Laparoscopic cholecystectomy after coronary artery bypass grafting using the right gastroepiploic artery: report of a case

A laparoscopic cholecystectomy (LC) was successfully performed on a 61-year-old man who had undergone coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA). He complained of right hypochondralgia 20 days after CABG. Gallstones were diagnosed and a cholecystectomy was performed 9 months after CABG. Under general anesthesia, the operation was performed using a pneumoperitonium. When a laparoscope was inserted, the RGEA pedicle could be clearly recognized. The pedicle obstructed the operating field and made the working space narrower than usual. No ST changes on the electrocardiogram were seen during LC, especially during the initiation of pneumoperitonium, the insertion of the ports, or when retracting the gallbladder. The postoperative course was uneventful. To avoid complications, care should be taken not to stretch the RGEA pedicle during LC, and careful monitoring of the electrocardiogram is also necessary. It is difficult to view the operating field and the RGEA pedicle together. It is therefore better to insert another laparoscope for concomitant monitoring of the RGEA pedicle. Received: June 25, 2001 / Accepted: January 8, 2002     

Recurrent gallstone ileus: a case report

Gallstone ileus is a rare complication of recurrent gallstone cholecystitis and usually occurs in elderly female patients. Recurrent gallstone ileus occurs in 5% of patients with a previous episode of gallstone ileus and is associated with a mortality of 20%. We present a 52-year-old female with recurrent gallstone ileus 1 year after her initial episode. Electronic Publication     

胰胆管合流异常及其相关疾病

胰胆管合流异常是一种胆管和胰管在十二指肠壁外汇合的先天性畸形。由于失去了Oddi括约肌的控制,胆汁和胰液可以相互返流从而引起胆总管扩张症,胆道结石,胆道肿瘤及其胆源性胰腺炎等疾病。     

一个大型胆囊结石病家系的遗传特征及流行病学分析

目的调查某胆囊结石(胆石)病家系的遗传特点及流行病学特征。方法对该家系进行问卷调查、体格检查及实验室检查。结果该家系四代共113人(男55人,女58人),胆石患者33例(男13例,女20例),女性发病率(34.48%)高于男性(23.64%),但差异无统计学意义。和先证者有血缘关系的亲属中Ⅱ、Ⅲ代发病率52%,明显高于配偶的发病率(20%),P=0.003。先证者Ⅰ级亲属遗传度86.38%±46.46%。患者平均体重指数(25.06±2.59)kg/m2,显著高于非胆石病者平均体重指数(22.69±3.24)kg/m2,P=0.012。胆石病患者中有高血压、高血脂病史者明显多于非胆石病者,差异有统计学意义,P值分别为<0.01和0.017。糖尿病病史、饮酒习惯、喜油腻饮食在胆石病患者和非胆石病者中无差异。胆石病患者血糖平均值(5.35±0.77)mmol/L。血胆固醇和甘油三酯在胆石病患者和非胆石病者中无差异。结论该家系胆石病具有明显家族聚集性,符合常染色体显性遗传特点;性别、肥胖、高血压和高血脂病史是该家系的危险因素。     

人正常与结石性胆囊上皮细胞分泌颗粒和溶酶体的定量分析及其意义

作者对２０例胆固醇结石和１５例正常人的胆囊上皮细胞分泌颗粒和溶酶体进行了定量分析，同时测定其胆囊胆汁中的糖蛋白含量，比较两组间的差异。结果显示：结石组胆囊上皮细胞分泌颗粒数、体密度和总面积均明显高于对照组，而溶酶体含量则明显低于对照组；结石组胆汁中糖蛋白含量较对照组高，且胆汁中糖蛋白含量与细胞分泌颗粒数呈正相关，与溶酶体含量呈负相关。作者认为胆囊上皮细胞分泌颗粒影响胆汁糖蛋白量的变化，而溶酶体则可能与细胞内分泌颗粒或蛋白的降解有关，提示胆囊粘膜细胞内结构改变对结石形成起有一定作用。     

核素肝胆动态显像对胆囊结石患者胆囊运动功能的研究

为了探求胆囊结石患者胆囊运动功能的状况，用(99m)锝一二乙基乙酸苯氨基亚氨二醋酸（(99m)Tc-EHIDA）为肝胆显像剂，以脂肪餐为胆囊收缩刺激剂，通过单光子计算机断层（SPECT）装置及计算机系统定量地研究了12例正常受试者和12例胆囊结石患者的胆囊运动情况。结果表明；潜伏期和排胆期在两组间无显著性差异（P＞0．05），而胆囊结石患者的排胆分数和排胆率明显低于正常对照组（P＜O．01）。说明胆囊结石患者的胆囊运动功能是降低的。     

Endoscopic sphincterotomy for prevention of the recurrence of acute biliary pancreatitis in patients with gallbladder in situ: long-term follow-up of 88 patients

Background Endoscopic sphincterotomy without cholecystectomy is a therapeutic option in selected patients after acute biliary pancreatitis. We conducted a prospective evaluation of the long-term effects of sphincterotomy in terms of the need for of subsequent cholecystectomy and the recurrence of gallstone pancreatitis.Methods We studied 88 patients with acute biliary pancreatitis and an intact gallbladder who, underwent endoscopic sphincterotomy either because they were high-risk candidates for surgery or because they had refused of cholecystectomy. The median follow-up was 51 months (range, 5–86).Results Only two patients (2.2%) experienced recurrent pancreatitis. Subsequent cholecystectomy was performed in 10 patients because of acute cholecystitis in eight cases and biliary colic in two cases. Sixty-six patiens (75%) remained asymptomatic.Conclusions Endoscopic sphincterotomy is a safe and acceptable alternative to cholecystectomy for the prevention of recurring attacks of gallstone pancreatitis. As a result of this procedure, 75% of patients remained free of symptoms in the long term.     

Late abscess formation after spilled gallstones masquerading as a liver mass

The most common complication during laparoscopic cholecystectomy is the spillage of stones into the abdominal cavity. Although spillage occurs in 30% of cases, the potential adverse effects of this event are rare and generally manifest within months. When complications do occur, however, they may cause significant morbidity for the patient. We report an unusual case in which an inflammatory mass mimicking a liver tumor developed 5 years after the stones had been lost during a laparoscopic cholecystectomy. We therefore urge all surgeons to make every attempt to retrieve gallstones from the abdominal cavity once they have been accidentally dropped.     

胆源性胰腺炎患者胆囊CCK受体的改变及临床意义

目的比较胆源性胰腺炎、胆囊结石及胆囊息肉患者胆囊CCK受体的改变，探讨胆囊收缩功能改变与胆源性胰腺炎发生的关系。方法免疫组化法分别检测胆囊结石、胆囊息肉、胆源性胰腺炎各20例患者的胆囊平滑肌标本中CCK受体含量。结果CCK—A受体表达强度胆囊结石组最强，胆囊息肉组次之，胆源性胰腺炎组最弱；胆源性胰腺炎组CCK—A受体数量明显减少。结论胆囊平滑肌细胞膜上的CCK受体改变与胆囊收缩功能减弱及胆源性胰腺炎的发生发展可能有一定关系。