细针侧径路经皮肝穿刺胆道造影

本文报道了我院在非X线电视监视下采用细针侧径路PTC检查42例阻塞性黄疸的体会。42例中38例穿刺成功,成功率为90％。38例穿刺成功者,诊断为胆石症24例,肿瘤9例,其它5例。38例中27例接受手术治疗,其中25例手术发现与影象学诊断相符,符合率为92％。对PTC的操作技术,适应证、禁忌证、诊断价值、并发症的有关因素等进行了分析探讨。     

实时灰阶超声对耳压法治疗胆石症的评价

本实验对35例胆囊结石患者按压肝、胆、胰等耳穴,配以高脂餐,治疗1～4个疗程。治疗前后分别进行肝胆系统的超声检查,根据超声图象及其录象测得胆囊结石量和胆囊容积(用三径乘积法表示),并据此计算胆囊收缩率。治疗后超声提示胆囊结石减少者7/35(20％),胆囊收缩功能较前改善者12/22(54.6％)。本报告尝试了用超声显象对胆囊结石进行定量估测的方法;分析了本组病人耳压排石疗效较低的原因。     

胆结石、胆囊切除术与大肠癌关系的探讨

目的　探讨胆结石、胆囊切除术与大肠癌的关系。方法　本院 1994年 10月～ 2 0 0 2年 12月共收治大肠癌患者 2 4 5例 (大肠癌组 ) ,同期收治其它肿瘤患者 4 6 5例 (对照组 ) ,并对两组胆结石、胆囊切除术的百分率进行对比分析。结果　大肠癌组有 4 4例 ( 17.96 % )存在胆结石及胆囊切除术 ,其中胆结石 38例 ( 15 .5 1% ) ,有胆囊切除术史 6例 ( 2 .4 5 % )。而对照组中有 17例 ( 3.6 6 % )存在胆结石及胆囊切除术 ,其中胆结石 15例 ( 3.2 3% ) ,有胆囊切除术史 2例 ( 0 .4 3% )。两组比较 ,有显著性差异 (P <0 .0 5 )。结论　提示胆结石、胆囊切除术是大肠癌的致病危险因素。     

LAPAROSCOPY-GUIDED PERCUTANEOUS CHOLECYSTOLITHOTOMY: AN EVOLVING TECHNIQUE

Gall-bladder conservation therapy has been evolving during the past decade. Popular techniques of conservative therapy are extracorporeal shock wave lithotripsy (ESWL) and medical dissolution therapy. The limitations of these procedures have prompted a search for alternative techniques, particularly in relation to percutaneous stone extraction. The cases of four patients with symptomatic gallstones who underwent percutaneous cholecystolithotomy under laparoscopic guidance are reported. The gall-bladder was punctured with a long needle and the tract dilated so that a nephroscope could be introduced. Three cases required stone fragmentation by an ultrasonic lithotripter before removal. Postoperative recovery was uneventful in all cases.     

Gallstone characteristics in mexican americans and non-hispanic whites

Mexican Americans have an elevated risk of gallstones. Their increased rates may be due to genetic admixture with Native Americans, who have extremely high prevalences of cholelithiasis. Native Americans are believed to have almost exclusively cholesterol stones, whereas only 73% of non-Hispanics are reported to have such stones. Hence we hypothesized that Mexican Americans would have a higher proportion of cholesterol stones than would non-Hispanic whites. We interviewed 398 Mexican Americans and 93 non-Hispanic whites undergoing cholecystectomy and analyzed the composition of their gallstones. Mexican Americans were younger than non-Hispanic whites (P<0.05). However, the age-sex standardized proportion of cholesterol stones was 89.7% in Mexican Americans and 87.2% in non-Hispanic whites. We conclude that Mexican Americans and non-Hispanic whites have gallstones of similar composition. The higher stone prevalence of Mexican Americans may be due to factors that predispose to both cholesterol and pigment stones.     

Characterization of lipid accumulation in the gallbladder mucosa of the ground squirrel fed a lithogenic diet

Richardson's ground squirrels (Spermophilus richardsonii) of both sexes were fed a 2 per cent cholesterol-enriched diet for intervals of 12, 18, and 24 h; 3, 5, and 7 days; and 2, 3, 10, and 20 weeks. It was shown that free (unesterified) cholesterol, phospholipid, and cholesterol ester accumulated in specific regions of the gallbladder mucosa during cholelithiasis. Electron microscopy revealed the presence of lipids inter- and intracellularly as early as 12 h after ingestion. By 7 days, lipids were seen in dilated endoplasmic reticulum, as well as in supranuclear and basal regions of epithelial cells. Histochemical localization revealed free cholesterol in dilated endoplasmic reticulum and residual bodies at the ultrastructural level. Neutral lipid was observed by light microscopy in the supranuclear and basal regions of the cells. In 10- and 20-week treated animals, lipid droplets were also seen in the lamina propria and macrophages. The lesion induced by cholesterol ingestion persisted throughout the experimental period, and while different from that in human tissue, it was similar to those observed in experimental canine cholesterosis.     

胆石病合并糖尿病患者的围手术期处理

胆石病合并糖尿病患者并非少见，本组16例胆石病合并有不同程度的糖尿病，均实施了胆囊切除或胆总管探查术。由于手术选择正确，加强了围手术期处理，未发生与糖尿病代谢有关的死亡和严重并发症。认为加强伴糖尿病的胆石病围手术期处理是降低手术死亡率的关键。     

Predicting iatrogenic gall bladder perforation during laparoscopic cholecystectomy: a multivariate logistic regression analysis of risk factors

BACKGROUND: Seventeen independent risk factors were examined using multivariate logistic regression analysis to develop a profile of patients most likely at risk from iatrogenic gall bladder perforation (IGBP) during laparoscopic cholecystectomy. METHODS: Since 1989, a prospectively maintained database on 856 (women, 659; men, 197) consecutive laparoscopic cholecystectomies by a single surgeon (R. J. F.) was analysed. The mean age was 48 years (range, 17-94 years). The mean operating time was 88 min (range, 25-375 min) and the mean postoperative stay was 1 day (range, 1-24 days). There were 311 (women, 214; men, 97) IGBP. Seventeen independent variables, which included sex, race, history of biliary colic, dyspepsia, history of acute cholecystitis, acute pancreatitis and jaundice, previous abdominal surgery, previous upper abdominal surgery, medical illness, use of intraoperative laser or electrodiathermy, performance of intraoperative cholangiogram, positive intraoperative cholangiogram, intraoperative common bile duct exploration, presence of a grossly inflamed gall bladder as seen by the surgeon intraoperatively and success of the operation, were analysed using multivariate logistic regression for predicting IGBP. RESULTS: Multivariate logistic regression analysis against all 17 predictors was significant (chi(2) = 94.5, d.f. = 17, P = 0.0001), and the variables male sex, history of acute cholecystitis, use of laser and presence of a grossly inflamed gall bladder as seen by the surgeon intraoperatively were individually significant (P < 0.05) by the Wald chi(2)-test. CONCLUSION: Laparoscopic cholecystectomy, using laser, in a male patient with a history of acute cholecystitis or during an acute attack of cholecystitis is associated with a significantly higher incidence of IGBP.     

Carcinoma of the gallbladder: autopsy findings in 287 cases and review of the literature

From 1950 to 1982, 287 patients with cancer of the gallbladder were autopsied. The ratio of men to women was 1:3.7. The average age of women was 70 years; that of men was 69.5 years. Most tumors (67.7%) had grown by diffuse infiltration and one-third (32.3%) were polypous-exophytic. Fundus and collum of the gallbladder showed an equal frequency (24%) of tumor localisation. The percentage of all gallbladder malignomas that were adenocarcinomas of various differentiation was 84.6, and 10.9% were anaplastic carcinomas, the rest consisted of squamous cell carcinomas (3.7%) and 0.8% sarcomas. Metastases were found in 265 cases (92.3%). Tumorous infiltration, lymph node metastases, and visceral metastases are discussed. A cholelithiasis was found in 78.4%. The results are compared with the literature.     

EST联合LC治疗胆囊结石合并胆总管结石

从1994年1月～1995年7月,作者对21例胆囊结石合并胆总管结石的病人先行ERCP检查。证实胆总管有结石,即行 EST,用 Dormia 网篮套取结石,于 EST 1周后再行 LC。获得满意效果。该方法损伤小,恢复快,可解除LC无法解决的炎性乳头狭窄,也可对LC后发生的继发性胆总管结石作妥善的补救处理,克服了单独使用LC和EST治疗胆石症的局限性。