B超在腹腔镜胆囊切除术前的应用

本文根据腹腔镜胆囊切除术(LC)前病人胆囊的大小、形态，胆囊壁厚薄，胆周有无粘连，胆囊结石及胆总管情况，胆道有无先天性畸形，将患者分为A(最适合组)、B(适合组)、C(相对适合组)、D(不适合组)四个组，为临床提供了较为全面的选择依据。与手术对照，B超符合率97.8％。对于减轻病人痛苦，减少手术风险，降低LC手术中转率具有重要临床价值。     

内镜逆行胰胆管造影术在胆囊切除术后胆漏的治疗中的作用

目的 探讨ERCP检查及治疗技术在胆囊切除术后胆漏的治疗过程中的作用。方法 对单纯胆囊切除术后发生的68例胆漏病人诊治过程进行回顾性分析，比较有无ERCP检查或治疗时，胆漏病例的治疗方案。结果 31例ERcP检查病例中,全部明确胆漏性质，12例仍需手术处理胆漏。37例未经ERCP检查病例中，20例手术治疗处理胆漏，其中5例术前PTC明确胆漏性质，其它病例于术中探查判断胆漏部位，2例探查误诊误治，6例单纯T管外引流术。结论 ERCP检查可明确胆漏的性质，提高手术治疗的准确性,并为部分病例提供有效治疗，降低手术治疗比例。ERCP对胆囊切除术后胆漏治疗具有重要价值。     

胆内瘘6例诊治分析

目的探讨胆内瘘的临床诊治方法。方法回顾性分析我院2002年以来收治的6例胆内瘘病人的诊治情况。结果6例病人术前均诊为萎缩性结石性胆囊炎，术中发现为胆囊十二指肠瘘3例，胆囊结肠瘘3例，瘘口直径在1．0cm以内。行胆囊切除、瘘口修补。无手术死亡，均临床治愈出院。结论胆内瘘是胆石症的一种少见且复杂的并发症，诊治过程复杂，误诊率高，手术风险大，术后并发症多。瘘口直径在1．0cm以内行胆囊切除、瘘口修补是安全的。     

不同频率探头对胆囊壁局限性增厚的B超诊断

Ｂ超对胆道系统疾病的诊断率是比较高的，如对胆系结石、胆系炎症、胆系肿瘤、先天性胆系疾病、胆道蛔虫病和各种原因引起的胆囊壁增厚、毛糙是非常清楚而且直观的。弄清疾因，及时诊治疗是很重要的。现将１例胆囊壁局限性增厚的报告分析如下： 资料与方法：患者：男性，３５岁，外院诊断为胆囊癌，来本院就诊欲行手术切除。所用仪器ＳＩＵＩ ＣＴＳ－２８０型，凸阵／线阵超声显像诊断仪，探头频率３．５ＭＨｚ、５．０ＭＨｚ。 结果：用３．５ＭＨｚ探头置于病人右上腹部胆囊窝处反复扫查，发现病人胆囊底部后壁略毛糙、增厚，从图像上看…     

胆囊切除术的几点体会

1989年7月-2006年8月我院行胆囊手术52例，其中4例不宜作胆囊切除，4例不应同时探查胆总管，1例胆总管损伤，1例术后伤口疼痛，死亡1例。为了减少手术并发症，降低死亡率，应严格掌握胆囊切除适应证，对危重病人，可采用胆囊部分切除和胆囊造瘘简单方法解除病灶，挽救生命。对胆肠引流患者无论胆囊有无病变，应常规切除胆囊，对解剖变异和严重粘连者逆行胆囊切除最为安全。胆囊切除时不应贸然对胆总管进行穿刺和探查，为了减少手术切口的损伤和污染，可采用右肋缘下斜切口。     

腹腔镜胆囊切除术严重并发症6例分析

我院于１９９４年７月～１９９８年８月共施行腹腔镜胆囊切除术（ＬＣ）３９２例，发生出血、胆漏、胆管损伤，需再手术或中转开腹手术的严重并发症６例（１．５３％），现分析报道如下。１临床资料本组男３例，女３例。年龄３６～６０岁。ＬＣ术后并发胆囊床广泛渗血２例...     

坏疽性胆囊炎的声像图特征及其应用价值

为了解坏疽性胆囊炎（ＧＣ）声像特征及基分型，减少ＧＣ的漏诊和误诊，预防严重并发症。采用超声仪品对２６３便因胆系疾病住院的空腹病人进行常规检查当发现胆囊增大或急性胆囊炎时，要及时随诊。结果检出ＧＣ２５例（９．５１％）。提示，熟悉ＧＣ发病规律，熟练掌握ＧＣ声像特征及时应用Ｂ检查并进行随访是术前ＧＣ的重要手段。     

B超诊断胆囊多发性息肉样病变6例

Ｂ超诊断胆囊多发性息肉样病变６例大庆市红岗区医院大庆市红岗区医院Ｂ超室张国柱邮政编码　１６３５１１本文报告６例胆囊多发性息肉样病变，均经手术证实．年龄４０～５５岁，平均４８岁。均为男性患者。Ｂ超发现胆囊轮廓清晰，壁毛糙，不规则增厚，囊内胆汁透声好、胆...     

肥胖病人腹腔镜胆囊切除术的临床研究

目的：提高肥胖病人腹腔镜胆囊切除术的技术水平。方法：回顾性分析817例肥胖病人的胆囊Calot三角区内脂肪堆积、腹腔镜胆囊切除术特点。结果：本组均在腹腔镜下完成手术，手术时间30～115min，平均49min。1例胆漏，1例大网膜损伤出血，2例胆囊动脉出血。结论：只要掌握肥胖病人胆囊Calot三角区内脂肪堆积特点，其腹腔镜胆囊切除术是安全可靠的。     

胆肠内瘘10例诊疗体会

我院自１９９０～１９９７年收治胆肠内瘘１０例，现就诊断和治疗谈几点体会。１临床资料１０例患者中，男３例，女７例；年龄５５～７４岁。全部病人都有反复发热后上腹痛、黄疸史，有１０年以上病史，多数急性发病而手术，术中所见：胆囊不同程度萎缩，壁厚色苍白，Ｃａ...     

经腹腔镜逆行胆囊切除术在临床中的应用分析

目的探讨经腹腔镜胆囊切除术中采取逆行胆囊切除在临床中的应用。方法回顾总结我院100例手术，均采取腹腔镜下逆行切除胆囊。结果经采取该术式均无胆瘘、胆管损伤等并发症的发生。结论经采取腹腔镜逆行胆囊切除术对于复杂性胆囊是一种行之有效的方法，降低了胆管损伤及中转开腹率。     

丝线加套扎线处理胆囊管在腹腔镜胆囊切除术中的应用

目的 探讨丝线加套扎线在腹腔镜胆囊切除术中的临床应用价值。方法2001年至2006年，采用丝线及套扎线结扎处理胆囊管的256例腹腔镜胆囊切除术，观察胆漏、术后胆囊动脉出血、右上腹不适、胆总管损伤和术后住院时间。结果 全部病例无并发症。手术后3~5天出院。随访1月，复查B超未发现胆囊窝积液。结论 在腹腔镜胆囊切除术中应用丝线加套扎线处理胆囊管，手术安全并能避免金属异物在体内留置。     

盆腔B超检查前膀胱充盈状况的研究

[目的]观察老年人盆腔B超检查前适量饮水后膀胱充盈与膀胱内尿量的关系,为做好检查前指导提供科学依据.[方法]随机选择行盆腔B超检查的95例住院老年人为受试对象,B超显示膀胱充盈度并测量膀胱容量;检查后立即排空膀胱并测量尿量;记录病人憋尿时的感受.[结果]膀胱充盈满意、基本满意、不满意者分别为63例、16例、16例;B超测膀胱容量及尿量分别为＞300mL、＞110 mL、＜100mL;膀胱充盈满意度与B超测膀胱容量、排出尿量密切相关;膀胱充盈满意者膀胱容量大、尿量多,较基本满意者、不满意者均有统计学差异;膀胱充盈满意者B超测膀胱容量及尿量均＞300 mL.憋尿时的感觉主要为烦躁出汗、小腹胀痛、急于解出小便及小量解出.不同膀胱充盈度者憋尿时的不适发生率无统计学差异,但膀胱充盈满意者中憋尿时的不适发生率较高.[结论]膀胱充盈度与膀胱内尿量密切相关,为使检查顺利进行,盆腔B超检查前应对饮水量给予指导,以保证膀胱内产生一定尿量;同时根据憋尿时的感受判断膀胱内充盈情况;急诊或不能耐受憋尿者可经导尿管注入150 mL～300 mL生理盐水以满足检查需要.     

Cefoperazone concentrations in bile and gall bladder wall after intravenous administration.

Cefoperazone concentrations in the common duct bile, gall bladder bile, and gall bladder wall were determined in four patients with cholelithiasis and one patient with carcinoma of the head of the pancreas, all of whom had normal renal functions. Within 65 min after a 1-g intravenous administration, maximum concentrations ranged from 373.4 to 3,100 micrograms/ml in common duct bile and from 6.8 to 680 micrograms/ml in gall bladder bile. Cefoperazone concentrations per gram of the gall bladder wall ranged from 16.8 to 48.0 micrograms.     

Assessment of gall bladder dynamics, cholecystokinin release and the development of gallstones during octreotide therapy for acromegaly.

The development of gallstones is a well recognized complication of therapy with the long-acting somatostatin analogue, octreotide in patients with acromegaly. A group of nine acromegalic patients was treated with octreotide at doses of 300-600 micrograms daily for 8 months and the changes in fasting and post-prandial cholecystokinin release, and gall bladder motor function (determined by a radiosotopic technique) were assessed at regular intervals. In addition the development of any gallstones was determined by serial ultrasonography. Fasting cholecystokinin levels showed no significant change over 6 months, whereas the post-prandial levels demonstrated a significant decrease (p less than 0.01) during therapy, yet remained significantly higher than fasting levels. Twenty-four hours after commencing therapy gall bladder ejection fraction was decreased by 57 +/- 23 per cent and gall bladder ejection rate decreased by 63 +/- 19 per cent compared to the pretreatment values, whereas after 6 months' therapy a marked reduction in gall bladder ejection fraction (greater than 35 per cent) and gall bladder ejection rate (greater than 40 per cent) persisted in only four of nine patients. Three of these four patients with persistently impaired gall bladder motor function were subsequently shown to have developed either gallstones or biliary sludge during the course of therapy. We conclude that treatment with octreotide is associated with an impaired post-prandial release of cholecystokinin in all acromegalic patients, but gallstones only develop in those patients who, in addition, have evidence of a persistently impaired gall bladder motor response to cholecystokinin.     

A case of accessory hepatic duct entering cystic duct successfully treated by laparoscopic cholecystectomy for cholecystolithiasis

Although laparoscopic cholecystectomy is a well-established surgical procedure, an accessory hepatic duct (AcHD) entering the cystic duct is poorly understood. A 77-year-old woman with symptomatic cholecystlithiasis was referred to our hospital. Abdominal ultrasonography indicated several small stones in the gall bladder. Magnetic resonance cholangiopancreatography (MRCP) did not reveal an anomalous cystic duct. Dissecting the gall bladder bed at operation, AcHD entering the cystic duct was suspected. Intraoperative cholangiography revealed that B5 branch entered the cystic duct. We ligated the AcHD, and divided it. Laparoscopic cholecystectomy was completed, and the patient was discharged without any complication. A week after the operation, MRCP showed that ventral branch of B5 was dilated. The patient showed no symptom for more than a year. The present case exhibited extremely rare AcHD entering the cystic duct, which was hardly recognized before surgery. It is possible to recognize such anomalous variants with standard laparoscopic approach based on 2018 Tokyo Guidelines and with attention to the possibilities of AcHD entering the cystic duct.     

无钛夹腹腔镜胆囊切除术625例经验

目的探讨无钛夹法处理胆囊管及胆管动脉在腹腔镜胆囊切除术中的应用。方法回顾性分析腹腔镜无钛夹法胆囊切除625例，术中应用超声刀或单极电刀封闭切断胆囊动脉，丝线结扎、套扎器结扎或可吸收夹结扎疸囊管。结果术后无1例病人出现腹腔感染、胆漏和出血等并发症。术后随访1-12个月。未见有腹痛、肩背部疼痛、黄疸及发热等症状。结论腹腔镜胆囊切除术中无钛夹法处理胆囊管及胆管动脉安全、可靠。能避免使用钛夹所致的并发症。     

光亮胆道造影法在腹腔镜胆囊切除术中的应用研究

目的在腹腔镜胆囊切除术(Laparoscopic cholecystectomy，LC)中利用光亮胆道造影法(light cholangiography，LCP)显示胆管走向，预防胆道损伤。方法在LC中分别经十二指肠乳头向胆总管置入光导纤维(light cholangiography through duodenum，LCPD)及经胆囊管置入光导纤维(light cholangiography through cysstic duct，LCPC)，导入冷光源，在腹腔镜电视图像中直接观看从胆管内透出的光亮，从而判断胆管的解剖位置。结果两种途径置入光导纤维行光亮胆道造影法均能在LC中提供直视胆道图像。LCPD操作复杂，但能提供全面的胆道图像。LCPC主要提供胆囊管及胆囊的胆道图像，与LCPD相比操作极为方便。结论光亮胆道造影法能清楚、直接地显示胆管走向。在解剖不清的LC中，能有效地帮助术者进行解剖，提高手术安全性，具有很高的实用价值。     

十二指肠镜、腹腔镜和胆道镜联合治疗胆道结石

目的 探讨胆囊结石合并胆总管结石、乳头狭窄、结石性胰腺炎等的微创外科治疗。方法 先行十二指肠镜逆行胰胆管造影（ERCP）＋乳头括约肌切开（EST）＋网篮取石（ESR）＋内镜鼻胆管外引流术（ENBD），术后3—7d再行腹腔镜胆囊切除术（LC）及术中胆道镜取石治疗胆囊结石合并胆总管结石、乳头狭窄、结石性胰腺炎286例，其中胆囊结石合并肝外胆管结石214例、肝外胆管结石＋乳头炎性狭窄39例、单纯乳头炎性狭窄22例、结石性胰腺炎28例。结果 ERCP成功率100％，EST成功率96．2％，tc（除外2例中转开腹）及术中胆道镜全部成功，无严重并发症发生。结论 十二指肠镜、腹腔镜和术中胆道镜联合治疗复杂性胆道结石，达到了治疗该类疾病的最小创伤，是目前治疗复杂性胆道结石的理想选择。     

Assessment of Gall Bladder Dynamics, Cholecystokinin Release and the Development of Gallstones During Octreotide Therapy for Acromegaly

The development of gallstones is a well recognized complicationof therapy with the long-acting somatostatin analogue, octreotidein patients with acromegaly. A group of nine acromegalic patientswas treated with octreotide at doses of 300–600 µgdaily for 8 months and the changes in fasting and post-prandialcholecystokinin release, and gall bladder motor function (determinedby a radiosotopic technique) were assessed at regular intervals.In addition the development of any gallstones was determinedby serial ultrasonography. Fasting cholecystokinin levels showedno significant change over 6 months, whereas the post-prandiallevels demonstrated a significant decrease (p<0.01) duringtherapy, yet remained significantly higher than fasting levels.Twenty-four hours after commencing therapy gall bladder ejectionfraction was decreased by 57±23 per cent and gall bladderejection rate decreased by 63±19 per cent compared tothe pretreatment values, whereas after 6 months, therapy a markedreduction in gall bladder ejection fraction (>35 per cent)and gall bladder ejection rate (>40 per cent) persisted inonly four of nine patients. Three of these four patients withpersistently impaired gall bladder motor function were subsequentlyshown to have developed either gallstones or biliary sludgeduring the course of therapy. We conclude that treatment with octreotide is associated withan impaired post-prandial release of cholecustokinin in allacromegalis patients, but gallstones only develop in those patientswho, in addition, have evidence of a persistently impaired gallbladder motor response to cholecyustonini.