残余胆囊合并胆系结石13例分析

目的 提高对胆囊切除术后残余胆囊合并胆系结石的认识,做出正确诊断和治疗.方法 回顾分析13例残余胆囊合并胆系结石的临床表现、影像学和病理学检查,以及外科治疗情况.结果 大多数病例获得正确的临床诊断.13例均获得手术切除,术后恢复良好.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惟一手段.     

12例残余胆囊结石诊治分析

目的 提高对胆囊切除术后残余胆囊合并结石的认识,做出正确的诊断和治疗.方法 回顾性分析我院收治的12例残余胆囊合并结石的临床资料.结果 本组12例术前获得正确的临床诊断,均行残余胆囊手术切除,术后恢复良好.结论 根据临床表现和影像学检查,残余胆囊结石能获得正确的诊断,再次手术切除是治愈该病的有效手段.     

残余胆囊合并胆系结石的诊治和预防体会

目的探讨残余胆囊合并胆系结石的诊治及预防。方法回顾性分析30例残余胆囊合并胆系结石患者的临床资料。结果 30例残余胆囊合并胆系结石患者二次手术后原症状及体征消失,未发生严重并发症,均顺利痊愈出院。结论对于残余胆囊合并胆系结石患者可经临床表现、影像学检查确诊、二次手术中处理好胆囊管、肝总管以及胆总管之间解剖关系。细致手术操作、良好术野显露、彻底止血等是再手术成功的关键因素。     

胆囊切除术后残余胆囊结石28例诊治分析

目的探讨胆囊切除术后残余胆囊结石的原因、诊治及预防方法。方法回顾性分析我院28例残余胆囊结石再次手术的病例。28例中初次手术行经典胆囊切除术18例，小切口胆囊切除术6例，腹腔镜胆囊切除术4例；急诊手术15例，择期手术13例。结果大多数病例术前获得正确的临床诊断，28例均行再次手术治疗，切除残留胆囊及结石后，症状均消失，疗效满意。结论根据临床表现和影像学检查，该病能获得正确诊断。再次手术是唯一治疗手段。首次手术中认清胆囊管、肝总管、胆总管三者的解剖关系是预防的关键。     

腹腔镜胆囊切除术后残株胆囊及胆囊管结石

目的探讨腹腔镜胆囊切除术后残株胆囊／胆囊管结石的原因、诊断、处理及预防方法。方法回顾总结我院 1992-2005年间收治的8例腹腔镜胆囊切除术后残株胆囊／胆囊管结石病例的临床资料。结果 8例病人术前经B超、MRI、 ERCP检查确诊后,均经再次手术治愈。残株胆囊结石2例;残株胆囊管结石6例,其中2例合并胆总管结石;2例行残余胆囊切除术,6例行残株胆囊管切除、其中4例附加胆总管切开探查和／或取石、T型管引流。随访1．1-13年,效果良好。结论判断失误是腹腔镜胆囊切除术后残株胆囊结石的主要原因,过长的炎性及畸形的胆囊管残留是腹腔镜胆囊切除术后残株胆囊管结石的主要原因;其症状和体征类似于结石性胆囊炎、合并胆管结石时可有黄疸;B超、CT、ERCP等检查可确诊;再次手术切除(或取出)残株胆囊／胆囊管(结石)是有效可靠的治疗方法;娴熟的腹腔镜技术、术中胆道造影、正确掌握中转开腹指征以及丰富的胆道外科经验是预防其发生的关键。     

腹腔镜胆囊切除术后残余小胆囊的诊治和预防

目的 探讨腹腔镜胆囊切除术后残余小胆囊的诊治经验和预防措施.方法 回顾性分析新疆克拉玛依市中心医院自1994年12月至2007年12月收治的12例腹腔镜胆囊切除术后残余小胆囊的临床资料.结果 该组12例,腹腔镜胆囊切除术后残余小胆囊发生率为0.46%(12/2609),均经再次手术证实,其中伴结石者3例;经再次手术切除胆囊管残株、清除残余结石而治愈,效果良好.结论 腹腔镜胆日囊切除术后残余小胆囊首选B超或MRI检查,确诊后再次手术切除残株是治疗该病的有效方法.严格把握腹腔镜胆囊切除术的适应证,强调手术操作规范,是预防本病发生的关键.     

腹腔镜胆囊切除术后残余小胆囊的诊治和预防

目的 探讨腹腔镜胆囊切除术后残余小胆囊的诊治经验和预防措施.方法 回顾性分析新疆克拉玛依市中心医院自1994年12月至2007年12月收治的12例腹腔镜胆囊切除术后残余小胆囊的临床资料.结果 该组12例,腹腔镜胆囊切除术后残余小胆囊发生率为0.46%(12/2609),均经再次手术证实,其中伴结石者3例;经再次手术切除胆囊管残株、清除残余结石而治愈,效果良好.结论 腹腔镜胆日囊切除术后残余小胆囊首选B超或MRI检查,确诊后再次手术切除残株是治疗该病的有效方法.严格把握腹腔镜胆囊切除术的适应证,强调手术操作规范,是预防本病发生的关键.     

腹腔镜胆囊切除术后残余小胆囊的诊治和预防

目的 探讨腹腔镜胆囊切除术后残余小胆囊的诊治经验和预防措施.方法 回顾性分析新疆克拉玛依市中心医院自1994年12月至2007年12月收治的12例腹腔镜胆囊切除术后残余小胆囊的临床资料.结果 该组12例,腹腔镜胆囊切除术后残余小胆囊发生率为0.46%(12/2609),均经再次手术证实,其中伴结石者3例;经再次手术切除胆囊管残株、清除残余结石而治愈,效果良好.结论 腹腔镜胆日囊切除术后残余小胆囊首选B超或MRI检查,确诊后再次手术切除残株是治疗该病的有效方法.严格把握腹腔镜胆囊切除术的适应证,强调手术操作规范,是预防本病发生的关键.     

残余胆囊的诊治体会

目的：探讨残余胆囊的发生、诊断、治疗以及预防。方法：通过对19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：19例患者均经影像学检查诊断且经再次手术治愈,随访6个月至8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。     

胆囊切除术后残余胆囊19例分析

目的 提高对胆囊切除术后残余胆囊的认识,做出正确诊断和治疗。方法回顾分析19例胆囊切除术后残余胆囊的临床表现、影像学和病理学检查,以及外科治疗。结果大多数病例获得正确的临床诊断。19例均获得手术切除,术后恢复良好。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唯一手段。     

Biliobiliary fistula. A trap in the surgery of cholelithiasis.

Of 24 cases of abnormal communication between gallbladder and main bile duct occurring in a service specializing in hepatobiliary surgery, jaundice was present in all, but variable in degree and persistence. No particular clinical picture suggested this complication of cholelithiasis, and preoperative diagnosis is rare. At operation, adhesions were strikingly dense, often first suggesting a diagnosis of cancer. The gallbladder, fused to the main bile duct, should not be dissected from it because of the risk of ductal injury. Under these conditions, the gallbladder should be opened peripherally, stones extracted, and a cholangiogram performed to assess the situation. Treatment consists of partial cholecystectomy and closure of a cuff of gallbladder wall over a T tube placed into the main bile duct through the fistula.     

十二指肠镜、腹腔镜序贯治疗胆石症2 248例分析

目的探讨十二指肠镜、腹腔镜序贯性诊治胆石症的价值. 方法回顾性分析2000年1月～2004年12月采用十二指肠镜、腹腔镜序贯性诊治方案治疗胆石症2 248例的临床资料. 结果确诊胆囊结石1 817例,胆囊结石合并胆总管结石431例.B超诊断为胆囊结石2 021例中,行术前ERCP 690例,发现胆总管结石213例;术中胆道造影(IOC)85例,发现胆总管结石10例;腹腔镜胆囊切除(LC)术后胆总管残余结石6例,并经EST治愈.B超诊断胆囊结石合并胆总管结石227例中,ERCP证实胆总管结石202例.行LC 1 817例,EST LC 395例,LBDE 36例(其中胆管一期缝合26例,T管引流10例).全组中转开腹28例(1.2%),并发症52例(2.3%). 结论十二指肠镜、腹腔镜序贯性诊治方案治疗胆石症,体现了内镜、腔镜联合应用的优势,术后残余结石率低,微创治疗成功率高.     

Primary carcinoma of the gallbladder

Primary carcinoma of the gallbladder is still a controversial issue. The paper reports a series of 25 patients affected by carcinoma of the gallbladder, observed from May 1975 to October 1989. Patients presented symptoms which in most cases were similar to those of cholelithiasis. Instrumental tests enabled a preoperative diagnosis to be made in only 8 cases (32%). In the remaining 17 cases (68%), diagnosis was only possible during the operation following the histological examination of the affected part. Mean survival was 7.3 months. These findings are in line with those reported in the literature, from which it is clear that carcinoma of the gallbladder, even when identified using instrumental tests, cannot be treated by radical surgery except in a very small percentage of cases.     

Diagnosis and surgical treatment of cancer of the gallbladder

Operations were carried out on 41 patients with carcinoma of the gallbladder. Coexistent cholelithiasis was encountered in all cases. Ultrasonic examination (USE) and computed tomography (CT) are the most informative methods of preoperative diagnosis. With the use of both methods the correct diagnosis was made in 100% of cases. The true diagnosis was made before the operation in 73% of cases. In 9 patients the correct diagnosis was established only during the operation. Two patients underwent operation for calculous cholecystitis, stage I gallbladder carcinoma was identified during planned histological study. Among 32 patients 2 were found to have stage I, one--stage II, 17--stage III, and 12 patients--stage IV of the disease. Radical operations were carried out on patients with stages I and II and on 7 patients with stage III of the disease. Nine patients (28%) died in the immediate postoperative period. Cholecystectomy with careful removal of the elements of the gallbladder bed should be considered the radical operation for stage I of the disease; in stage II the operation should be supplemented by lymphadenectomy along the course of the hepatoduodenal ligament. Hemihepatectomy or atypical resection of the liver is indicated in stage III of the disease.     

胆囊腺肌增生症11例临床分析

目的探讨胆囊腺肌增生症的病因、诊断、恶变倾向及治疗方法。方法回顾11例经病理检查确诊的胆囊腺肌增生症的临床资料,并复习相关文献。患者术前均行B超检查,2例行CT检查。结果11例胆囊腺肌增生症临床表现与慢性胆囊炎、胆石症相似,术前B超明确诊断4例,诊断率为36．36％。在我们的病例中,局限型10例,节段型1例,无弥散型。11例均行胆囊切除,全部合并胆囊炎,6例合并胆囊结石,提示其发病与炎症和结石有关。结论胆囊腺肌增生症是一种胆囊壁增生性疾病,病因尚未十分清楚,其临床诊断困难,确诊需依赖病理检查。结合B超、CT及MRI等综合分析可提高术前诊断的准确性。因其具有恶变的潜在性,特别是60岁以上合并节段型者,故一旦诊断明确,均应手术切除胆囊。     

胆囊结肠瘘的临床分析：附14例报告

目的:探讨胆囊结肠瘘的临床特点。方法:回顾性分析中南大学湘雅医院15年来收治的8 235例胆囊结石患者中确诊的14例胆囊结肠瘘患者的临床、病理、随访等资料。结果:胆囊结肠瘘在胆石症患者中的发生率为0.17%(14/8 235);14例患者中,术前确诊2例(14.28%),其余为术中确诊;残余胆囊与横结肠间形成内瘘1例,胆囊体部与横结肠间形成内瘘2例,因胆囊萎缩后胆囊瘘口位置不明1例,其余10例胆囊与横结肠瘘口均位于胆囊底部。14例患者均行胆囊切除术,结肠瘘口行I期修补缝合术12例,行部分结肠切除、吻合术2例;术后切口和膈下感染各1例(7.14%)。结论:对于高度怀疑胆囊结肠瘘患者,运用ERCP等多种检查有助于提高其术前确诊率。     

Gallbladder Carcinoma Associated with Gallstones

The great majority of gallbladder carcinoma is associated with gallstones. This cancer is generally diagnosed in advanced stages, and the prognosis is very poor. In this study we analysed retrospectively 3119 patients with cholelithiasis alone, and 35 patients with gallbladder cancer. Thirty-three of 35 cancer cases (94%) were associated with gallstones. Cancer rate was 1% in patients with cholelithiasis. Mean age was significantly higher in patients with gallbladder cancer than in those with cholelithiasis alone, 66.5 and 53.3 respectively (p < 0.0001). Sixty four percent of cancer cases were between 61–70 years of age, and the rate of carcinoma was 2.8% in this group (p < 0.001). The cancer rate was found to be 0.29% in patients under 60 years of age, and 2.56% in those over 60 years (p < 0.001). According to Nevin’s classification, 88% of cancer cases were found in advanced stages. Seventeen (52%) cases were diagnosed preoperatively. Ninety four percent of patients with preoperative diagnosis were in advanced stages compared with 31% of patients with incidental diagnosis (p = 0.0002). Patients with early stages carcinoma were alive and free of disease 58 months after operation. Average survival was only 9.5 months in patients with advanced cancer. We conclude that the incidence of gallbladder carcinoma increases significantly in patients over 60 years of age. Today preoperative early diagnosis is almost impossible, and long-term survival is possible only for early cases incidentally discovered at postoperative pathological examination of removed gallbladders for gallstone disease. Radical surgery has not provided long-term survival. We recommend close follow-up of patients with cholelithiasis, and enlargement of indication for cholecystectomy in a selective manner, considering some criteria in patients older than 55 years of age who are known with long-standing cholelithiasis.     

46例自发性胆囊内瘘的回顾性分析

目的总结结石引起的自发性胆囊内瘘的诊治经验。方法对46例胆囊内瘘的病例进行回顾性分析。结果46例胆囊内瘘中胆囊十二指肠瘘29例，胆囊结肠瘘9例，胆囊胆总管、肝总管瘘11例，胆囊胃瘘3例，其中同时有两处瘘7例。术前经B超检查44例，9例提示胆囊积气；1例提示胆囊壁腹腔面消失，右下腹探得结石影。术前7例行腹部平片检查，4例提示小肠梗阻；6例见结石影；2例显示胆道积气。8例行CT检查，其中2例显示胆囊、胆管气体。3例行ERCP检查，其中1例见十二指肠有造影剂异常溢出。术前仅9例考虑到胆囊内瘘的诊断，其余均在术中发现。46例均开腹行胆囊切除或部分切除，39例胆囊胃肠瘘行瘘口修补，其中5例瘘口过大则利用部分胆囊壁来修补；10例胆囊胆管瘘在取尽结石后，经瘘口置T管引流，瘘口较大者亦利用胆囊壁修补，1例切除部分胆囊后行胆囊空肠Roux-Y吻合。术后1例因感染性休克死亡；1例有少量胆漏。经引流治愈，其余均恢复良好。结论萎缩性胆囊炎、胆囊结石应警惕合并胆囊内瘘。出现以下情况提示胆囊内瘘：(1)B超、CT、腹部平片发现胆道积气。(2)CT、腹部X线平片提示肠梗阻。有下列情况可确诊胆囊内瘘：(1)B超发现胆囊腹腔面消失。(2)B超、CT、腹部平片提示原有明确的胆囊结石消失或在异位出现。(3)ERCP、PTC等发现非胆管开口有胆汁或造影剂溢出。(4)口服造影剂或钡剂灌肠见造影剂进入胆囊。治疗时应修补瘘口，瘘口过大可利用部分胆囊壁来修补。     

Gallbladder carcinoma associated with gallstones

The great majority of gallbladder carcinoma is associated with gallstones. This cancer is generally diagnosed in advanced stages, and the prognosis is very poor. In this study we analysed retrospectively 3119 patients with cholelithiasis alone, and 35 patients with gallbladder cancer. Thirty-three of 35 cancer cases (94%) were associated with gallstones. Cancer rate was 1% in patients with cholelithiasis. Mean age was significantly higher in patients with gallbladder cancer than in those with cholelithiasis alone, 66.5 and 53.3 respectively (p < 0.0001). Sixty four percent of cancer cases were between 61-70 years of age, and the rate of carcinoma was 2.8% in this group (p < 0.001). The cancer rate was found to be 0.29% inpatients under 60 years of age, and 2.56% in those over 60 years (p < 0.001). According to Nevin's classification, 88% of cancer cases were found in advanced stages. Seventeen (52%) cases were diagnosed preoperatively. Ninety four percent of patients with preoperative diagnosis were in advanced stages compared with 31% of patients with incidental diagnosis (p = 0.0002). Patients with early stages carcinoma were alive and free of disease 58 months after operation. Average survival was only 9.5 months in patients with advanced cancer. We conclude that the incidence of gallbladder carcinoma increases significantly in patients over 60 years of age. Today preoperative early diagnosis is almost impossible, and long-term survival is possible only for early cases incidentally discovered at postoperative pathological examination of removed gallbladders for gallstone disease. Radical surgery has not provided long-term survival. We recommend close follow-up of patients with cholelithiasis, and enlargement of indication for cholecystectomy in a selective manner, considering some criteria in patients older than 55 years of age who are known with long-standing cholelithiasis.