The response to medical litholytic treatment of gallstones according to their specific gravity

Summary The buoyancy of gallstones was observed by taking anterior-posterior scout X-ray films of two patients standing during endoscopic retrograde cholangiography. In case 1, the large and small gallstones differed in buoyancy, and ursodeoxycholic acid treatment dissolved the floating small stones while failing to dissolve the nonfloating large stone. In case 2, both the large and small stones floated and are being dissolved by ursodeoxycholic acid treatment. Since floating or nonfloating and the plane of flotation depend on the specific gravity of the gallstone, the above findings suggest that a gallstone with a low specific gravity is more readily dissolved than one with a high specific gravity. The present method of estimating the buoyancy of gallstones was therefore considered extremely useful in selecting patients for medical litholytic treatment.     

Early ERCP for Gallstone Pancreatitis: For Whom and When?

The indications for early endoscopic retrograde cholangiopancreatography (ERCP) in gallstone pancreatitis are unclear, and the examination is often requested or performed without substantial supporting evidence. Several trials have been performed to determine the benefit of early ERCP in pancreatitis, yet the results of these studies are inconsistent. To more closely analyze these studies, we performed an evidence-based review of the outcomes of early ERCP in gallstone pancreatitis. To obtain the best available evidence, a PubMed search using the MeSH terms “gallstones” and “pancreatitis” was performed and further refined to identify appropriate studies. We included five randomized trials, a meta-analysis, and a Cochrane Database Systematic Review in our detailed examination of the pertinent literature. Collectively, these studies suggest that early ERCP does not alter mortality in gallstone pancreatitis. In addition, few patients with mild pancreatitis benefit from the procedure, whereas some studies indicate that patients with severe pancreatitis or documented biliary obstruction may experience fewer complications if ERCP is performed. The data in the studies are confounding because of heterogeneity of the patient population and the inability to confirm gallstones in up to one third of patients. In conclusion, ERCP is not indicated for patients with mild pancreatitis. In select patients with severe disease or biliary obstruction, ERCP may be indicated. A multicenter trial designed to study the effect of early ERCP in severe pancreatitis only may provide additional useful information in patients with documented gallstones. Presented at the Postgraduate Course of the 48th Annual Meeting of The Society for Surgery of the Alimentary Tract (Digestive Disease Week 2007), Washington DC, USA, May 20, 2007.     

急性胆源性胰腺炎手术治疗探讨——附96例报告

目的 探讨急性胆源性胰腺炎手术时机的选择。方法 回顾性分析1999-2004年收治的急性胆源性胰腺炎96例患者的临床资料。结果 59例急性非梗阻性胆源性胰腺炎中，48例经非手术治疗症状缓解后1-2周内延期手术；11例急诊手术，1例死亡。37例急性梗阻性胆源性胰腺炎先经非手术治疗，18例在24-48h后症状不缓解行急诊手术，19例在症状缓解后1—2周内行延期手术，均获治愈。结论 急性非梗阻性胆源性胰腺炎早期应选择非手术治疗，症状缓解后延期手术。急性梗阻性胆源性胰腺炎在非手术治疗24h-48h症状不缓解则急诊手术。     

Recurrent enteric gallstone obstruction

Small bowel gallstone obstruction may recur, most often within a few days after surgery, due to an overlooked intraenteric stone or subsequent passage of another gallstone via the cholecystoenteric fistula. In the case reported herein there was a 6-month interval. A critical review of the radiologic signs of gallstone ileus is presented.     

腹腔镜手术与开腹手术治疗胆囊炎、胆结石的疗效比较

目的 比较腹腔镜手术与开腹手术治疗胆囊炎、胆结石的临床疗效.方法 回顾性分析2007年1月-2009年12月收治于我院且采取腹腔镜肌囊切除术治疗的86例胆囊炎、胆结石患者的临床疗效资料,并与之前采取传统开腹手术治疗的86例胆囊炎、胆结石患者的临床疗效资料进行比较.结果 腹腔镜手术组患者在手术时间[(77.2±28.7)...     

胆囊结石合并肝硬化患者行腹腔镜手术与开腹胆囊切除术效果对比研究

目的观察腹腔镜手术治疗胆囊结石合并肝硬化的临床疗效。方法胆囊结石合并肝硬化患者56例随机分为观察组和对照组各28例,观察组采用腹腔镜手术,对照组采用常规开腹手术。观察比较2组患者手术时间、术中出血量、术后禁食时间、住院时间及并发症发生情况。结果观察组术中出血量、手术时间、术后禁食时间、住院时间均少于对照组,并发症发生率低于对照组,差异均有统计学意义(P<0.05)。结论腹腔镜手术治疗胆囊结石合并肝硬化安全有效。     

腹腔镜胆囊切除术治疗50例急性化脓性胆囊炎、胆囊结石的临床分析

目的探讨腹腔镜胆囊切除术(LC)治疗急性化脓性胆囊炎、胆囊结石的临床效果。方法随机将我科100例急性化脓性胆囊炎、胆囊结石患者分为开腹胆囊切除术治疗组(OC组)和腹腔镜胆囊切除术治疗组(LC组),术后对比两组患者的手术疗效、并发症发生率和胆囊炎复发率等情况。结果 LC组在手术时间、术中出血量、术后恢复进食时间及术后平均住院天数等方面与OC组比较,差异有高度统计学意义(P<0.01);LC组并发症发生率(4.00%)明显低于OC组(16.00%)(P<0.05);所有患者术后6个月均获得正常随访,均无复发病例。结论与传统的开腹胆囊切除术相比,行腹腔镜胆囊切除术具有创伤小、疗效好、恢复快等优点,能够明显减轻急性化脓性胆囊炎、胆囊结石患者痛苦和改善预后,在掌握手术适应证、手术时机和手术操作技巧的前提下尽早实施手术,提高患者的生存质量。     

利胆汤佐助腹腔镜胆囊切除术治疗胆囊结石并发胆囊炎50例

目的探讨利胆汤佐助腹腔镜胆囊切除术治疗胆囊结石并发胆囊炎的临床疗效。方法 100例胆囊结石并发胆囊炎患者,分成观察组和对照组。对照组行腹腔镜胆囊切除术;观察组采用利胆汤佐助腹腔镜胆囊切除术。结果观察组总有效率(98.00%)高于对照组(78.00%),差异具有统计学意义(P<0.01);观察组胆囊术后综合征发生率少于对照组,差异有统计学意义(P<0.05)。结论利胆汤佐助腹腔镜胆囊切除术治疗胆囊结石并发胆囊炎患者疗效佳,可减轻患者痛苦。     

幽门螺杆菌感染与结石性胆囊炎患者胆囊黏膜病变分析

目的探讨结石性胆囊炎患者幽门螺杆菌（Hp）感染与胆石形成的关系。方法对56例结石性胆囊炎患者血清及胆汁HpIgG阳性的26例手术切除胆囊标本,采用Giemsa染色及特殊Hp免疫组织化学染色进行观察。结果26例血清及胆汁HpIgG阳性胆囊黏膜标本中Giemas检出19例（73．08％）,7例为阴性;Hp免疫酶标记5例为阳性（19．23％）,21例为阴性。Giemsa染包阳性率高于Hp免疫酶标记阳性率（P〈0．05）。Giemsa染色阳性切片中,在黏膜表面上皮、腺体上皮表面及腺腔的黏液中,可发现染成蓝色细菌。免疫组织化学阳性切片中,在同样部位发现呈阳性反应的着棕黄色菌体。细菌球形菌多呈现于杆状菌。结论结石性胆囊炎患者胆石形成过程中Hp感染起着一定的作用。     

腹腔镜胆囊切除术治疗急性胆囊炎合并胆囊结石体会

目的探讨急性胆囊炎合并胆囊结石患者行腹腔镜胆囊切除术（laparoscopic cholecystect omy,LC）的术式、术中处理,并发症的防治。方法回顾性分析我院2005年2月至2009年2月为54例急性胆囊炎合并胆囊结石患者行LC的临床资料。结果50例成功完成LC,腹腔镜完整胆囊切除术44例,胆囊大部切除术加残余胆囊黏膜电灼破坏术6例。因Calot三角致密粘连,解剖不清,转开腹3例,因胆囊坏疽中转开腹1例。手术时间40～130min,平均60min。术后住院5～10d,平均7.2d。术后无严重并发症发生。结论急性胆囊炎合并胆囊结石患者行腹腔镜胆囊切除术是安全有效的。