胆石的体外背向散射积分测定

目的评价背向散射积分(IBS)可否体外预测胆石的化学性质。方法以红外光谱定量分析结石的化学性质,将结石分为纯胆固醇性和纯胆色素性两组(以胆固醇≥70%为胆固醇性结石;胆固醇≤30%为胆色素性结石),每组30例共60例,对结石及其声影进行体外IBS测定。结果胆固醇组和胆色素组结石的图像峰-峰值(PII)及图像强度标准差(SDI)之间无显著性差别,两组间的图像平均强度(AII)有显著性差别(P<0.05),胆色素类结石的AII大于胆固醇类结石的AII;胆固醇组和胆色素组声影的IBS值比较只有AII有显著性差别(P<0.001),胆色素类结石声影的AII小于胆固醇类结石的AII;两组间结石-声影AII差值之间有显著性差别(P<0.001),胆色素组大于胆固醇组。结论背向散射积分能体外区分纯胆固醇性和纯胆色素性结石。     

胆结石超声性质的离体研究

本文使用脉冲插入取代法,在1MHz频率下,对25个离体胆结石的声学参数,如声速、声衰减等进行了测量。结果表明,声速值分布很宽,从1688.8m/s到2414.5m/s,且声速值C_s(m/s)随胆石厚度D(mm)增加而趋于减小,其变化关系可由拟合方程C_s=3382.2×D~(-0.30)予以描述(r=0.92)。胆石的超声衰减值很高,从21.6dB/cm到107.2dB/cm。对于不同化学组份类型的胆结石,未发现它们的声学参数有明显不同。由此可认为,胆石的声学参数主要决定于其结构,而不是其化学组份。对所获结果的意义结合超声临床应用进行了讨论。     

Gallstone duodenum: Unusual complication of an obstructing intraluminal duodenal diverticulum

An unusual case of gallstones within the duodenum, secondary to obstruction by an intraluminal diverticulum, is reported. The gallbladder appeared normal an oral cholecystogram, excluding internal biliary fistula as the source of duodenal gallstones.     

Cystic duct dilation through endoscopic retrograde cholangiopancreatography for treatment of gallstones and choledocholithiasis: Six case reports and review of literature

BACKGROUNDCholedocholithiasis removal via endoscopic retrograde cholangiopancreatography (ERCP) then followed by laparoscopic cholecystectomy (LC) has gradually become the principal method in the treatment of gallstones and choledocholithiasis. We use ERCP through the cystic duct to treat gallstones combined with choledocholithiasis, with the aim to preserve the normal function of the gallbladder while simultaneously decreasing risk of biliary tract injury.CASE SUMMARYA total of six cases of patients diagnosed with gallstones and choledocholithiasis were treated with ERCP. The efficacy was evaluated via operation success rate, calculus removal rate, postoperative hospital stay and average hospitalization costs; the safety was evaluated through perioperative complication probability, gallbladder function detection and gallstones recrudesce. The calculus removal rate reached 100%, and patients had mild adverse events, including 1 case of postoperative acute cholecystitis and another of increased blood urinary amylase; both were relieved after corresponding treatment, the remaining cases had no complications. The average hospital stay and hospitalization costs were 6.16 ± 1.47 d and 5194 ± 696 dollars. The 3-11 mo follow-up revealed that gallbladder contracted well, without recurrence of gallstones.CONCLUSIONThis is the first batch of case reports for the treatment of gallstones and choledocholithiasis through ERCP approached by natural cavity. The results and effects of six reported cases proved that the new strategy is safe and feasible and is worthy of further exploration and application.     

腹腔镜联合胆道镜腹腔外保胆取石术的临床应用

目的:探讨腹腔镜联合胆道镜腹腔外微创保胆取石术的临床应用价值.方法:65我院2004年1月_2006年12月符合保胆取石条件的110例胆结石分为3组,行腹腔镜下腹腔外胆道镜保胆取石术40例(A组)、腹腔镜下腹腔内胆道镜取石术30例(B组)和传统胆道镜取石术40例(C组),比较3组手术时间、术后至出院时间及术后并发症发生情况.结果:A组手术时间、并发症与B组比较差异具有显著性意义(P<0.05),A组出院时间与C组比较差异具有显著性意义(P<0.05).结论:腹腔镜下腹腔外胆道镜保胆取石术具有手术时间短、术后并发症少、恢复快等优点.具有临床推广价值.     

绍兴市815例健康人群胆囊良性疾病流行病学调查

目的调查本地区的健康人群,对其中的各种良性胆囊疾病的发生情况进行分析。方法对健康体检的815例健康人群进行调查,其中38例胆囊结石患者作为观察组,777例无胆囊结石患者作为对照组,对两组血清生化指标进行比较分析。结果共115例良性胆囊疾病患者。两组Cl、IBIL、TG差异无显著性(P>0.05),其他观察指标均具有显著性(P<0.05)。K、Ca、Na、CH、DBIL等是胆囊结石患者的危险因素。结论在胆囊结石患者中,其形成受到血清生化指标的影响,应对其危险因素提高重视,对于胆囊结石患者发生率的降低也具有一定的积极的临床意义。     

Spontaneous resolution of gallbladder hematoma in blunt traumatic injury: A case report

BACKGROUNDWe report a case of intragallbladder hematoma and biliary tract obstruction caused by blunt gallbladder injury. We report that the patient was safely treated by conservative treatment after the obstruction was resolved by endoscopic retrograde cholangiopancreatography (ERCP).CASE SUMMARYA 67-year-old man was admitted via the emergency department due to complaints of right-sided abdominal pain that started 2 d prior. Four days prior to presentation, the patient had slipped, fallen and struck his abdomen on a motorcycle handle. His initial vital signs were stable. On physical examination, he showed right upper quadrant pain and Murphy’s sign, with decreased bowel sounds. Additionally, he had had a poor appetite for 4 d. He had been on aspirin for 2 years due to underlying hypertension. Initial simple radiography revealed a slight ileus. The laboratory findings were as follows: white blood cell count, 15.5 × 10³/µL (normal range 4.8 × 10³–10.8 × 10³); hemoglobin, 9.4 g/dL; aspartate aminotransferase/alanine transferase, 423/348 U/L; total bilirubin/direct bilirubin, 4.45/3.26 mg/dL; -GTP , 639 U/L (normal range 5–61 U/L); and C-reactive protein, 12.32 mg/dL (0–0.3). Abdominal computed tomography showed a distended gallbladder with edematous wall change and a 55 mm × 40 mm hematoma. Dilatation was observed in both the intrahepatic and common bile duct areas. Antibiotic treatment was initiated, and ERCP was performed, with hemobilia found during treatment. After cannulation, the patient’s symptoms were relieved, and after conservative management, the patient was discharged with no further complications. After 1-month follow-up, the gallbladder hematoma was completely resolved.CONCLUSIONIn the case of traumatic injury to the gallbladder, conservative treatment is feasible even in the presence of hematoma.     

影响微创保胆取石术难度的相关因素及患者术后长期随访分析

目的探讨腹腔镜下保胆取石术手术难度的影响因素及应用保胆取石术后结石复发的危险因素。方法对150例行腹腔镜保胆取石术治疗的胆囊结石患者进行术前评估及术后24个月内随访,分析可能影响手术难度和术后结石复发的相关因素。结果 (1)胆囊体积≥50 cm2、最大结石直径、胆囊壁厚度≥4 mm、胆囊颈黏连、胆囊底黏连、胆囊颈结石嵌顿是引起手术困难的危险因素;(2)患者年龄≥60岁、体质量指数(BMI)≥25 kg/m2、家族史是引起结石复发的危险因素。结论对于有影响微创手术效果危险因素的患者要对其进行术前综合评估以选择针对性的治疗手段;对于有引起结石复发危险因素的患者术后要进行药物预防性治疗以减少结石复发几率。     

临床应用内镜治疗化脓性胆管炎的研究

目的 采用探讨内镜治疗急性化脓性胆管炎的临床疗效。方法 对35例化脓性胆管炎患者急诊ERCP检查和治疗,其胆管结石23例;乳头狭窄及功能异常4例;胆管管损伤后狭窄2例;恶性肿瘤6例。胆总管结石的治疗：ERCP检查明确为胆总管结石,如患者生命体征平稳,则予急诊取石。十二指肠乳头炎性狭窄和功能异常的治疗可选择ES或乳头括约肌球囊扩张。胆管恶性梗阻的治疗：使用胆管扩张探条沿导丝插入予以扩张后再放置引流管进行治疗。结果 35例急性胆囊炎患者中31例完成治疗,成功率93．84％。经内镜治疗后48h内,26例患者腹痛缓解,体温下降,急性胆囊炎症状均得到有效控制。23例胆管结石,急诊行取石术或同时放ENBD,取出全部结石。十二指肠乳头狭窄或功能异常4例,3例行E卵治疗,急性胆管炎得到控制。结论 急性化脓性胆管炎,无论是胆管结石还是良恶性狭窄所致,均可以选择内特引流,可减轻患者痛苦、缩短住院时间、减少费用。     

老年胆囊切除术围手术期抗菌药物应用分析

目的:了解某院老年胆囊炎胆囊结石患者围手术期抗菌药物的使用情况。方法:对76例60岁以上胆囊炎胆囊结石胆囊切除术患者围手术期抗菌药物使用品种、用药频度、使用方法等进行统计分析。结果:76例中,单一用药10例(13.2%),二联用药51例(67.1%),三联用药8例(10.5%),三联以上用药7例(9.2%),围手术期合理使用抗菌药物11例(14.5%),基本合理31例(40.8%),应用不合理34例(44.7%)。结论:胆囊切除术围手术期预防应用抗菌药物存在较高的不合理性,应加强监测提高合理用药水平。