腹腔镜胆囊切除意外胆囊癌的处理

目的:探讨腹腔镜胆囊切除术(laparoscopiccholecy stectomy, L C) 遇意外胆囊癌(unsuspected gallbladder carcinoma, UGC)的原因及应对策略.方法:回顾性分析本院1989-06/2008-11行LC患者6429例中遇到的术中及术后诊断为UGC的27例(0.4%)临床资料.结果:所有27例胆囊癌病例中, 在LC术中诊断17例, LC术后诊断有10例. pT1期、pT2期和pT3期各9例. 患者的1、3和5年存活率分别为74.1%、63%和59.3%. pT1期的5年存活率为100%, pT2期的5年存活率为66.7%, pT3期的5年存活率为0.0%, 差异有统计学意义( P<0.05).结论:UGC患者的存活与肿瘤分期相关, pT1期胆囊癌, 行LC即可. 怀疑有胆囊癌在可能情况下及时行冰冻病理检查, 对于确诊pT1期以外的UGC应该尽早开腹行胆囊癌根治术, 并采取必要措施防止肿瘤种植和转移.     

胆管扩张症术后胆道感染的相关因素分析

目的:探讨胆管扩张症患者在术后近期和远期发生胆道感染的相关因素。方法:回顾性分析2012年5月至2020年10月北京协和医院收治并获得随访的121例胆管扩张症患者的临床资料。男性21例（17.4%）,女性100例（82.6%）,年龄（40.5±15.3）岁（范围：18~80岁）。将术后30 d内发生的胆道感染定义为近期...     

109例成人型胆管囊肿的诊治经验

Objective To discuss the diagnosis and treatment of congenital choledochal cyst (CCC).Methods The clinical data of 109 adult patients with congenital choledochal cyst admitted in Peking Union Medical College Hospita between 1984 and 2007 were retrospectively analyzed.The male: female ratio was 1 : 3.8.The mean age was 32.8 years.Seventy-eight of the patients belonged to Todani type Ⅰ, while twenty-six to type Ⅳ and five to type Ⅴ.There was no case of type Ⅱ or Ⅲ.Results Right upper abdominal pain or discomfort and recurrent cholangitis were the predominant presentations.Thirty patients had undergone previous surgical procedures while 26 procedures were done before 2000.B-US and MRCP were the primary methods for diagnosis after 2000.Ninety-four patients underwent complete excision of the extrahepatic cyst and hepaticojejunostomy.Four patients required the left lateral hepateetomy in addition.Four patients were testified malignant change by pathological examination.There were four pancreatic fistulas and two Subphrenic abscesses.There was no postoperative death.Forty-six patients were available for follow-up.The late complications in-eluded recurrent cholangitis, hepaticojejunostomy anastomosis stricture and intrahepatic biliary calcu-la.Conclusions Right upper abdominal pain or discomfort and recurrent cholangitis were the most common presentations in adult congenital choledochal cyst patients.B-US and MRCP should be the prefered imaging methods for diagnosis.Complete excision of the extrahepatic cyst and hepaticojeju-nostomy were ideal treatment.     

医源性胆管损伤的外科治疗

由于各种原因 ,手术引起胆管损伤的发生率在0 0 5 %～ 0 2 % ,随着腹腔镜胆囊切除技术的广泛应用 ,其胆管损伤的发生率也有增高的趋势[1] ,损伤后继发性的胆管狭窄 ,若不及时正确处理 ,将会带来严重的后果。我院 1988年以来 ,共收治外院 16例损伤后胆管狭窄、胆管炎病例 ,总结我院对胆管损伤和继发胆管狭窄的治疗体会。1　临床资料本组 16例 ,男 4例 ,女 12例 ,年龄 33～ 69岁 ,平均 4 7 2岁。在最初手术中 :择期手术 15例 ,急诊手术 1例 ,10例为单纯胆囊切除术 ,6例为胆囊切除加胆管探查Ｔ管引流术。损伤后处理情况 :4例术后出现胆漏行胆…     

CT引导下经皮胆囊造瘘引流在高危急性胆囊炎患者中的应用

急性胆囊炎患者常需急诊行胆囊切除术,但高龄,合并有糖尿病、高血压、心脏病、哮喘等严重基础性疾病的高危患者,手术并发症和死亡率较高.CT或超声引导下经皮胆囊造瘘(percutaneous cholecystostomy,PC)引流在局麻下进行,创伤较小,能够通过置管对胆囊减压达到缓解病情的目的,为患者在身体条件得到改善的情况下行择期胆囊切除术创造条件,从而降低或避免手术风险.本研究评估了CT引导下PC在高危急性胆囊炎患者中的应用情况,以期为今后的临床治疗提供帮助.     

胆囊神经内分泌肿瘤32例分析

目的 探讨胆囊神经内分泌肿瘤的诊治方式和外科手术后的治疗效果。方法 回顾性分析北京协和医院2012年1月至2023年2月收治的32例胆囊神经内分泌肿瘤病人的临床资料。根据获得随访病人的预后不同,比较分析生存与死亡病例的临床及预后资料。结果 32例病人中,27例接受手术切除治疗,3例接受手术活检,2例接受肝穿刺活检。有4例病人发生术后并发症,其中Clavien-Dindo分级Ⅰ级和Ⅱ级各2例。所有病人均顺利出院,住院时间（12.0±6.0）d。在接受手术切除治疗的27例病人中,神经内分泌瘤5例,神经内分泌癌15例,混合性腺神经内分泌癌7例。截至2023年7月,31例病人获得随访,1例失访。中位随访时间为13(8,29)个月。31例获得随访病人的1、2和3年累积总体生存率分别为72.5%、53.4%和48.1%;26例接受手术切除治疗病人的1、2和3年累积总体生存率分别为80.1%、57.8%和52.0%。31例获得随访病人的1年累积无瘤生存率为40.0%。接受手术切除治疗的病人中,死亡病人的Ki-67指数高于生存病人（P=0.039）。结论 胆囊神经内分泌肿瘤的主要治疗方式是手术,总体预...     

109例成人型胆管囊肿的诊治经验

Objective To discuss the diagnosis and treatment of congenital choledochal cyst (CCC).Methods The clinical data of 109 adult patients with congenital choledochal cyst admitted in Peking Union Medical College Hospita between 1984 and 2007 were retrospectively analyzed.The male: female ratio was 1 : 3.8.The mean age was 32.8 years.Seventy-eight of the patients belonged to Todani type Ⅰ, while twenty-six to type Ⅳ and five to type Ⅴ.There was no case of type Ⅱ or Ⅲ.Results Right upper abdominal pain or discomfort and recurrent cholangitis were the predominant presentations.Thirty patients had undergone previous surgical procedures while 26 procedures were done before 2000.B-US and MRCP were the primary methods for diagnosis after 2000.Ninety-four patients underwent complete excision of the extrahepatic cyst and hepaticojejunostomy.Four patients required the left lateral hepateetomy in addition.Four patients were testified malignant change by pathological examination.There were four pancreatic fistulas and two Subphrenic abscesses.There was no postoperative death.Forty-six patients were available for follow-up.The late complications in-eluded recurrent cholangitis, hepaticojejunostomy anastomosis stricture and intrahepatic biliary calcu-la.Conclusions Right upper abdominal pain or discomfort and recurrent cholangitis were the most common presentations in adult congenital choledochal cyst patients.B-US and MRCP should be the prefered imaging methods for diagnosis.Complete excision of the extrahepatic cyst and hepaticojeju-nostomy were ideal treatment.     

原发性胆囊癌69例的外科治疗

目的 总结原发性胆囊癌的治疗经验,探讨提高原发性胆囊癌生存率的方法。方法 回顾性分析了我院１９８６－１９９９年收治的６９例胆囊癌病例资料。本组诊断依赖于临床表现和影像学检查,Ⅰ期４％,Ⅱ期７％,Ⅲ期１５％,Ⅳ期１７％,Ⅴ期５７％。６８％的病例行手术治疗。结果 本组术前诊断率８４％,Ｂ超和ＣＴ是提高诊断率的重要手段。手术切除率４９％,长期存活者仍以Ⅰ、Ⅱ期病例为主,单纯胆囊切除术即可获得良好的存活率,３年为１００％,Ⅲ期病例术后２年存活率为５０％。结论 手术是治疗Ⅰ、Ⅱ、Ⅲ期病例的首选方法。手术能使Ⅳ、Ⅴ期患者的短期存活率稍有延长,早期诊断和手术切除是提高手术疗效的关键。对于有高危因素的无症状胆囊结石和隆起样病变患者,应行预防性胆囊切除。     

原发性胆囊癌诊治体会(附52例病例报道)

目的 提高原发性胆囊癌的早期诊断率。方法 回顾性总结我院1988年至1998年52例胆囊癌的病例。结果 术前诊断率：90.3%，其中属胆囊癌早期诊断率25％（12例），总手术切除率55.8%，晚期胆囊癌手术切除率17.8％。结论 早期诊断是提高治疗效果的关键，以下特征应引起我们对胆囊癌高度注意：（1）50岁以上有反复发作的胆囊炎，胆囊结石病史；（2）先天胆道畸形者；（3）胆囊壁局限性增厚，囊壁不规则；（4）胆囊腔内大于1cm息肉样病变，不规则；（5）胆囊萎缩；（6）胆囊内的占位不随体位的改变而移动；（7）区域淋巴结肿大。     

CONGENITAL CHOLEDOCHAL CYST——REPORT OF 56 CASES

Objective. The aim of this paper is to describe the mechanism, clinical manifestation, diagnosis and surgical management of congenital choledochal cyst. Methods. From 1984 to 1997, 56 cases of congenital choledochal cyst were reviewed. Among them, 8 patients were male, 48 patients were female, the age ranges from 12 to 50 years old with an average of 26.3. Results. The main clinical manifestation includes jaundice, abdominal pain and abdominal mass. All of them were confirmed by ultrasonography, while 39 cases were performed ERCP and PTC with the same diagnosis. Fifty-one patients were performed cystectomy and hepatojejunostomy, two cases were per-formed cystjejunostomy because of diffused angioma and severe hemorrhage respectively, external drainage was performed in one case with emergent cholangitis, the other two cases were reported malignancy through biopsy and operation was abandoned. Conclusions. Ultrasound diagnostics is essential to accurately diagnose the cyst, preoperative ERCP is helpful for differentiating pancreatic duct from bile duct, while MRCP is a reliable method ; cystectomy and cholangiojejunostomy is recommended, laparoscopic procedure is becoming more and more accepted.