胆囊穿孔的CT诊断及鉴别诊断(附12例分析)

目的 探讨胆囊穿孔的CT诊断及鉴别诊断.方法 12例经临床手术病理证实的胆囊穿孔患者的CT表现征象进行回顾性分析.结果 胆囊穿孔CT表现包括胆囊壁的改变、胆囊周围和右上腹腔的异常、肝脏内的异常密度.胆囊壁的特征性改变表现为连续性中断或局限性缺损、膨出.胆囊周围和有上腹的异常包括胆囊窝积液及右上腹包裹性积液,肌囊周围脂肪间隙密度增高或条索状影,胆囊邻近器官的改变.肝脏内异常灶表现为肝脓肿形成,胆囊与肝脓肿之间有通道.结论 螺旋CT能显示穿孔的胆囊壁连续性中断或局限性缺损,以及胆囊穿孔周围病变特征,为临床诊断和治疗提供可靠的影像学依据.     

肝门部胆管癌的外科治疗

目的：探讨肝门部胆管癌外科治疗策略及其治疗结果。方法：回顾性分析1997—09～2004-10收治的28例肝门部胆管癌的临床资料。结果：Bismuth—CorletteⅠ型10例，Ⅱ型8例，Ⅲa型4例，Ⅲb型3例，Ⅳ型3例。手术切除16例(57．1％)，其中根治性切除11例(39．3％)，姑息性切除5例(17．8％)，外引流7例(25．6％)，剖腹探查5例(17．9％)。手术切除组、外科引流组及剖腹探查组的平均生存时间分别为20．6、7．3及1．5个月。1例术后10d因肾功能衰竭死亡。结论：治疗应以手术切除为主，根治性切除术可延长患者生存时间。对不能切除的病例应设法减轻黄疸。     

非创伤性下消化道穿孔的急诊影像学研究

目的:回顾性分析经手术证实的下消化道穿孔患者的影像资料,探讨急诊非创伤性下消化道穿孔的影像学诊断方法。方法:收集2005年～2007年我院经手术证实的57位下消化道穿孔患者的影像资料,包括立位腹平片、MSCT平扫或增强扫描及超声成像,所有影像学检查均在手术前24h内完成。以手术及术后病理所见为参考标准,评价立位腹平片、MSCT及超声影像诊断下消化道穿孔的准确性。结果:该组病例中有29例患者在手术前行立位腹平片检查,仅7例(24.1%)出现膈下游离气体。37例患者在手术前腹部超声检查,仅8例(21.6%)发现腹腔内游离气体,这8例患者中有4例(50%)经超声明确诊断了穿孔部位。10例患者在手术前行MSCT腹部平扫或增强扫描,9例患者(90%)的CT影像发现了腹腔内游离气体,其中有8例患者(88.9%)明确了穿孔部位。MSCT平扫或增强扫描发现下消化道穿孔所致腹腔内游离气体准确性明显优于X线立位腹平片(P=0.001)及腹部超声(P<0.001)。MSCT发现下消化道穿孔位置的能力较腹部超声(P=0.08)优越性不明显。结论:急诊腹部MSCT扫描能够准确发现下消化道穿孔所致腹腔内游离气体。     

Intervention for gallbladder disease

Intervention in the gallbladder includes therapy for both acute and chronic gallbladder disease. Although drainage for acute cholecystitis has been described by several investigators, the future seems to be in removal of calculi in symptomatic patients without acute cholecystitis. The technique for acute gallbladder drainage is described in detail using ultrasound guidance with or without fluoroscopy: for symptomatic gallstones, the clinical and technical aspects are described. We also discuss in detail the totally new concept for gallstone removal and the initial patient work using rotational contact lithotripsy with the Kensey-Nash device.     

US-guided gallbladder aspiration: a new diagnostic method for biliary fascioliasis

Fasciola hepatica is a trematode which is found worldwide. The diagnosis is usually delayed because the disease is relatively rare and the parasite or its eggs must be shown in bile samples for verification. We report three cases in which the diagnosis of fascioliasis was established by simple US-guided aspiration of the gallbladder. This new diagnostic method is less invasive, safe, and easy compared with the conventional endoscopic methods. Received: 8 June 1998; Revision received: 11 September 1998; Accepted: 14 September 1998     

Percutaneous transcatheter treatment of an intracavitary aspergilloma

We describe a case of massive hemoptysis, secondary to an intracavitary aspergilloma, successfully treated by computed tomography (CT)-guided placement of a Cope-loop catheter with daily transcatheter instillation of amphotericin B and cavitary irrigation. Over a 15-day period, this regimen resulted in cessation of hemoptysis and radiographic resolution of the aspergilloma. No complications were encountered. A follow-up CT of the thorax showed no recurrence of the aspergilloma at 3 months.     

Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

Objective

To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis.

Materials and Methods

Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique.

Results

Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days).

Conclusion

Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis.     

Ultrasonic evaluation of gallbladder function prior to non-surgical treatment of gallstones

A comparative analysis of ultrasonic and oral cholecystographic assessment of gallbladder function in symptomatic patients with cholelithiasis is presented. Ultrasonic evaluation demonstrated non-contractile gallbladders in all but one patient with non-opacification during oral cholecystography, whereas all those opacifying on oral cholecystography contracted on ultrasonography. Both techniques showed similar abilities to quantify the size and number of biliary calculi within the limits necessary to determine suitability for treatment. Although computed tomography remains necessary to quantify gallstone density prior to non-surgical treatment, ultrasonography is a safe, acceptable, cheap and preferable alternative to oral cholecystography in assessing gallbladder function.     

腹腔镜治疗胃十二指肠穿孔的临床研究

目的对比腹腔镜下微创手术与开腹手术治疗胃十二指肠穿孔的临床疗效和安全性。方法选取我院收治的胃十二指肠穿孔患者64例,根据手术治疗方案不同,分为腹腔镜组和开腹组各32例。腹腔镜组采用腹腔镜下胃十二指肠修补术治疗,开腹组采用开腹单纯胃十二指肠修补术治疗,对比两组患者的手术指标及术后并发症。结果两组手术平均时间无差异（P〉0.05）,腹腔镜组术中出血量、术后首次肛门排气时间以及术后住院天数均明显少于开腹组（P〈0.05）,腹腔镜组术后有2例患者需要镇痛,明显少于开腹组的17例（P〈0.05）。腹腔镜组术后并发症发生率9.38%,明显低于开腹组的28.13%（P〈0.05）。结论腹腔镜下胃十二指肠修补术治疗胃十二指肠穿孔具有手术创伤小、患者恢复快、术后疼痛轻以及术后并发症少等优势。     

Interruption of gallbladder wall with pericholecystic fluid: a CT finding of perforation

In this report, we present an unusual case of gallbladder perforation due to acalculous cholecystitis, masked clinically by acute pancreatitis. Severe abdominal pain referred to the patient's back, nausea, vomiting, and high serum and urinary amylase values were compatible with acute pancreatitis. However, on contrast-enhanced CT, the size and appearance of the pancreas were normal while the gallbladder was abnormally enlarged with a wall defect indicating perforation, soon afterward confirmed by surgery.     

Surgical treatment of patellar tendinitis

Patellar tendinitis is an overuse syndrome affecting the origin of the patellar tendon and its underlying part. Ultrasonography is useful to investigate tendinous pathology. It describes the anatomical lesions and their extent. Surgical excision of irreversible lesions, demonstrated on ultrasonography, is a logical attitude which provides good results.     

Endoscopic ultrasonography for demonstrating loss of multiple-layer pattern of the thickened gallbladder wall in the preoperative diagnosis of gallbladder cancer

The purpose of this study was to elucidate the roles of endoscopic ultrasonography (EUS), conventional US, CT, and MRI in differential diagnosis of gallbladder wall thickening. We scrutinized images for the presence of the multiple-layer patterns of the thickened gallbladder walls during preoperative images (EUS, n = 22; US, n = 23; CT, n = 20; MRI, n = 15) and retrospectively correlated them with surgical results in 25 patients. The pathological diagnoses included 7 gallbladder cancers, 9 cases of chronic cholecystitis, 5 cases of xanthogranulomatous cholecystitis, and 4 cases of adenomyomatosis. Multiple-layer patterns of gallbladder wall were observed in patients with inflammatory and benign diseases by US, EUS, CT, and MRI. This pattern was demonstrated by EUS more efficiently compared with other means of imaging. All subjects with loss of multiple layers were finally diagnosed by use of EUS as having gallbladder cancer at surgery. Loss of multiple-layer patterns of the gallbladder wall demonstrated by EUS was the most specific finding in diagnosing gallbladder cancer. Received 29 July 1996; Revision received 27 November 1996; Accepted 21 January 1997     

超声引导下肝脓肿介入治疗的临床研究

目的 :比较超声引导下针刺抽吸术与置管引流术在肝脓肿治疗中的优劣。方法 :将 30例肝脓肿患者随机分组 ,针刺抽吸组 15例 ,置管引流组 15例 ,针刺抽吸组最多行两次抽吸 ,第二次抽吸失败后改为量管引流 ,此类患者不包括在置管引流组。观察比较两组患者治疗结果、住院天数及并发症等 ,每 3天行超声检查。结果 :针刺抽吸组有效率6 6 6 7% ,置管引流组有效率 10 0 % ,有效治愈患者中 ,两种方法临床进展 (局部症状及体征缓解、体温下降、白细胞数正常 )所需平均时间及住院平均天数相似 (P >0 0 5 ) ,尽管针刺抽吸组脓腔直径由原来减小 5 0 %所需时间明显多于置管引流组 (13天 /6天 ) (P 0 0 5 ) ,但两组患者脓腔完全或近乎完全消失所需平均时间相似 (P >0 0 5 ) ,两组患者都未见主要并发症。结论 :从脓腔缩小 5 0 %所需时间及有效率来说 ,置管引流较针刺抽吸更有效。     

Arteriovenous malformation of the gallbladder

Review of the literature shows no reports of vascular malformation of the gallbladder. Herein we report an unusual case of arteriovenous malformation of the gallbladder in a patient with hepatocellular carcinoma. The gallbladder lesion was found incidentally during abdominal angiography for the carcinoma. The angiographic features were specific, comprising dilated and tortuous feeding cystic arteries, a racemose vascular network, and early-filling cystic veins. Received 10 October 1995; Revision received 3 May 1996; Accepted 6 May 1996     

低场强MRI对胆囊内胆固醇结晶的探讨

目的：探讨胆囊内胆固醇结晶的MRI表现。方法：回顾性分析我院16例经MRI诊断为胆固醇结晶的患者，同时有10例行B超对比检查。结果：16例患者胆囊内均可见短T1长T2信号，STIR序列可见胆囊内高信号被抑制变为低信号，有3例患者胆囊内的短T1高信号被完全抑制变为低信号，13例短T1信号被部分抑制，主要是胆囊底部被抑制，说明胆固醇沉积在底部。10例患者B超检查示胆囊内未见明显异常。结论：低场强MRI对胆囊内胆固醇结晶有重要诊断价值，准确性明显高于B超。     

胃癌急性穿孔的外科治疗(附68例报道)

目的探讨胃癌急性穿孔的外科治疗方法。方法回顾性分析1990年1月-2007年1月对68例胃癌穿孔患者实施的手术方式及其疗效。本组68例患者分为3组,即穿孔修补组(对照组,n=27)、姑息性切除组(n=21)、根治性切除组(n=20)。其中男性60例,女性8例。平均年龄58岁。术前诊断胃癌穿孔30例,疑诊胃癌穿孔25例,误诊为胃溃疡病穿孔13例。所有病例均行手术治疗。穿孔位于胃上部1/3的6例,中部1/3的12例,下部1/3的50例。BorrmannⅡ型38例,Ⅲ型30例。将姑息性切除组、根治性切除组与穿孔修补组术后生存期进行比较。结果本组穿孔修补27例;姑息性切除21例;根治性切除20例,包括根2式胃癌次全切除术(D2)8例,根3式胃癌次全切除术(D3)12例。术后并发症发生率7·4%(5/68),手术死亡率5·9%(4/68)。3组患者术后1、3、5年生存率分别为:穿孔修补组3·7%、0、0;姑息性切除组52·4%、23·8%、0;根治性切除组75·0%、55·0%、10·0%。穿孔修补、姑息性切除、根治性切除术后生存期(月)分别为5·93±4·95、28·33±16·44、35·25±20·36,差异有显著性意义(P<0·01)。结论对于胃癌急性穿孔的病例,采取积极的治疗措施,如姑息性切除或根治性切除术,可望延长患者的生存时间,提高患者的生存质量。     

胆囊腺瘤的M RI表现

目的：探讨胆囊腺瘤的M RI表现特征,提高胆囊腺瘤M RI诊断水平。回顾性分析术前行M RI检查、术后经病理证实的37例患者的40枚胆囊腺瘤病灶的M RI表现。结果40枚胆囊腺瘤病灶中30枚位于胆囊体部,占75％;直径均数±标准差为（1．64±0．87）cm ,95％可信区间（1．36～1．92）,其中直径＞1cm有30枚,占75％。37例病例中35例为单发,占95％。40枚病灶中类圆形18枚,不规则形22枚;边缘光滑16枚,毛糙12枚,分叶12枚。40枚病灶中37枚T2 WI呈等高信号影,占92．5％;38枚呈广基,占95％。结论胆囊腺瘤具有相对特征性M RI表现：单发、T2 WI呈等高信号、直径＞1cm ,掌握这些M RI表现有利于提高诊断准确性。     

胆囊癌的CT诊断

目的：提高对胆囊癌的认识和诊断水平并总结有鉴别诊断意义的征象。方法：收集经手术及病理证实的胆囊癌14例,进行回顾性分析。结果：（1）胆囊壁局限性或弥漫性不规则增厚8例;（2）胆囊壁突向腔内肿块4例,囊腔尚存;（3）肿块型2例,胆囊区软组织肿块,囊腔缩小或闭塞;其中合并胆囊结石6例、胆囊癌肝转移6例、淋巴结转移5例。结论：CT是诊断胆囊癌影像检查的重要手段之一,结合临床表现有助于提高诊断准确性。     

患胆囊息肉飞行人员与健康飞行人员的胆囊收缩功能比较

目的探讨飞行人员胆囊息肉患者组与健康飞行人员（对照组）胆囊排空功能的差异。方法对来院接受年度大体检的18例患有胆囊息肉的飞行人员及18例年龄、飞行机种、飞行时间相仿的健康飞行人员进行胆囊超声检查,分别于空腹状态下及脂餐后1 h 测量胆囊最大长径、上下径、前后径,根据椭圆体公式计算空腹胆囊体积及脂餐后残余胆囊体积,计算胆囊排空率。比较两组之间胆囊排空率的差异。结果 PLG 组18例,约占同期住院体检飞行人员（257例）的7.0％,总体上PLG 组的胆囊排空功能显著低于正常对照组（P<0.05）。结论 PLG 是飞行人员中的常见病,其发病可能与胆囊排空功能不良有密切关系。胆囊排空功能检查可以列为招飞体检及飞行员年度体检的常规检查项目。