原发性胆囊癌的超声表现及误诊分析

目的回顾性分析70例原发性胆囊癌患者的声像图及临床表现,旨在通过对其超声表现及误诊原因的分析,提高超声诊断率。方法70例原发性胆囊癌均为1993年至2004年住院患者。男24例,女46例,年龄37～91岁,平均64．7岁。所有患者术前1周内进行超声检查,后经手术和病理证实。结果70例患者超声诊断符合率为36％（25／70）,检出的胆囊肿块声像图特点各不相同,以充满型最多见,其次是结节隆起型、团块型,囊壁不均匀性增厚型最少检出,分别占32％（8／25）、28％（7／25）、24％（6／25）、16％（4／25）,漏误诊率高达64％,误诊原因包括病变隐匿、长期胆囊炎合并结石,囊内胆汁减少和稠厚,或肿块生长于颈部以及结石本身干扰超声医师判断。结论超声医师需加强对原发性胆囊癌的认识,在对慢性胆囊炎和胆囊结石,尤其多发性结石患者的随访中,要倍加仔细以及时发现问题,争取早期诊治。     

胆囊癌超声检查误诊15例分析

目的：探讨胆囊癌的超声误诊原因。方法：回顾性分析超声误诊的坫例胆囊癌的超声声像图。结果：8例误诊为胆囊结石并慢性胆囊炎，2例误诊为胆囊充满型结石，1例误诊为胆囊息肉，3例误诊为胆泥沉积，1例误诊为肝左外叶占位侵犯胆囊。结论：胆囊癌的超声误诊原因主要是胆囊内其他病变掩盖了肿瘤图像及操作者的水平有限。     

原发性胆囊癌B超误诊原因分析

本文分析经Ｂ超检查并手术和病理证实的３０例原发性胆囊癌的误诊原因，其中假阳性２５例，假阴性５例。误诊原因有：（１），充满型胆囊结石因弧形光带伴宽声影，掩盖了肿瘤声像不能显示；（２）只满足于发现胆囊结石，对伴有胆囊癌未引起重视，又缺乏多体位、多切面扫查，造成误诊；（３）胆囊不显像，无法判明胆囊的情况造成误诊；（４）将胆囊腔内蛔虫残体的声像误诊为胆囊癌；（５）因胆囊炎症致囊壁增厚且凸凹不平误诊为厚壁型胆囊癌；（６）胆囊腔内除见两块结石强光团外，还可见２．８×１．９ｃｍ较强光团但不伴声影，超声诊断为胆囊结石伴胆囊癌，手术证实不伴声影的较强光团系胆囊结石外周包裹了结缔组织所致；（７）Ｂ超与ＣＴ均诊断为胆囊癌伴胆囊周围癌浸润，手术和病理证实为胆固醇肉芽肿，胆囊壁由于炎症致使增厚并与周围肝组织粘连。     

超声诊断胆囊结石合并胆囊癌的临床价值分析

目的:分析彩色多普勒超声诊断胆囊结石合并胆囊癌的临床价值。方法:回顾性分析2021年7月—2023年6月常熟市中医院收治的80例疑似胆囊结石合并胆囊癌患者的临床资料,所有患者均行超声检查,以病理检查结果为金标准,分析超声检查对胆囊结石合并胆囊癌的诊断价值,计算灵敏度、特异度、准确率、阴性预测值、阳性预测值及超声检查与病理结果在胆囊结石合并胆囊癌中的一致性;比较胆囊结石、胆囊结石合并胆囊癌患者超声声像图特征。结果:超声诊断胆囊结石合并胆囊癌的灵敏度为90.63%,特异度为93.75%,准确率为91.25%,阳性预测值为98.31%,阴性预测值为71.43%,Kappa值=0.755,与病理结果一致性良好。经超声检查显示,胆囊结石患者胆囊内见强回声团伴声影,胆囊壁光整,胆汁透声好。胆囊结石合并胆囊癌患者胆囊内见强回声伴声影,胆囊底部胆囊壁不规则增厚,胆囊前壁另见低回声团,向囊腔内凸起,CDFI团块内见条状彩色血流信号。64例胆囊结石合并胆囊癌患者超声声像图显示:小结节型13例,胆囊病灶内部回声为等回声或稍高回声,基底宽,表面不规则,呈息肉状,向囊腔方向突出生长,结石活动情况差;厚壁型21例...     

37例胆囊息肉样病变术前B超与术后病理结果分析

目的 探讨胆囊息肉样病变（PLG）声像图与病理结果的相互关系。方法 回顾分析了37例胆囊息肉样病变术前声像图和术后病理结果。结果 PLG的B超诊断符合率为88．6％（31／35）,15例PLG合并有胆囊结石,占40．5％（15／37）,29例合并有不同程度的慢性胆囊炎,占78．4％（29／37）,4例胆囊腺瘤术前未能获得确诊。结论 胆囊结石和胆囊炎是PLG发生癌变的高危因素,超声不能对胆囊腺瘤早期癌变与单纯性腺瘤作出明确鉴别诊断。     

B超诊断胆囊息肉样病变与病理对照分析

目的：本通过对胆囊息肉样病变的超声诊断与病理结果分析，以探讨不同类型胆囊息肉样病变的声像图特征，为早期分类诊断提供依据。方法：对75例胆囊息肉样病变患的超声图像与手术后病理诊断进行对照分析。结果：胆固醇性息肉64例，腺瘤并局部不典型增生及癌变4例，单纯性腺瘤2例，粘膜息肉样变1例，慢性胆囊炎4例。在病理诊断为胆囊息肉样病变中合并慢性胆囊炎61例，合并胆囊结石3例。超声与病理诊断符合率为94．67％。结论：应用超声图像分析，可以提高对胆囊息肉样病变的良性病变与恶性病变及病理分型的诊断率，特别是对胆囊癌前病变及早期胆囊癌的预防和早期诊断有重要价值。     

胆囊癌的超声漏误诊分析

目的：分析不典型胆囊癌的声像图特点，提高超声诊断胆囊癌的准确性。方法：对34例术前超声未明确诊断，而术后病理证实为胆囊癌病例进行回顾性分析。结果：超声误诊13例：肝癌3例，肝脓疡2例，胰头癌2例，胆道肿瘤3例，胆囊息肉2例，消化道肿瘤1例，21例漏诊，其中包括9例隐匿性胆囊癌。结论：胆囊癌有多种声像图表现，不能仅满足于胆囊炎胆囊结石的诊断，应仔细观察胆囊的界限，尤其是胆囊颈部和底部，对可疑病例应同时结合其他检查，以提高超声诊断胆囊癌的准确性。     

黄色肉芽肿性胆囊炎

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术前均经超声检查。结果：１６例ＸＧＣ均合并胆囊结石，胆囊壁均最４￣１５ｍｍ，其中１例登工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。     

610例胆囊切除标本组织学观察

目的 探讨本地区胆囊疾病种类及发生率。方法 对610例胆囊标本进行组织学分析。结果 610例都有慢性胆囊炎表现，其中胆囊癌1例，胆囊腺瘤2例，胆囊胆固醇息肉39例，胆囊胆固醇沉着病22例，胆囊结石580例，胆囊纤维化缩小4例，胆囊腺肌瘤1例，胆囊潴留囊肿1例，慢性胆囊炎急性发作13例。结论 胆囊切除标本中以慢性胆囊炎、胆囊结石多见，胆囊肿瘤少见。     

厚壁型胆囊癌与慢性胆囊炎CT鉴别诊断

目的：着重探讨CT对厚壁型胆囊癌与慢性胆囊炎的鉴别诊断价值。材料和方法：回顾性分析15例厚壁型胆囊癌和30例慢性胆囊炎的CT表现特征,并作鉴别诊断。结果：①厚壁型胆囊癌15例中,CT显示为胆囊肿大且壁不均增厚9例（33．3％）,胆囊壁僵硬且边界不清8例（53．3％）,胆囊壁连续性中断5例（33．3％）,胆囊壁均匀强化13例（86．0％）,肝门淋巴结肿大5例（33．3％）,②慢性胆囊炎30例中,CT显示胆囊壁均匀增厚5例（16．7％）,胆囊边缘模糊不清25例（83．3％）,胆囊壁轻度强化30例（100．0％）,胆囊周围积液、积气4例（13．0％）,胆囊炎合并结石9例（30．0％）。结论：螺旋CT双期增强扫描在显示厚壁型胆囊癌与慢性胆囊炎CT表现特征及其鉴别诊断上,具有重要价值。     

黄色肉芽肿性胆囊炎12例临床病理分析

目的 探讨黄色肉芽肿性胆囊炎（XGC）的临床病理特点。方法 对481例胆囊切除标本中病理确诊的12例XGC进行回顾性分析。结果 12例XGC临床表现与一般的慢性胆囊炎胆石症类似。大体观察示胆囊壁明显不规则增厚，多数病例切面可见淡黄或黄褐色大小不等的结节或斑点，有的呈息肉样突起，镜下观察胆囊壁的正常结构受到不同程度的破坏，代之以特征性肉芽肿性结构。由大量泡沫样组织细胞，急慢性炎症细胞，纤维母细胞，异物巨细胞和Touton巨细胞等组成。结论 XGC的临床表现难与一般的慢性胆囊炎，胆石症或胆囊癌鉴别，但多有慢性胆囊炎急性发作表现，确诊需依赖病理检查。     

Endoscopic sonography in the diagnosis of gallbladder wall lesions in patients with gallstones

PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of endoscopic sonography (EUS) in the detection of gallbladder wall lesions in patients with and without gallstones. METHODS: We retrospectively reviewed the medical records, sonograms, and sonographic reports of 62 patients who underwent cholecystectomy for gallbladder wall lesions evaluated by EUS. We assessed the accuracy of EUS in diagnosing gallbladder wall lesions in the presence or absence of gallstones and on the basis of the size and number of stones and the size of the gallbladder wall lesions. We also evaluated the effect of acoustic shadowing. The EUS results were compared with the histopathologic results. RESULTS: EUS correctly diagnosed the gallbladder wall lesions in 17 (71%) of 24 patients with gallstones and in 34 (89%) of 38 patients without gallstones. The diagnostic accuracy of EUS was 86% in patients with gallbladder wall lesions smaller than 20 mm and 79% in patients with gallbladder wall lesions 20 mm or larger. The diagnostic accuracy was 75% in patients with gallstones smaller than 5 mm and 67% in patients with stones 5 mm or larger. The accuracy was 67% in patients with 1-5 stones and 83% in patients with 6 or more stones. None of these differences was statistically significant. Acoustic shadowing did not affect the diagnostic accuracy of EUS. CONCLUSIONS: The diagnostic accuracy of EUS for gallbladder wall lesions is not affected by the presence of gallstones. However, better diagnostic criteria must be established based on larger studies, and technical refinements of the equipment are needed to increase the accuracy of EUS in the diagnosis of gallbladder wall lesions.     

胆囊切除术后残余胆囊的声像图研究

目的 :探讨胆囊切除术后残余胆囊的声像图 ,分析其形成原因。方法 :对 3 7例残余胆囊的术前、术后声像图对比分析 ,设对照组对其胆总管进行测量及统计学分析。结果 :萎缩性胆囊炎术后发生残余胆囊概率较高 ,残余胆囊结石复发率 86.2 % (2 5/ 2 9) ,残余胆囊组的胆总管宽度大于对照组 (P=0 .0 0 0 1)。结论 :超声显像在残余胆囊的诊断及预防中均有较好的应用价值     

Postoperative fistula of the abdominal wall after laparascopic cholecystectomy due to lost gallstones.

Abdominal fistula caused by cholesterol gallstones, which remained in the abdominal wall after laparascopic cholecystectomy: a laparascopic cholecystectomy was performed in a 60-years-old man who was diagnosed as acute necrosing cholecystitis due to cholecystolithiasis. After removal of the gallbladder using an Endocath some gallstones remained in the excision channel of the abdominal wall. Therefore, a fistula developed in the excision channel postoperatively. As the wound healing was disturbed an investigation of the abdominal wall was performed by ultrasound. In the former excision channel several small, oval, formations with high echogenicity and faint ultrasound shadows were detected, corresponding to additional gallstones. After excision of granulation tissue and removal of the cholesterol stones, complete healing of the fistula in the abdominal wall was achieved.     

胆囊结石并发急性胰腺炎的超声诊断价值

目的探讨胆囊结石并发急性胰腺炎的超声诊断价值。方法采用超声检查37例胆囊结石并发急性胰腺炎患者,观察胆囊内结石大小与数量并进行比较,同时观察胰腺大小形态、实质回声及周围情况。结果胆囊结石中83.8%（31/37）为多发性结石,其中80.6%（25/31）为直径小于0.9cm的小结石。结论多发性且直径小的胆囊结石患者急性胰腺炎的发病率明显增高。超声检查胆囊结石可为临床提供急性胰腺炎的可能病因,并为胆囊结石患者选择性地施行胆囊切除术提供影像学诊断依据。     

Computed tomographic evaluation of gallbladder disease

Evaluation of gallbladder diseases by computed tomography (CT) is limited compared with ultrasonographic evaluation. However, CT can bring about excellent information in advanced carcinoma of the gallbladder, severe and complicated cholecystitis, porcelain gallbladder, and indication for dissolution of gallbladder stones. Unique findings are also available in emphysematous cholecystitis, xanthogranulomatous cholecystitis, stones with gas (Mercedez-Benz sign), limy bile, and enhancement in acute cholecystitis. Combined use of CT and ultrasound apparently increase the accuracy of diagnosis in carcinoma and cholecystitis. This article is composed of sections on carcinoma, cholecystitis, stone, bile in the gallbladder, calcification, gas and fat, and miscellaneous topics including polypoid lesions, adenomyomatosis, hydrops, and wall thickening.     

Gallbladder motility and cholesterol crystallization in bile from patients with pigment and cholesterol gallstones

BACKGROUND: Little is known about gallbladder motility in patients with black pigment stones when compared to cholesterol gallstone patients, or about their relationship to biliary composition, crystallization and stone characteristics. DESIGN: Fasting and postprandial gallbladder volumes were studied by ultrasonography in 49 gallstone patients with pigment (n = 14) or cholesterol (n = 35) stones and 30 healthy controls. After cholecystectomy stone composition, gallbladder wall inflammation, cholesterol saturation index and appearance of platelike cholesterol crystals in bile were evaluated in gallstone patients. RESULTS: Fasting gallbladder volume was significantly (P < 0.05) increased in cholesterol stone patients (31.7 +/- 1.9 mL) but not in pigment stone patients (21.9 +/- 3.1 mL), compared to controls (21.0 +/- 1.5 mL). Postprandial emptying was delayed in patients (half-emptying time: 31 +/- 2 min, 35 +/- 3 min, 24 +/- 2 min in cholesterol stone patients, pigment stone patients and controls, respectively, P < 0.05) and incomplete (residual volume: 43.2 +/- 2.7%, 40.0 +/- 4.3%, 15.8 +/- 1.6% min in cholesterol stone patients, pigment stone patients and controls, respectively, P < 0.05). The inflammation of the gallbladder wall was mild or absent in all cases. Biliary cholesterol saturation index was 152.3 +/- 8.5% and 92.9 +/- 4.8% in patients with cholesterol and pigment stones, respectively (P < 0.01). Whereas cholesterol crystals never appeared during 21 days in biles from patients with pigment stones, crystal observation time in patients with cholesterol gallstone was 5 days (median) and was significantly shorter in patients with multiple (4 days) than in patients with solitary (12 days) cholesterol stones (P = 0.0019). CONCLUSIONS: Patients with black pigment stones who do not have excess cholesterol and do not grow cholesterol crystals in bile have decreased gallbladder emptying, although to a lesser extent than patients with cholesterol stones. Thus, gallbladder stasis is likely to put a subset of subjects at risk for the formation of pigment gallstones, and pathogenic mechanisms need to be further investigated.     

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。