实时超声显像LUNDH试餐冰棒法在胆囊收缩功能检查中的应用价值

目的 探讨实时超声显像LUNDH试餐冰棒法在胆囊收缩功能检查中的应用价值。方法 选择空腹血浆胆囊收缩素(CCK)水平正常,超声检查胆囊大小、形态正常、囊内胆汁透声好,油煎鸡蛋脂餐试验胆囊最大收缩率≥35%的50名受试者。试验前所有受试者均空腹行常规超声检查。试验1:选择体重50～60kg的23名受试者,第1天空腹服用LUNDH试餐冰棒1份(1支冰棒),同一组受试者于LUNDH试餐试验后第3天,空腹服用油煎鸡蛋1枚;试验2:选择体重50～100kg的受试者50名,分别于第1天、第3天、第5天空腹服用LUNDH试餐冰棒1份、1.5份、2份。所有受试者均分别于餐后15、30、60、90、120、150、180min行常规超声检查。常规超声检查测量胆囊最大长径、最大横径和最大前后径,计算每名受试者空腹胆囊容积、服用试餐后各个时间点胆囊容积,并取胆囊容积最小值作为胆囊最小残余容积,计算胆囊最大收缩率。结果 试验1:23名受试者服用LUNDH试餐冰棒后90min内均达到胆囊最大收缩率,而服用油煎鸡蛋后90min内仅有82.61%(19/23)达到胆囊最大收缩率。23名受试者服用LUNDH试餐冰棒1份所诱发的胆囊最大收缩率为(55.57±8.34)%,大于服用油煎鸡蛋1枚所诱发的胆囊最大收缩率(35.18±7.39)%,差异有统计学意义(t=8.777,P<0.05)。试验2:体重50～70kg的28名受试者服用1份试餐冰棒可达到胆囊最大收缩率,体重70～80kg的15名受试者服用1.5份试餐冰棒可达到胆囊最大收缩率,体重90～100kg的7名受试者服用2份试餐冰棒可达到胆囊最大收缩率。不同体重的受试者达到胆囊最大收缩率所需要的LUNDH冰棒试餐量随受试者体重的增加而增加。结论 LUNDH冰棒试餐制作、使用方便,便于存储,可作为标准脂餐用于胆囊收缩功能测定。实时超声显像LUNDH试餐冰棒法是理想的胆囊收缩功能检查方法,具有较好的临床应用价值。     

肥胖症患者胆囊体积和收缩功能的超声研究

目的 探讨肥胖症患者与正常体质量者空腹胆囊体积及胆囊收缩功能的差异.方法 对44例肥胖症患者(BMI≥28 kg/m2)、47例体质量正常者(BMI＜24 kg/m2)行胆囊超声检查.分别于空腹状态下及脂餐后第30 min、第45 min、第60 min、第120 min测量胆囊最大长径、左右径、前后径,根据椭圆体公式计算空腹胆囊体积、餐后残余胆囊体积,计算胆囊排空率.比较肥胖组与正常体质量组之间空腹胆囊体积、脂餐后不同时段胆囊排空率的差异.结果 肥胖组的空腹胆囊体积明显大于正常对照组.脂餐后第30 min、45 min、60 min胆囊排空率均明显小于对照组,以第45 min差异最显著.餐后第120 min与第60 min的胆囊残余体积在两组内差异均无统计学意义.结论 肥胖症患者空腹胆囊体积增大,餐后收缩功能减弱.超声对于肥胖症患者胆囊收缩功能的评价时间可缩短至餐后60 min,第45 min为最佳观察时机.     

慢性胆囊炎与胆结石形成关系的超声研究

目的 探讨慢性胆囊炎与胆结石形成的关系.方法 慢性胆囊炎、胆结石患者及正常人各20例采用超声法进行脂餐前后胆囊容积及排空率的测定.结果 结石组较对照组脂餐前、餐后各期胆囊容积增大,排空率降低(P＜0.05).慢性胆囊炎组餐后胆容积及排空率与对照组无显著性差异(P＞0.05),但空腹容积显著增大(P＜0.05).结论 慢性胆囊炎患者存在胆囊运动功能异常,这种异常可能是胆囊结石形成的原因之一.     

胆囊腺肌增生症的超声漏误诊分析(附23例报告)

目的总结胆囊腺肌增生症的超声特点 ,分析漏、误诊原因 ,提高诊断准确率。方法对 2 3例经手术病理证实的胆囊腺肌增生症 ,术前均行超声检查 ,其中 17例加做彩色多普勒超声检查 ,探头频率 3 5～ 5 0MHZ ,13例第 2天予脂餐试验后进行超声对比扫描。结果 2 3例中胆囊呈弥漫型增生 9例 ,节段型增生 2例 ,局限型增生 12例。术前诊断为胆囊腺肌增生症 8例 ,漏诊 3例 ,误诊 12例。超声表现为胆囊壁弥漫或局限性增厚 ,增厚的囊壁内见小圆形无回声区 ,部分可见强回声光点伴彗星尾征。脂餐试验示胆囊收缩功能亢进。结论胆囊腺肌增生症合并胆囊炎、胆结石致胆囊无收缩排空功能 ,脂餐试验超声图像无特有的胆囊亢进征象是超声误诊的主要原因。熟悉胆囊腺肌增生症的超声特点、临床症状 ,可减少该病的漏误诊 ,对患者的治疗及预后有重要意义     

慢性胆囊炎三维容积测定的临床意义

目的 应用三维容积自动测量技术测量正常胆囊及慢性胆囊炎的胆囊容积，找出三维超声成像在测量胆囊容积及功能方面的优越性。方法 随机选取二维超声成像诊断为正常的胆囊及慢性胆囊炎的胆囊各15例，测量其容积，然后让被测试服用油煎蛋，并连续测量服蛋后不同时间的胆囊容积。结果 不同的正常胆囊的容积差异很大，服用油煎蛋90min后基本上缩小为空腹时的一半。慢性胆囊炎的胆囊收缩功能明显下降，90min内未能缩小到空腹时的一半。结论 三维容积自动测量技术可准确判断胆囊的收缩功能，并且操作简单、省时。     

健康名言

糖尿病性自主神经病变是糖尿病常见的慢性并发症之一。当自主神经病变累及消化系统时，胆囊收缩功能会出现异常。而胆囊收缩功能的异常可使糖尿病病人较非糖尿病病人易发生慢性胆囊炎和胆石症。针对胆囊收缩功能异常早期无明显症状，我们用超声脂餐试验的方法对糖尿病患者的胆囊收缩功能进行了观察，现报告如下。     

糖尿病患者胆囊功能的B超观察

糖尿病性自主神经病变是糖尿病常见的慢性并发症之一.当自主神经病变累及消化系统时,胆囊收缩功能会出现异常.而胆囊收缩功能的异常可使糖尿病病人较非糖尿病病人易发生慢性胆囊炎和胆石症[1].针对胆囊收缩功能异常早期无明显症状,我们用超声脂餐试验的方法对糖尿病患者的胆囊收缩功能进行了观察,现报告如下.     

萎缩性胆囊炎脂餐前后声像变化的探讨

目的对萎缩性胆囊炎患者进食脂肪餐后胆囊的声像变化进行分析、比较。方法在超声筛查出的17例胆囊萎缩患者,进食脂肪餐后30min复查,了解胆囊大小、内腔液区和囊内结石显示情况的变化。结果17例中,脂餐后胆囊均增大,胆囊轮廓、囊内情况较餐前更易显示,胆囊结石检出率增高。结论对超声检查胆囊显示不清或萎缩的患者,可采用进食脂肪餐后复查,对提高超声诊断的准确性有较大帮助。     

Lundh试餐在胆囊收缩功能检查中的价值

胆囊收缩功能检查常用油煎蛋脂餐法，此法使用麻烦，无法标准化。Lundh试餐是胰腺外分泌功能刺激剂．成分与胆囊标准餐相近。我们应用Lundh试餐对20例慢性胆囊炎患者及22例健康对照看。作了胆囊收缩功能测定，现报告如下：     

慢性药物性肝病胆囊排空功能观察

目的超声观察抗结核药引起的慢性药物性肝病患者胆囊排空功能。方法对31例慢性药物性肝病患者脂餐后测定胆囊排空率。结果慢性药物性肝病组胆囊排空率较正常对照组明显减小。正常对照组的最大胆囊排空指数在脂餐后60min，慢性药物性肝病组最大胆囊排空指数在餐后120min。结论慢性药物性肝病患者的胆囊收缩功能较差。     

三维超声评价胆囊排空功能

目的　探讨三维超声评价胆囊排空功能及其用于诊断慢性胆囊炎的准确性。方法　用三维、二维超声测量 74例健康成人和 61例慢性胆囊炎患者获得满意图像的脂餐后胆囊的排空指数 ,其中 5 1例同时采用核素显像法测量。以病理和核素显像法为标准 ,比较三维、二维超声评价胆囊排空功能及诊断慢性胆囊炎的准确性。结果　三维超声评价胆囊排空功能及诊断慢性胆囊炎的准确性分别为 92 .2 %和 93 .4% ,高于二维超声。结论　三维超声测量胆囊排空功能及诊断慢性胆囊炎的准确性高于二维超声方法。     

Contractility of maternal and fetal gallbladder: an ultrasonic study

The volumes of the maternal and fetal gallbladder were examined by ultrasound in a fasting condition during the last trimester of pregnancy in 25 cases and then monitored for 180 min after a standard peroral test meal or glucose administration. The ratio of maternal to fetal gallbladder fasting volumes corresponded to the ratio of the weights. A significant decrease in maternal gallbladder size was observed at 30, 60, and 120 min in both groups, but the changes in the volume of the fetal gallbladder were not significant. This latter observation points toward a resting condition and passive role for the gallbladder in the antenatal gastrointestinal physiology of the fetus.     

超声引导经皮胆囊穿刺置管引流术在老年急性胆囊炎中的应用

目的　探讨超声引导经皮胆囊穿刺置管引流术 (PGCD)在老年人急性胆囊炎中的应用价值。方法　回顾性分析了超声引导下PGCD在 1组 16例老年人急性胆囊炎中的应用的临床资料 ,并与同期 18例接受了胆囊切除术和 8例手术胆囊造瘘术的急性胆囊炎老年患者的资料相比较。结果　胆囊切除术组和胆囊造瘘术组的手术并发症率和死亡率以及平均住院天数分别为 38.9%、12 .5 %和 11.1%、12 .5 %以及 2 2 .4天与 32 .0天 ,而PGCD组的并发症率和死亡率均为 0 ,平均住院 16 .3天 ,其中胆囊切除术组和胆囊造瘘术组的手术并发症率和平均住院天数明显高于PGCD组 ,P <0 .0 5。结论　超声引导下PGCD是治疗老年人急性胆囊炎的有效、安全和简便的方法。     

Intramural gallstones mimicking typical lithiasic cholecystitis

Gallstone disease is common in the western population. Intramural gallstones are rare, with only a few cases reported in the literature. We present a 30-year-old female patient with typical symptoms of cholecystitis. The patient underwent laparoscopic cholecystectomy one month later. Dark greenish intramural gallstones were identified right after the resection of the gallbladder, and the pathologic examination revealed adenomyomatosis of the gallbladder. To our knowledge, this is the first report of intramural gallstones presenting with cholecystitis. The presence of intramural gallstones is not easily detected during ultrasound examination, and does not affect the natural course or treatment of gallstone disease.     

超声引导下经皮肝穿置管引流治疗急性重症胆囊炎

目的探讨彩超引导下经皮经肝穿刺胆囊置管引流术（PTGD）在急性重症胆囊炎治疗中的应用价值。方法回顾性分析2005年6月-2008年6月97例行超声引导下经皮经肝穿刺胆囊置管引流术的急性重症胆囊炎患者的临床资料。结果行超声引导下经皮经肝穿刺胆囊置管引流术的97例患者中,96例炎症均得到有效的控制（1例于术后第2天死于全身脏器衰竭）。76例患者于置管3～6周后择期行胆囊切除术,痊愈出院;4例急性非结石性胆囊炎患者于症状及体征缓解后拔管出院16例因合并有其它脏器疾病不能耐受手术而带管随访,带管最长者已达1年。结论彩超引导下经皮经肝穿刺胆囊置管引流术在急性重症胆囊炎治疗中的具有极大的应用价值。     

Ultrasound in postoperative acalculous cholecystitis

Eleven patients were examined by ultrasound before undergoing cholecystectomy (n=9) or cholecystostomy (n=2) for acalculous cholecystitis after abdominal surgery. The ultrasound images were analyzed retrospectively and compared with the surgical and histologic findings. The results indicate several established ultrasound criteria of cholecystitis to be less reliable than usual. Although 10 of 11 patients were on parenteral hyperalimentation, gross distention of the gallbladder was observed in only 3. In 4 of 7 patients, in whom pericholecystic fluid was observed, no gallbladder perforation was found at surgery. However, thickening of the gallbladder wall was displayed in 10 of 11 cases, combined with a sonolucent intramural layer in 6. Furthermore, intraluminal nonshadowing echogenic densities correlated with empyema or hemorrhage in 5 of 8 cases. In conclusion, despite several limitations, ultrasound can be of considerable help when one is deciding to perform repeat laparotomy when acalculous cholecystitis is suspected.     

Point-of-care ultrasound diagnosis of pediatric cholecystitis in the ED

Objective

The diagnosis of cholecystitis or biliary tract disease in children and adolescents is an uncommon occurrence in the emergency department and other acute care settings. Misdiagnosis and delays in diagnosing children with cholecystitis or biliary tract disease of up to months and years have been reported in the literature. We discuss the technique and potential utility of point-of-care ultrasound evaluation in a series of pediatric patients with suspected cholecystitis or biliary tract disease.

Methods

We present a nonconsecutive case series of pediatric and adolescent patients with abdominal pain diagnosed with cholecystitis or biliary tract disease using point-of-care ultrasound. The published sonographic criteria is 3 mm or less for the upper limits of normal gallbladder wall thickness and is 3 mm or less for normal common bile duct diameter (measured from inner wall to inner wall) in children. Measurements above these limits were considered abnormal, in addition to the sonographic presence of gallstones, pericholecystic fluid, and a sonographic Murphy's sign.

Results

Point-of care ultrasound screening detected 13 female pediatric patients with cholecystitis or biliary tract disease when the authors were on duty over a 5-year period. Diagnoses were confirmed by radiology imaging or at surgery and surgical pathology.

Conclusions

Point-of-care ultrasound to detect pediatric cholecystitis or biliary tract disease may help avoid misdiagnosis or delays in diagnosis in children with abdominal pain.     

多模态超声造影在胆囊穿刺置管引流术中的临床研究

【】 目的：探讨多模态超声造影在胆囊穿刺置管引流术中的临床应用价值。方法：选取240例急性胆囊炎患者随机分为3组,A组120例采用不同置管方式行胆囊穿刺置管引流术;B组60例,30例行超声引导下胆囊穿刺置管引流术,30例行经静脉超声造影+超声引导下胆囊穿刺置管引流术;C组60例,30例行经静脉超声造影+超声引导下胆囊穿刺置管引流术,30例行经静脉超声造影+超声引导下胆囊穿刺置管引流术+经引流管超声造影,统计并分析各组数据。结果：A组中一步法与置换法并发症发生率比较;B组中行胆囊穿刺置管引流术与行经静脉超声造影+超声引导下胆囊穿刺置管引流术成功率比较;C组中行经静脉超声造影+超声引导下胆囊穿刺置管引流术与行经静脉超声造影+超声引导下胆囊穿刺置管引流术+经引流管造影疗效进行比较,其结果均有显著性差异(p<0.05),具有统计学意义。结论：多模态超声造影联合胆囊穿刺置管引流术减少了并发症的发生率,提高了穿刺准确性,达到了理想引流减压效果,值得临床进一步推广应用。     

Performance and interpretation of focused right upper quadrant ultrasound by emergency physicians

The objectives of this study were to determine the accuracy of Emergency Physicians (EP) performing focused right upper quadrant (RUQ) ultrasound, to quantify how sonographic experience affects accuracy for gallbladder pathology, and to establish the time needed to complete a focused RUQ ultrasound. A convenience sample of patients with suspected gallbladder disease received a focused RUQ ultrasound by an EP. Sonographic findings, number of previous RUQ ultrasounds performed, and time for examination completion were recorded. Each patient then had a formal RUQ ultrasound by a sonographer blinded to the focused RUQ ultrasound results. Focused RUQ and formal ultrasound findings were compared, with the exception of the sonographic Murphy sign, which was compared to pathology reports. One hundred nine patients were enrolled. Fifty-one had gallstones. Forty-nine were detected by EPs, yielding a sensitivity of 96% [95% confidence interval (CI).87-.99]. Of the 58 patients without gallstones, 51 were correctly diagnosed by EPs (specificity = 88%, 95% CI.77-.95). The sonographic Murphy sign was present during 54 emergency examinations, but in only 24 formal studies. When compared to pathology reports, the emergency sonographic Murphy sign had a sensitivity of 75% compared to the formal ultrasound sensitivity of 45% for acute cholecystitis. EPs were less accurate for other sonographic findings, and level of experience had little effect on sensitivity or specificity for detecting gallstones. Eighty-three percent of emergency studies were completed in less than 10 min. Gallstones are accurately detected by EPs in a timely fashion. Additionally, compared to the radiologist's interpretation, the EP-detected sonographic Murphy sign was more sensitive for diagnosing acute cholecystitis.