腹腔镜与直视微创胆囊切除术治疗胆囊炎性疾病的对比分析

目的对腹腔镜与直视微创胆囊切除术治疗胆囊炎性疾病进行对比研究,探讨胆囊炎性疾病外科治疗的理想术式。方法回顾176例腹腔镜胆囊切除术(LC)与150例直视微创胆囊切除术(MPC)手术治疗胆囊炎性疾病患者临床资料,从术中及术后恢复情况各方面对比分析2者在治疗胆囊炎性疾病方面的优缺点。结果 2者比较LC创伤小、恢复快、并发症较少。结论 2种方式均具有微创特点,但是LC是外科治疗胆囊炎性疾病的金标准。     

Cholecystitis and cholelithiasis

Cholelithiasis and cholecystitis, with their complications, remain major health problems in the United States. At this time, cholecystectomy is the treatment of choice for all patients with symptomatic gallstones and those with acute cholecystitis, except those who are too ill to undergo surgery. Present therapeutic options may be summarized as follows: Asymptomatic patients and those with flatulence and dyspepsia who have gallstones should be observed. Those who have symptoms of biliary pain, gallstone-induced pancreatitis, or common duct stones should have corrective surgery. Those who refuse surgery or who aren't surgical candidates might be treated with dissolution therapy. Dissolution of gallstones with chemical agents and extracorporeal shock-wave lithotripsy show some promise. We need a better understanding of the etiology and formation of gallstones to address the disease from a preventive standpoint and reduce the incidence of cholelithiasis and cholecystitis, and their complications.     

黄色肉芽肿性胆囊炎(附16例分析)

目的： 本文回顾性分析１６ 例黄色肉芽肿性胆囊炎 （ＸＧＣ） 的临床表现、超声特点及手术和病理结果。方法： １６ 例ＸＧＣ （男６ 例, 女１０ 例, 年龄 ４３～７８ 岁） 术前均经超声检查。结果： １６ 例ＸＧＣ 均合并胆囊结石, 胆囊壁均见增厚 ４ｍ ｍ ～１５ｍ ｍ , 其中１ 例合并肝浸润以致胆囊壁与肝实质无法分界。结论： ＸＧＣ 是一种良性慢性胆囊炎, 可能发展成胆囊癌, 尽管在组织学上具有特征, 但是在超声上无明显特异性。     

Chronic Cholecystitis

Personal, social, and medical factors unique to individual patients have a bearing on the efficacy of specific antihypertensive agents and on the frequency and severity of side effects. The factors relate to age, sex, occupation, potential for adherence to a prescribed program of therapy, and associated health problems. The importance of a simple, inexpensive program is emphasized.     

Management of Acute Cholecystitis

The management of acute cholecystitis is cholecystectomy. Safe cholecystectomy requires the careful dissection of the cystic duct. The importance of Hartmann's pouch, the patho-anatomy which develops as a result of cholecystitis, is emphasized. A definite technic is the best insurance against surgical injury to the common duct.     

Cholecystitis occurring without stones

POSTGRADUATE MEDICINE invites submission of brief case reports, especially those related to ambulatory medical care. Illustrations and references should be included only when essential.     

Cholecystitis occurring without stones

A case of acalculous cholecystitis in a 65-year-old man with underlying diabetes mellitus, hypertension, and peripheral arteriosclerosis is presented here. His case remained diagnostically puzzling for some time until symptoms and signs became more severe and very suggestive of acute cholecystitis. The clinical impression was then supported by an abnormal radioisotope biliary scan. The scan has fairly good sensitivity in detecting this condition but may not be totally dependable. Acalculous cholecystitis is an unusual but serious variant of a common disorder in which treatable gallbladder disease may masquerade as a less treatable liver malady. A common denominator among this disorder's many etiologies may be impairment of the gallbladder microcirculation in the presence of one or more conditions that lower the gallbladder's resistance to bacterial invasion. Prompt detection and treatment are desirable to reduce morbidity and mortality. However, early diagnosis is not always possible, because the clinical picture often is unclear, clear, gallstones are absent, and laboratory test results may be normal or equivocal. As in the case reported here, the vague clinical picture may dictate following a patient until the illness reaches an intensity acute enough to permit identification. The greatest aid to earlier diagnosis for the physician faced with circumstances similar to those described here is to think of cholecystitis and then to give strong weight to that clinical suspicion. At times, a recommendation for cholecystectomy may have to be made mainly on clinical judgment.     

腹腔镜胆囊切除术治疗急性胆囊炎

目的：探讨腹腔镜胆囊切除术治疗急性胆囊炎的方法和经验。方法：回顾分析2008年10月—2010年9月行腹腔镜胆囊手术的54例急性胆囊炎患者的临床资料。结果：在54例急性胆囊炎患者中45例72h内手术,9例72h后手术,其中最长者发病5d手术;成功完成腹腔镜手术53例,中转开腹1例。结论：急性胆囊炎、胆囊结石患者应在72h内行腹腔镜胆囊切除术,病程长、操作困难、高龄和合并有心血管疾病的患者应及时中转开腹手术。     

腹腔镜治疗急性胆囊炎

目的：探讨急性胆囊炎的手术时机与手术时间、手术并发症之间的关系。方法：急性胆囊炎的病人，无论发病时间长短均进行常规的术前准备后手术或急诊手术。通过术前症状、体征、血象、B超和术后病理切片证实为急性胆囊炎，并根据病理改变，分为急性单纯性胆囊炎、急性化脓性胆囊炎，急性坏疽性胆囊炎和总性胆囊炎穿孔，记录不同病理类型胆囊炎的手术时间、并发症、住院天数和中转开腹例数。根据发病到手术的时间，分为发病后72h内施行手术组和发病72h以后施行手术组，分别记录其手术时间、并发症、住院天数和中转开腹例数。结果：254例病人中单纯急性胆囊炎166例，急性坏疽性胆囊炎35例，怠性胆囊炎穿孔5例，急性化脓性胆囊炎48例，怠性发作时间在72h以内96例，超过72h158例。急性坏疽性胆囊炎、急性胆囊炎穿孔、急性化脓性胆囊炎的手术时间较单纯急性胆囊炎延长。5例急性胆囊炎穿孔病人中有1例病人中转开腹，48例急性化脓性胆囊炎中有2例病人中转开腹。时间超过72h手术的病例，较发病72h以内手术的病例手术时间明显延长，3例中转开腹的病例全部为发病72h以后手术的病例，各组病例的术后住院天数免明显差别，各组病例未出现胆道损伤。无死亡病例。结论：由具有丰富的腹腔镜手术经验的外科医生完成腹腔镜总性胆囊炎手术，仍是一种安全的手术，急性胆囊炎，特别是急性坏疽性胆囊炎、急性胆囊炎穿孔、急性化脓性胆囊炎和发病时间超过72h的急性胆囊炎手术，手术难度明显加大，手术时间明显延长。     

黄色肉芽肿性胆囊炎CT和病理特征

【目的】探讨黄色肉芽肿性胆囊炎（XGC）的CT和病理特征。【方法】回顾性分析经手术病理证实的13例XGC患者的CT影像学和病理学资料。【结果】13例XGC均表现为胆囊壁不同程度增厚,增强扫描增厚的胆囊壁轻一中度强化,n例增厚的胆囊壁内见条片状、结节状低密度影,增强扫描低密度影均无明显强化;7例囊内壁光整,黏膜线连续;6例黏膜面毛糙,不完整;13例胆囊内见均见结石,4例累及肝脏,5例与周围肠管粘连、分界不清;13例病理特点均表现为胆囊壁特征性的黄色肉芽肿结构,主要为泡沫样组织细胞,大量纤维组织增生,伴有淋巴细胞和浆细胞浸润,6例黏膜糜烂、渍疡形成。【结论】XGC的CT表现及病理具有一定的特征性,CT检查有助于XGC的诊断。     

原发性胆囊癌与慢性化脓性胆囊炎的CT鉴别诊断

目的:探讨原发性胆囊与慢性化脓性胆囊炎的CT诊断及鉴别诊断。材料与方法:回顾性分析29例胆囊癌及12例慢性化脓性胆囊炎的临床表现及CT资料。结果:两组病例临床表现类似。CT显示胆囊癌的胆囊壁增厚6例,突入胆囊腔内肿块16例及肿块占据整个肿囊7例。肝内胆管扩张18例。病灶均有轻度至中度强化。慢性胆囊炎均表现胆囊增大,壁增厚;5例壁内存在低密度区;增强后明显强化。肝内胆管扩张1例。结论:CT显示胆囊癌主要表现为局部肿块及肝内胆管扩张;胆囊炎表现为胆囊壁增厚、边缘模糊,尤其CT可以发现壁内低密度小脓肿。     

超声对胆囊炎的诊断价值

胆囊炎是临床上的常见病及多发病 ,分为结石性和无结石性胆囊炎。超声对胆囊炎检出率高 ,尤其是对无症状型胆囊炎的诊断起着重要的作用。本文作者对 1 6 6 9名 4 0岁以上的体检者进行超声检查 ,发现胆囊炎发病率较高 ,现报告如下。资料与方法1 1 临床资料2 0 0 0年 ,在我院进行体检者中 ,年龄在 4 0岁以上的有 1 6 6 9人 ,其中男性 1 0 1 8人 ,女性 6 51人 ;平均年龄 56岁 ,其中 4 0～ 50岁的有 82 0人 ,51～ 6 0岁的有4 55人 ,6 1～ 70岁的有 30 6人 ,70岁以上有 88人。检出患胆囊炎的人数为 32 7人 ,占体检总人数的 1 9 6 %。1 2 仪器…     

萎缩性胆囊炎的外科处理

目的 :探讨萎缩性胆囊炎的外科治疗经验。方法 :对 1995年年 10月至 2 0 0 1年 10月经手术治疗的萎缩性胆囊炎 10 3例进行回顾性分析。结果 :术中医源性损伤胆道 3例 ,损伤肠道 2例 ,术后残余小胆囊 1例 ,胆道残余结石1例 ,术后胆石性肠梗阻 1例 ,术后死亡 2例。结论 :萎缩性胆囊炎常伴有许多复杂的临床问题 ,选择恰当的治疗方法可降低术后并发症的发生