残余胆囊9例报告

目的探讨残余胆囊的发生、诊断、治疗以及预防。方法通过对9例残余胆囊患者的诊治,讨论其发病特点、临床症状、诊治方法以及预防措施。结果 9例患者均经影像学检查诊断且经再次手术治愈,随访12个月~5年无复发。结论根据临床表现和影像学检查该病能获得正确诊断,再次手术切除是治愈该病的最有效手段。     

腹腔镜胆囊切除术后残余胆囊、残余胆囊管结石14例分析

残余胆囊、残余胆囊管从解剖学上是两个概念，由于二者结石形成的原因几近相同，在此一并讨论。笔者所在医院1995年6月至2009年8月共手术治疗16例残余胆囊、残余胆囊管结石，其中有14例系腹腔镜胆囊切除术（LC）后所致，报告如下。     

腹腔镜胆囊大部分切除在复杂胆囊结石手术中的临床应用

目的 探讨腹腔镜胆囊大部分切除术的适应证、手术方法及临床价值.方法回顾分析总结本科自2005年7月至2011年4月128例腹腔镜胆囊大部分切除术的原因、方法和体会.结果 126例手术顺利完成,2例中途转开腹手术,无死亡,手术时间25～160 min,平均105 min.术中出血10～100 mL,平均51 mL.术后5～10 d痊愈出院,平均7.46 d.随访3个月～3年,无症状复发,效果满意.结论 在化脓性胆囊炎或胆囊三角严重黏连疤痕化等不能够常规行胆囊切除的患者,行腹腔镜胆囊大部分切除术简便而安全可行,不但能够达到胆囊切除的目的,又能减少肝外胆管和血管损伤,避免了中转开腹,不失为复杂胆囊手术治疗的一种较好的选择,但必须严格掌握适应证,正确处理胆囊残余部分.     

LC术后残余胆囊的预防和处理(附11例报告)

目的：探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后残余胆囊的预防和处理。方法：回顾分析自1998年12月至2003年5月收治的LC术后残余胆囊患者的病历资料。结果：本组11例LC术后残余胆囊均经开腹手术证实,其中6例残余胆囊,3例残余胆囊合并残余胆囊结石,2例胆总管结石行探察术中发现残余胆囊。所有病例均行残余胆囊切除,胆囊标本经病理检查证实均为残余胆囊慢性炎症改变。结论：严格把握LC的适应症和操作规范是防止残余胆囊的关键。     

腹腔镜胆囊切除术406例分析

目的探讨腹腔镜胆囊切除术的适应证、手术方法以及并发症的处理。方法回顾分析2006-2009年张家口市宣化县人民医院手术治疗的胆囊结石、胆囊息肉患者406例的临床资料。结果 395例腹腔镜胆囊切除治疗成功,效果满意;11例行中转开腹手术;术后并发症8例。结论腹腔镜胆囊切除术是治疗胆囊良性疾患安全可靠的治疗方法。     

残余胆囊的诊断和治疗(附52例报告)

目的探讨残余胆囊的诊断价值,提出有效预防和正确处理残余胆囊的方法。方法回顾分析解放军413医院2000年1月至2011年1月收治的52例残余胆囊病例的诊治过程。结果全组51例行择期残余胆囊切除手术,1例行内镜治疗(支架内引流)。其中49例病理证实为残余胆囊,2例为残余胆囊腺癌。全组除3例残余胆囊癌变外,其他病例近远期疗效良好。结论临床上残余胆囊的诊断日趋增多,可出现类似胆囊炎的症状,影响正常生活;部分患者可继发出现癌变,更应高度重视,因此,预防和治疗胆囊切除术后的残余胆囊很有必要。     

胆囊术后残余胆囊并结石三例

残余胆囊并结石是胆囊切除术后少见的并发症之一 ,常因术后患者反复右上腹不适 ,B超检查时始发现 ,应引起临床重视。现结合我们在 1990～ 2 0 0 1年收治的 3例分析报告如下。1　临床资料【例 1】　女 ,3 7岁。 8个月前在某医院因胆囊多发结石行胆囊切除术 ,术后常感右上腹胀痛不适 ,经 2次B超检查发现残余小胆囊并结石入院。再次手术见原胆囊颈部仍存在 ,其内有直径1 5cm圆形结石一枚 ,胆囊管及胆总管未见异常 ,切除残余胆囊颈及结石。痊愈出院。【例 2】　女 ,42岁。 6个月前在某医院因胆囊多发结石行胆囊切除术。术后因右上腹胀痛 ,B超…     

腹腔镜胆囊切除术9603例临床分析

目的 总结该院9603例腹腔镜胆囊切除术(LC)的治疗经验,探讨腹腔镜胆囊切除术的术中、术后并发症的预防和处理.方法 回顾性分析9603例腹腔镜胆囊切除术手术的临床资料.结果 全组无死亡病例.术后出血3例,2例急诊手术后治愈,1例保守治疗治愈;胆管损伤2例,1例术中行对端吻合后治愈,1例术后再次手术行肝门胆管空场Rouxen-Y吻合术后治愈;术后胆漏5例,2例行急诊手术后治愈,1例经穿刺引流治愈;胆总管残余结石4例.结论 腹腔镜胆囊切除术应尽量避免并发症的发生,一旦发生并发症应及时、妥善处理.术中遇到解剖关系不清、操作困难的复杂病例、应果断中转开腹.     

腹腔镜胆囊大部分切除术在复杂胆囊手术中的应用

【目的】总结腹腔镜下胆囊大部分切除在复杂胆囊切除术中应用的经验。【方法】回顾分析本院2002年1月至2005年9月施行的36例腹腔镜胆囊大分部切除术的病例,对手术方法、手术疗效及并发症进行分析。【结果】36例均在腹腔镜下行胆囊大部分切除,无中转开腹、无术后出血及肝外胆管损伤,手术时间为(56±16.5)min,开始下床活动时间(13±4.3)h,开始进食时间(23±8.5)h,住院时间(5±1.5)d,术后胆漏1例,经保守治疗治愈。随访7~28个月,未见与手术有关的并发症。【结论】在复杂胆囊手术中,腹腔镜胆囊大部分切除术可简化手术,降低手术风险,可收到胆囊造瘘与标准胆囊切除相结合的疗效。     

腹腔镜胆囊切除术在老年良性胆囊疾病中的应用

目的:探讨腹腔镜胆囊切除术(LC)对老年胆囊良性疾病的临床应用价值.方法:回顾性分析76例老年胆囊良性病变患者围术期的处理,特别是对合并心血管、呼吸系统及糖尿病、肝硬化及糖尿病等疾病的治疗,以及对手术时机、适应证的选择.结果:本组73例经LC成功切除胆囊;2例因解剖不清和出血中转开腹行胆囊切除;1例因误伤胆总管中转开腹行胆囊切除术加T管引流.本组无死亡病例,治疗成功率为96.1%.结论:老年人尽管合并多脏器疾病,只要严格掌握LC的适应证和禁忌证,做好充分的术前准备工作,术中、术后严密监护病情,均能顺利切除胆囊.     

Insufficient cholecystectomy diagnosed by endoscopic ultrasonography

Recurrent attacks of upper right quadrant pain after cholecystectomy are not infrequent. In most of these cases, the cause of the pain remains undiagnosed. Insufficient cholecystectomy has been described as a rare cause of post-cholecystectomy pain, although the true incidence is unknown. It is difficult to diagnose a residual gallbladder or a large cystic duct with residual stones, due to the size of the remaining structures. This report presents three patients who had experienced a long period of agonizing biliary-type pain after cholecystectomy. Abdominal ultrasound examinations, and magnetic resonance cholangiopancreatography (MRCP) in one patient, were normal. Endoscopic ultrasonography (EUS) demonstrated the presence of a small cystic structure with echogenic foci compatible with a residual gallbladder containing small gallstones. Two of the three diagnoses were confirmed by repeat surgery. EUS thus appears to be a valuable method for diagnosing insufficient cholecystectomy, and should be considered in patients with persistent pain attacks after cholecystectomy.     

黄色肉芽肿性胆囊炎的临床诊断及手术治疗：附25例报告

目的总结黄色肉芽肿性胆囊炎（xanthogranulomatous cholecystitis,XGC）的诊治经验。方法回顾性分析我院2001年1月～2009年5月25例经病理确诊为XGC的临床资料。结果 25例术前均未明确诊断,行B超检查25例,CT检查17例,MRI检查5例,术前诊断为胆囊癌3例,胆囊炎、胆囊结石22例。术中见所有病例胆囊壁明显增厚,23例与周围组织粘连致密,22例合并胆囊结石,4例合并Mirizzi综合征,4例合并有胆囊内瘘。13例行单纯胆囊切除术,4例行胆囊大部分切除术,3例行胆囊切除及十二指肠修补术,2例行胆囊切除、肝部分楔形切除、肝门部淋巴结清扫,2例行胆囊切除、胆总管探查引流术,1例行胆囊切除、结肠部分切除术。术中经冷冻切片病理检查确诊XGC 17例;余8例中,6例诊断为急性胆囊炎,2例诊断为慢性胆囊炎急性发作,胆囊癌不能排除,术后病理检查均诊断为XGC。术后并发胆漏2例,切口感染5例。结论 XGC是一种特殊类型的胆囊慢性炎症,临床非常少见,术前诊断比较困难,术中易诊断为胆囊癌,病理检查是XGC的诊断关键,胆囊切除是基本治疗方法。     

Diagnosis of lymphoma from a cholecystectomy specimen: case report and review of the literature.

A 31-year-old woman had cholecystectomy for recurrent acute cholecystitis. Pathologic examination of the resected gallbladder revealed unsuspected histiocytic lymphoma. A staging laparotomy seven weeks after cholecystectomy revealed disseminated disease. Lymphomatous involvement of the gallbladder is rarely diagnosed antemortem and indicates disseminated disease until proved otherwise.     

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     

Port-site metastasis of unsuspected gallbladder carcinoma with ossification after laparoscopic cholecystectomy: A case report

BACKGROUNDUnsuspected gallbladder carcinoma (UGC) refers to cholecystectomy due to benign gallbladder disease, which is pathologically confirmed as gallbladder cancer during or after surgery. Port-site metastasis (PSM) of UGC following laparoscopic cholecystectomy is rare, especially after several years.CASE SUMMARYA 55-year-old man presenting with acute cholecystitis and gallstones was treated by laparoscopic cholecystectomy in July 2008. Histological analysis revealed unexpected papillary adenocarcinoma of the gallbladder with gallstones, which indicated that the tumor had spread to the muscular space (pT1b). Radical resection of gallbladder carcinoma was performed 10 d later. In January 2018, the patient was admitted to our hospital for a mass in the upper abdominal wall after surgery for gallbladder cancer 10 years ago. Laparoscopic exploration and complete resection of the abdominal wall tumor were successfully performed. Pathological diagnosis showed metastatic or invasive, moderately differentiated adenocarcinoma in fibrous tissue with massive ossification. Immuno-histochemistry and medical history were consistent with invasion or metastasis of gallbladder carcinoma. His general condition was well at follow-up of 31 mo. No recurrence was found by ultrasound and epigastric enhanced computed tomography.CONCLUSIONPSM of gallbladder cancer is often accompanied by peritoneal metastasis, which indicates poor prognosis. Once PSM occurs after surgery, laparoscopic exploration is recommended to rule out abdominal metastasis to avoid unnecessary surgery.     

Gallstones--surgical aspects

Between 10% to 15% of the adult population develop gallstones. Therefore, cholecystectomy is among the most common operations in general surgery. The diagnosis of cholelithiasis depends on the patient's history, clinical findings, laboratory tests and ultrasound examination. Once diagnosis of symptomatic gallbladder disease has been confirmed, laparoscopic cholecystectomy is the treatment of choice. Its advantages in comparison with open surgery are decreased morbidity, costs and hospital stay. Open cholecystectomy is still the treatment of choice for complicated gallstone disease (i.e. cancer, Mirizzi's syndrome, severe inflammation) and in high-risk patients. In case of acute cholecystitis, early laparoscopic cholecystectomy is a safe procedure and is associated with the same benefits as for symptomatic disease.     

胆囊切除术后残留胆总管结石的内镜诊治

目的：探讨经内镜逆行胰胆管造影（ERCP）在胆囊切除术后残留胆总管结石诊治中的应用价值。方法：对胆囊切除术后腹痛、发热、黄疸或肝功能异常而经B超、CT或磁共振胰胆管造影（MRCP）证实或怀疑残留胆总管结石的患者进行ERCP检查，对发现胆总管结石的患者行EST或EPBD后取石。结果：ERCP检查的成功率为96．4％（108／112）。85例证实胆总管结石的患者行EST或EPBD后取石，79例（92．9％）取石治疗成功；6例因合并肝内胆管多发结石而行外科手术治疗。并发症发生率为4．5％，其中消化道出血2例，急性胰腺炎3例。结论；对于胆囊切除术后残留胆总管结石的患者，ERCP是理想的诊断方法，而且还可以同时进行治疗。     

腹腔镜胆囊切除术后胆囊窝异常回声的超声鉴别和治疗后随诊

目的探讨超声对腹腔镜胆囊切除术后胆囊窝出现异常回声诊断鉴别和治疗的价值。方法对24例经腹腔镜胆囊切除术后出现胆囊窝液性异常回声的患者进行超声观察或介入治疗。结果胆囊窝液性回声区在胆囊床范围内的有19例;积液区大于胆囊床范围合并邻近部位或腹腔积液5例。临床处理为:保守治疗19例,超声介入胆囊窝穿刺及置管引流各1例,腹腔穿刺置管引流2例,胆囊窝、腹腔及膈下均穿刺置管1例。24例患者均未再行手术,痊愈出院。讨论超声在胆囊窝液性异常回声的诊治中有重要价值。     

2 419例17 530颗胆囊息肉内镜微创保胆手术后病理结果分析

目的 通过对胆囊息肉保胆手术后病理结果分析,评估内镜微创保胆手术对胆囊息肉的治疗价值。方法 收集2007年1月－2020年12月行内镜微创保胆手术的2 419例17 530颗胆囊息肉患者的病理资料,纳入回顾性研究,以内镜微创保胆手术的手术适应证作为入组标准,分析其术后病理结果。结果 胆囊良性息肉占99.68%,均行保胆取息肉手术,0.20%的患者息肉为恶性,且为早期,均行胆囊癌根治术,0.12%的患者为腺瘤高级别上皮内瘤变,行胆囊切除术。结论 胆囊息肉中恶性肿瘤占比较低,内镜微创保胆手术是治疗胆囊息肉的首选手术方法,既可以去除胆囊良性病变,又能保留胆囊功能,还可以早期发现胆囊癌。因此,胆囊息肉应早期行微创保胆手术以明确诊断,防止恶变。