,E-mail: audiliu12@163.com
Abstract Objective To assess the clinical feasibility of endoscopic retrograde cholangiopancreatography(ERCP) combined with SpyGlass system for the treatment of concomitant gallbladder stones and secondary common bile duct stones in high-risky surgical patients. Methods A retrospective review of 4 consecutive patients with concomitant gallbladder stones and secondary common bile duct stones, who accepted ERCP combined with SpyGlass system to treat in General Surgery Center of PLA, Chengdu Military General Hospital from December 2016 to March 2017 were performed. Results The technique success rate of ERCP combined with SpyGlass system was 100%, and the stone removal rate also was 100%; ERCP operating time was 38-62 min, SpyGlass examination time was 17-33 min; All adverse events were mild, one patient developed acute cholecystitis and one patient underwent hyperamylasemia after surgery and both were cured by conservative treatment. According to Clavien-Dindo classification, all post-operative complications were grade ??. Abdominal ultrasound suggested that no stone residual in gallbladder and common bile duct within 3 months after the operation. In addition the gallbladder contractility function was normal in 3 months after the operation. Conclusion ERCP combined with SpyGlass system for the treatment of concomitant gallbladder stones and secondary common bile duct stones is safe and feasible in high-risky surgical patients.