B超引导经皮胆囊穿刺置管引流治疗老年急性化脓性胆囊炎

目的 探讨B超引导经皮胆囊穿刺置管引流(PGCD)治疗老年急性化脓性胆囊炎的临床应用价值.方法 对2002年3月～2005年12月接受PGCD治疗的37例老年急性化脓性胆囊炎患者的临床资料进行回顾性分析.结果 全组患者穿刺置管成功率达100%,2例术后36 h内导管脱落给予重新置管,无一例发生出血、胆漏等并发症,症状及体征于术后24～48 h明显改善,平均引流14 d,20例择期行胆囊切除术.结论 PGCD治疗老年急性化脓性胆囊炎具有效果显著、安全、微创等优点,具有重要的临床应用价值.     

B超引导经皮胆囊穿刺造瘘术治疗高龄急性胆囊炎68例报告

目的 探讨B超引导经皮胆囊穿刺造瘘术对高龄急性胆囊炎患者的疗效.方法 回顾性分析采用B超引导经皮胆囊穿刺造瘘术治疗高龄急性胆囊炎68例患者的临床资料.结果 68例患者全部成功施行穿刺置管,3例因引流管脱落或堵塞而再次行穿刺,67例(98.5％)获得有效的胆囊引流,1例(1.5％)术后病情无明显缓解,术后1d行急诊腹腔镜胆囊切除术.无一例因经皮胆囊穿刺造瘘术引起的并发症死亡,无出血、胆瘘等并发症发生.术后3个月45例(66.2％)择期行腹腔镜胆囊切除术,术后患者恢复好.结论 B超引导经皮胆囊穿刺造瘘术是治疗高龄急性胆囊炎患者的一项安全、简单、有效的方法.它有较高的成功率和较低的并发症发生率,值得推广.     

腹腔镜胆囊部分切除术32例体会

我院从 1994年 5月～ 2 0 0 0年 12月施行腹腔镜胆囊切除 6 0 0例 ,其中困难的腹腔镜胆囊切除术行胆囊部分切术 32例 ,现报告如下。1　临床资料1·1　本组行腹腔镜胆囊部分切除术 32例 ,男性 11例 ,女性 2 1例 ,年龄 2 3～ 73岁 ,平均 4 3 1岁。病史 1～ 6年 ,平均 3 4年 ,手术时间 1 2 5～ 3 2 0ｈ ,平均1 5ｈ。行胆囊部分切除术 32例中 ,萎缩性胆囊 18例 ,急性胆囊炎 14例 ,其中胆囊颈结石嵌顿 5例。2　结果32例中 ,中转开腹 1例 ,为胃癌根治术后急性坏疽性胆囊炎 ,胆囊管钛夹松脱重新置管 1例 ,术后随访上腹部轻微疼痛不适 5例。其余恢复…     

术后发现胆囊管残株结石6例分析

胆囊管残株结石是胆囊术后一种少见的并发症。我院自1995年1月-2004年8月,共因胆石症行胆囊手术603例。术后B超发现胆囊管残株结石6例,现分析如下。1临床资料本组病例男2例,女4例,年龄38-72岁。胆囊多发性结石2例,急性胆囊炎胆囊结石1例,慢性萎缩性胆囊炎胆囊结石2例,胆总管结石胆囊炎胆囊结石1例。术后发现时间1个月～3年。例1:女,38岁,因胆囊多发结石而行胆囊切除术。术后反复出现右上腹隐痛不适,半年后B超发现胆囊管残株结石。例2:女,59岁,因急性胆囊炎胆囊结石行胆囊切除术,术后2年反复出现右上腹隐痛不适,向右肩放射,B超提示:胆囊管残株结石。     

胆囊双管穿刺引流联合胆道镜治疗老年急性结石性胆囊炎

目的探讨通过胆囊双管穿刺引流后,使用胆道镜取石治疗老年急性结石性胆囊炎的方法及价值。方法回顾性分析2011年7月~2014年12月,在成都军区总医院接受此项技术治疗的49例患者的临床资料。患者首先行经皮经肝胆囊穿刺置管引流,再从右侧肋缘下经皮胆囊穿刺置管引流,最终扩张窦道,用胆管镜取石。结果全部患者的症状及体征均缓解,取石后治愈出院。主要并发症是出血(4.1%),无胆漏、肠瘘等严重并发症发生。随访41例,复发2例(4.9%)。结论胆囊双管穿刺引流联合胆管镜治疗老年急性结石性胆囊炎安全、有效,值得推广应用。     

经皮肝胆囊穿刺置管引流术治疗25例伴发MODS的高龄急性胆囊炎

目的：探讨伴发多器官功能不全综合征（MODS）高龄急性胆囊炎患者的治疗方法。方法：应用B超引导下经皮肝胆囊穿刺置管引流术（PTGCD）治疗25例伴发MODS的≥70岁急性胆囊炎患者。结果：25例患者均在24h内腹痛缓解，24～72h内体温正常，住院日10～15d，无一例围手术期死亡，无一例出现术前的伴发疾病加重。结论：PTGCD是伴发MODS的高龄急性胆囊炎患者应急救治疗方案，是暂时不宜手术患者的过渡治疗方法。     

腹腔镜治疗急性结石性胆囊炎临床分析

目的探讨腹腔镜治疗急性结石性胆囊炎临床的临床疗效。方法选择我院2010年6月-2011年6月我院收治的21例急性结石性胆囊炎患者,采用腹腔镜胆囊切除术治疗,总结、分析本组21例患者临床资料。结果本组18例患者均顺利施行腹腔镜胆囊切除术,3例患者中转开腹手术,行腹腔镜胆囊切除术18例患者术中出血量少,术后恢复好。结论急性结石性胆囊炎应及早施行腹腔镜胆囊切除术,可减少并发症发生。     

腹腔镜胆囊切除术治疗老年急性胆囊炎的护理对策

目的：总结老年急性胆囊炎患者行腹腔镜胆囊切除术的临床护理,提高护理工作水平.方法：笔者所在科对 43 例急性胆囊炎老年患者施行腹腔镜胆囊切除术,根据个体情况给予整体护理方案,观察结果并探讨高效的护理措施.结果：43 例老年急性胆囊炎抗感染1～2 d 后行腹腔镜胆囊切除术,无中转开腹手术者,住院时间 5～23 d,无死亡病例 ;术后 1～2 d 胆囊炎的症状及体征均有不同程度的缓解,黄疸减轻,体温恢复正常;均予以整体化护理方案,无严重术后出血、切口感染、肺部感染、胆漏、术后下肢深静脉血栓形成等严重并发症 ;住院 4～12 d 后痊愈出院.结论：整体化护理方案对急性胆囊炎行腹腔镜胆囊切除术的老年患者具有重要意义,能够积极防止并发症的发生,促进早期康复出院.     

B超引导下的床旁经皮经肝胆囊穿刺引流术在老年急性化脓性胆囊炎患者中的临床应用

目的 探讨B超引导下的床旁经皮经肝胆囊穿刺引流术(PTGD)治疗老年急性化脓性胆囊炎的疗效.方法 对20例老年急性化脓性胆囊炎行B超引导下的床旁PTGD治疗患者的临床资料进行回顾性分析,评价疗效.结果 PTGD穿刺成功19例,穿刺成功率95％(19/20),穿刺时间(28.82±12.29) min,引流胆汁量(189.92±26.60) ml,腹痛、发热症状均在穿刺成功后的36 h之内恢复正常.术后1周复查B超,增大胆囊均恢复正常大小,恢复率100％( 20/20),拔管时间(5.32±1.11)周,住院时间6～11周,16例有胆囊结石患者在拔管后半年择期进行了胆囊切除术.结论 B超引导下的床旁PTGD治疗老年急性化脓性胆囊炎能快速缓解危急症状,手术相对微创,安全,并发症少,对于不适合急诊手术的老年患者值得推广使用.     

双通道植管联合胆道镜保胆取石治疗老年高危结石性胆囊炎

目的评价B超引导下胆囊穿刺双通道植管联合胆镜保胆取石治疗高龄高危急性结石性胆囊炎患者的疗效。方法回顾性分析2015年1月~2017年1月70例﹥80岁急性结石性胆囊炎患者的临床资料。结果 70例患者均行超声引导下胆囊穿刺双通道植管胆囊冲洗、减压、持续引流,6~8周后,行胆道镜经窦道保胆取石。所有患者超声引导穿刺植管均一次性成功,2例发生穿刺后出血,经对症处理止血成功;2例因植管窦道形成不佳改行胆囊切除术,余68例均成功保胆取石(68/70);随访4~24个月,结石复发2例(2/68)。结论双通道胆囊穿刺植管联合胆道镜保胆取石治疗高龄高危胆囊结石方法简单、疗效可靠,具有推广价值。     

Diagnosis and treatment of cholelithiasis

Most patients with gallbladder stones are asymptomatic and do not require treatment. Biliary colics are the main indication for laparoscopic cholecystectomy: the treatment of choice for gallbladder stones. Dyspepsia is not an indication for treatment of gallstones. The indications for bile salt therapy and extracorporeal lithotripsy are limited. Acute cholecystitis should be treated with cholecystectomy à chaud whereas longstanding cholecystitis is preferably treated with cholecystectomy à froid. Bile duct stones are mainly treated endoscopically during endoscopic retrograde cholangiopancreatography (ERCP): pancreatitis, bleeding and perforation are the main complications. Prior to cholecystectomy, an ERCP is indicated in case of cholangitis, severe pancreatitis, persisting jaundice, bile duct stones on ultrasonography, or the combination of dilated ducts and abnormal liver function tests. After endoscopic stone removal, a cholecystectomy is indicated for patients < 50 years but a 'wait and see' policy is justified in elderly patients.     

Cholecystectomy in two small community hospitals

From 1958 to 1988, the author performed 981 cholecystectomies for nonmalignant gallbladder disease in two small southeastern Minnesota hospitals. Of the 981 patients treated, 708 were women. Among patients under age 40, the proportion of women was even higher, about 9 to 1. The peak age for cholecystectomy in both sexes was between 50 and 70. A normal gallbladder was found in 0.5% of patients, and 0.4% had cholecystitis without stones. The complication rate was 9.7%, and the mortality rate was 0.6%. All of those who died were 70 years old or older. These results compare favorably with those published from large institutions and indicate gallbladder surgery can be performed safely and effectively in small hospitals.     

Percutaneous gallbladder puncture and drainage

The authors present their experience and results of 88 percutaneous cholecystostomies performed on 72 high-risk patients suffering from acute cholecystitis during the last 11 years. The local and general treatment resulted in total recovery in 24 cases, surgery could be abandoned. In 37 patients the improvement of their general condition made elective cholecystectomy possible. In 4 cases urgent operation became necessary because of reappearance of acute symptoms after a temporary relief. 7 patients died during the acute phase. In 51 patients out of all cases treated with long-term drainage, the gallbladder was washed out with cooled saline 2-3 times daily.     

左氧氟沙星在老年院内下呼吸道感染的应用

目的观察左氧氟沙星在老年院内下呼吸道感染中的疗效及安全性. 方法以老年院内下呼吸道感染患者为观察对象,给予左氧氟沙星300 mg/次,1～2次/d,静脉点滴,疗程7～14 d. 结果 32例患者痊愈17例,显效10例,进步3例,总有效率84.4%,不良反应有1例血管刺激症状、2例表现为夜间失眠,不良反应发生率9.4%,未见肝、肾功能异常.结论左氧氟沙星治疗老年院内下呼吸道感染疗效比较肯定,副作用少,安全性较好.     

实验性胆囊结石取石前后胆囊壁的超显微结构变化

目的 探讨结石性胆囊炎超微结构变化与结石复发的关系。方法 手术植入人胆固醇结石制作兔胆石性胆囊炎动物模型，对取石前后3个月的兔胆囊壁作扫描电子显微镜和透射电子显微镜观察。结果 植石兔胆囊黏膜上皮片块状破坏，微绒毛脱落，细胞核浓缩，线粒体破坏，次级溶酶体增多。取石后，上皮细胞形态结构未能恢复正常，结缔组织裸露，表面附有粘液，胞浆中溶酶体减少，粘液滴明显增多，且向胆囊腔主动分泌。结论 植石所致的兔胆囊炎与人胆石性胆囊炎病理改变一致：取石后，胆囊的超微结构未恢复正常，且粘液分泌增加，是结石复发的病理基础。     

低分子肝素对老年下肢骨折形成深静脉血栓的疗效观察

目的观察低分子肝素(low-molecular-weight heparin,LMWH)治疗老年下肢骨折形成下肢深静脉血栓(deep venous thrombosis,DVT)的效果和安全性。方法选择2006年1月-2010年6月在本院就诊的156例老年下肢骨折患者中形成深静脉血栓的30例患者作为观察对象。治疗前后进行DVT症状评估、下肢深静脉的彩超检查。结果治疗后,治愈18例,显效6例,有效4例,无效2例,总有效率93.33%。凝血指标APTT、Fib与治疗前相比较差异有统计学意义(P<0.01)。结论使用LMWH治疗老年下肢骨折形成下肢深静脉血栓的效果好,安全性高。     

Influence on gallbladder volume of early postoperative gastric supply of nutrients

BACKGROUND & AIM: The gallbladder volume is a predictor of biliary stasis and the formation of biliary sludge. Biliary stasis and sludge have been recently recognized as the precursors of acute acalculous cholecystitis, as well as 'idiopathic' postoperative pancreatitis, rare but very serious complications after surgery. The aim of the study was to establish how early postoperative gastric supply of nutrients affects the gallbladder volume in patients after noncardiac and cardiac surgery. METHODS: In the two prospective, randomized studies 40 patients (study I-noncardiac surgery) treated at surgical ICU after major elective extrahepatobiliary and extragastrointestinal surgeries (7 thoracic, 19 vascular, 14 urological) and 40 patients (study II-cardiac surgery) treated at cardiosurgical ICU after CABG surgery were analyzed. In both studies the patients were divided into two groups: control group C (study I: 20 patients, age 45+/-18 yrs, male 65%; study II: 20 patients age 58+/-7 yrs, male 60%) and group E (group of early postoperative gastric supply of nutrients) (study I: 20 patients, age 52+/-17 yrs, male 50%; study II: 20 patients; age 59+/-8 yrs, male 65%). For the first 24 hours the patients in group C received only crystalloid solutions and the gallbladder volume was verified 24 hours after the surgery. In group E, postoperative gastric supply of nutrients began 18 hours after surgery (Osmolite, Ross; first 3 hours 30 ml/h and second 3 hours 50 ml/h; total 240 ml after 6 hours). In all patients sonographic measurement of gallbladder volume was performed immediately before surgery and 6 hours after the start of feeding (24 hours after surgery). The measurement was done with ultrasonographic scanner Hitachi 405 EUB (convex probe 3.5-5MHz) by the same specialist, and the volume was calculated using the ellipsoid method. RESULTS: The gallbladder volume measured by ultrasonography 24 hours after surgery in study I (noncardiac surgery) in group E amounted to 43+/-25 ml while in control group C it was significantly higher, i.e. 67+/-30 ml (P<0.05). In study II (cardiac surgery) in group E gallbladder volume amounted to 59+/-15 ml while in control group C it was also significantly higher, i.e. 71+/-11 ml (P<0.05). CONCLUSION: An early postoperative gastric supply of nutrients after both noncardiac and cardiac adult surgery diminishes the volume and probably stimulates the motility of the gallbladder, thus preventing biliary stasis and the formation of biliary sludge.     

Volvulus of the gallbladder. Report of two cases and review of the literature

Torsion or volvulus of the gallbladder is a rare cause of acute cholecystitis. Although it has been reported in all age groups, it is most commonly seen in the elderly. With our increasingly aged population, it behooves the clinician to keep this entity in mind when treating the older patient with abdominal pain. We present two cases of torsion of the gallbladder and review the clinical and pathological aspects of this disease.     

腹腔镜手术治疗急性化脓性胆囊炎36例临床分析

目的：探讨急性化脓性胆囊炎时如何安全实施腹腔镜胆囊切除术。方法：回顾分析2010年2月-2011年10月在普外科施行腹腔镜手术的36例急性化脓性胆囊炎患者的临床资料,并对治疗过程进行讨论。结果：36例行腹腔镜手术者,全组患者无死亡病例,平均手术时间55min,中转开腹2例,平均术后第4天出院,本组36例患者均无胆管损伤、血管损伤。36例术后随访3～6个月,无黄疸、发热等并发症发生。结论：注意正确掌握操作技巧,腹腔镜手术在治疗急性化脓性胆囊炎时是能够安全实施的。     

腹腔镜胆囊切除术在急性胆囊炎中的应用

目的对急性胆囊炎患者在腹腔镜下对患者进行胆囊切除手术,对其的治疗效果进行分析和总结。方法该院在2011年1月—2013年2月期间,对收治的498例急性胆囊炎患者的临床资料进行回顾性分析和总结。对这些患者进行随机分组,分成试验组和对照组,分别为249例。对照组:从患者的胆囊三角后侧进行解剖;试验组:对患者进行腹腔镜胆囊三角Ⅴ型解剖;对两组患者在手术后出现的并发症进行分析。结果在试验组中:患者在手术中,胆道的损伤患者有3例,占1.2%;胆漏患者有2例,占0.8%。在对照组组:胆道损伤患者有20例,占8%;胆漏患者有12例,占4.8%。对两组患者的并发症进行比较和分析,差异显著,具有统计学意义(P<0.05)。结论对患者进行胆囊切除,采用腹腔镜胆囊三角V型解剖,效果显著,减少在手术中出现的并发症。