Coexistent gallbladder carcinoma in Mirizzi syndrome

A 52‐year‐old woman presented with right upper quadrant pain and obstructive jaundice. Computed tomographic scan showed Mirizzi syndrome type 1 and a thickened and calcified gallbladder wall, raising the possibility of coexistent gallbladder carcinoma that was later confirmed on histology post‐cholecystectomy.     

金桃消石散治疗胆囊结石临床研究

目的:观察金桃消石散治疗胆囊结石的临床疗效及其对胆囊收缩功能的影响。方法:选择胆囊结石患者67例,随机分为治疗组和对照组。治疗组32例,口服金桃消石散;对照组35例,服用胆石通。共治疗4个月,分别于治疗前及治疗后,B超检测胆囊结石及胆囊排空率变化情况。结果:治疗组痊愈6例,显效9例,有效15例,无效2例;对照组痊愈2例,显效6例,有效18例,无效9例,两组治疗后胆囊排空率均较治疗前好转,但治疗组与对照组比较,疗效更为显著。结论:金桃消石散可以明显改善胆囊的收缩功能,是治疗胆囊结石有效的方剂。     

Target nursing care on anxiety and depression in patients with gallbladder cancer during perioperative period

Background:This study retrospectively investigated the effects of target nursing care (TNC) on anxiety and depression in patients with gallbladder cancer (GBC) during the perioperative period.Methods:This retrospective study analyzed the data of 80 patients with GBC during perioperative period. These records were divided into an intervention group (n = 40) or a control group (n = 40). All 80 patient records in both groups were administered routine nursing care (RNC). The patients in the intervention group also underwent TNC. The primary outcomes were depression (measured using the Hamilton Depression Scale, HAMD) and anxiety (assessed using the Hamilton Anxiety Scale, HAMA). The secondary outcomes were quality of life (assessed using the 36-Item Short Form Health Survey, SF-36) and adverse events. We collected and analyzed the outcome data before and after treatment.Results:After treatment, patients in the intervention group showed more promising effects on depression (HAMD, P < .01) and anxiety (HAMA, P < .01) than those in the control group did. However, there were no significant differences in the quality of life before and after treatment. No TNC- or RNC-associated adverse events were reported in patient records.Conclusion:This study found that TNC was more effective than RNC in relieving depression and anxiety. Future studies should be conducted to validate the present findings.     

胆乐化瘀片防止食饵性胆固醇结石的实验研究

目的探讨胆乐化瘀片防止食饵性胆固醇结石机理。方法通过改变饮食成分诱发豚鼠胆结石。各组连续喂养8周后（各给药组拌入规定剂量的药物）,观察肝脏的病理变化,从胆囊中收集胆石,吸取胆囊胆汁,测定胆汁中成分的含量。结果胆乐化瘀片预防组的成石率均显著降低,其高剂量预防组成石率降至0％。模型组动物肝脏发生明显脂肪变性,其发生率为90％;而预防组动物发生率仅为40％（低剂量组）和20％（高剂量组）。结论胆乐化瘀片通过调节胆汁酸的代谢,增加胆汁酸的含量;降低胆汁中游离胆红素的含量;以及利胆等综合作用与防止胆石的形成有关。     

胆胃舒颗粒预防胆囊结石及对胆囊收缩素受体(CCK-AR)基因表达的影响

目的:观察利胆健脾方胆胃舒颗粒对胆囊结石的预防作用及其作用机制。方法:实验用短毛雄性豚鼠90只,随机分为3组,每组30只,空白组:喂养普通饲料每天40g/只;模型组:喂养胆固醇结石诱石饲料40g/天/只;治疗组喂养胆固醇诱石饲料40g/天/只,并胆胃舒颗粒溶液灌胃2mL(含300mg胆胃舒颗粒)。实验2个月后观察胆囊内结石情况、胆囊收缩功能、及胆囊、胃窦平滑肌CCK-AR最大结合容量;结果:胆囊结石情况:空白组3.33%(1/30);模型组92.59%(25/27);治疗组:10.71%(3/28)。胆囊收缩功能:空白组为66.83%±5.34%;模型组43.06%±4.27%;治疗组67.93%±6.82%;胆囊平滑肌CCK-AR基因表达:空白组0.862±0.112;模型组0.521±0.083;治疗组0.792±0.098。结论:利胆健脾法可降低胆囊结石的形成,其作用机制可能通过提高胆囊CCK-AR基因表达,从而加强胆囊收缩功能,促使胆汁流动,防止胆囊结石的发生。     

胆囊癌组织中蛋白赖氨酸乙酰化的变化及临床意义

目的:探讨蛋白赖氨酸乙酰化在胆囊癌组织中的变化情况。方法:采用Western 免疫印迹法,分别检测30例胆囊癌组织和20例慢性胆囊炎组织中蛋白赖氨酸乙酰化的变化。结果:与慢性胆囊炎组织相比,胆囊癌组织中的蛋白赖氨酸乙酰化显著增加（P < 0.01）,乙酰化的显著增加主要发生在相对分子质量为10 000~36 000的蛋白。结论:利用赖氨酸乙酰化单克隆抗体特异性能够检测到胆囊组织蛋白的赖氨酸乙酰化,且相对分子质量为10 000~36 000蛋白的赖氨酸乙酰化增加显著。     

彩色超声对原发性胆囊癌的诊断价值

目的：探讨原发性胆囊癌的彩色超声图像特征,提高原发性胆囊癌的超声诊断准确率,减少临床的误诊和漏诊。方法回顾性分析了该院2009年以来45例原发性胆囊癌患者的超声图像特征及检查结果,并与手术后的病理结果进行了对照。结果45例胆囊癌中术前彩色超声诊断了35例,准确率77.8%,误诊10例,误诊率22.2%,根据彩色超声图像的特点将原发性胆囊癌分为5型。结论彩色超声为原发性胆囊癌的首选检查方法,对临床诊断和鉴别诊断具有重要价值,但还应与其他检查相结合以提高早期诊断率。     

超声内镜引导下经口胆囊穿刺引流术 入路选择的实验研究

目的 比较超声内镜引导下经胃窦和十二指肠球部胆囊穿刺引流术的操作难度、手术效果、术 后并发症及后续胆汁对胃黏膜的影响。方法 实验猪8 头,将其分为经胃窦组和经十二指肠球部组,每组4 头。 在腹腔镜下实时观察超声内镜引导下经胃窦和十二指肠球部胆囊穿刺引流术,并于模型复制术后10 d 处死 实验动物,取吻合口及胃黏膜观察组织学改变。结果 两组均有3 头猪完全成功,两组操作成功率均为75%。 经胃窦组平均操作时间短于经十二指肠球部组（21.67 min VS 26.67 min）（P <0.05）,而胃黏膜损伤病理评分 总分高于经十二指肠球部组（8.33 分 VS 6.33 分）（P <0.05）。结论 猪动物模型中,超声内镜引导下经十二 指肠球部胆囊穿刺引流术操作难度稍大,但术后并发症少,较经胃窦胆囊穿刺引流术有优势。     

腹腔镜胆囊切除术中结石漏入腹腔的处置体会

目的：探讨腹腔镜胆囊切除术中结石漏入腹腔的处置方式。方法：探讨腹腔镜胆囊切除术中结石漏入腹腔的处置方式。结论：预防腹腔漏入结石的关键是LC术中防止胆囊分破或取出时撕破致胆汁、结石漏入腹腔，胆囊分破、结石落入腹腔后采取必要的处理措施，随着LC术中腹腔漏入结石处理方式的改进，取石时间缩短，腹腔残石发生率大大降低。