【Abstract】Objective To analysis the clinical characteristics, pathogenesis, diagnosis and treatment of acute acalculous cholecystitis.Methods Seventy-nine cases of acute acalculous cholecystitis from January 1996 to January 2003 were retrospectively reviewed.Results Of those 79 cases, 13 cases were treated nonoperatively and 66 cases were treated operatively. Twentythree cases were suppurative, 43 cases were gangrenous with perforation in 18 cases，which were proved by postoperative pathology. Seventysix cases were cured and 3 cases were dead. Conclusion Keeping vigilant alert, observing dynamically as well as appropriate operative intervention are effective to improve the prognosis of acute acalculous cholecystitis.
目的:观察和探讨细胞角质素CK18慢性胆囊炎患者的胆囊组织和血清中的表达及其意义。方法:35例经腹腔镜胆囊切除的慢性结石性胆囊炎患者(27例女性患者,8例男性患者,年龄在55.65±13.48岁),将患者分为两个组,A组为患慢性非活动性结石性胆囊炎者(n=10),B组为患慢性活动性胆囊炎者(n=25),在细胞凋亡早期胱门蛋白酶分裂的CK18用M30细胞凋亡酶联免疫吸附测定,总细胞角蛋白18(从凋亡及坏死细胞中分离)用M65酶联免疫吸附测定。然后计算M30/M65结果:胱门蛋白酶分裂的CK18,特别是总CK18在胆汁中的表达远高于血清。在B组中,胱门蛋白酶分裂的CK18和总CK18的表达在胆囊组织和血清中表达差异相当大。在胆囊粘膜上皮细胞胱门蛋白酶分裂的CK18染色呈强阳性。结论:CK18在胆囊上皮细胞中表达。胱门蛋白酶分裂的CK18和总CK18在胆囊组织中的表达远高于血清中的表达。胱门蛋白酶分裂的CK18和总CK18的表达水平在活动性胆囊炎和非活动性胆囊炎中的表达并无明显差异。
目的:探讨高龄胆囊炎的外科手术治疗。方法:回顾分析1999年1月至2008年10月100例高龄胆囊炎患者的临床资料。结果:手术治疗治愈99例,平均住院12天。结论:高龄胆囊炎患者合并症多,病情进展快,治疗难度大,风险高,要重视围手术期处理和手术时机、方法的选择,才能保证外科手术的成功。
目的 探讨减少和预防腹腔镜胆囊切除术(LC)并发症的措施。方法 对我院2004年1月至2008年12月期间1 050例LC患者的临床资料进行回顾性分析。结果 手术时间11～86 min，平均32 min; 术中出血2～106 ml，平均21 ml。18例(1.7%)患者中转开腹，其中7例为术中无法完成胆囊三角解剖，4例胆管损伤，2例Mirizzi综合征，1例胆肠内瘘和4例发生无法控制性出血。6例患者术后出现胆漏，其中胆囊床迷走胆管漏2例，肝外胆管漏4例; 8例患者术后继发胆总管结石，2例术后胆囊管残石; 51例术后诊断为胆囊切除术后综合征，其中胆总管下端狭窄24例，残余胆囊管过长（≥1 cm）或残余胆囊结石16例，11例无明显原因。术后1例患者因肺栓塞死亡，2例胆心综合征患者未改善转心内科继续治疗。结论 掌握好LC手术适应证、成熟的LC操作技巧、术中仔细处理胆囊三角和胆囊床、选择性安置腹腔引流管、适时中转开腹是减少术中、术后并发症发生的关键。
To study the expressions of CA19-9 and CA125 and their clinicopathologic significancesin gallbladder adenocarcinoma , pericancerous tissues and chronic cholecystitis. Methods EnVisionTM immunohistochemist ry was used for assaying the expressive levels of CA1929 and CA125 in the routinely paraffin2embedded sections of specimens f rom gallbladder adenocarcinoma ( n = 108) , pericancerous tissues ( n = 46) , and chronic cholecystitis ( n = 35) . Results The positive rates of CA19-9 and CA125 were significantly higher in gallbladder adenocarcinoma ( 49. 1 % , 51. 9 %) than those in pericancerous tissues ( 26. 1 % , 15. 2 %) and chronic cholecystitis(14. 3 % , 5. 7 %) , respectively ( Plt; 0. 01) . The positive rates of CA19-9 and CA125 were significantly lower in thecases of adenomatous canceration , maximal diameter lt; 2 cm , no-metastasis of lymph node and no-invasion of regional tissues than those in the ones of low-differentiated adenocarcinoma , maximal diameter ≥2 cm , metastasis oflymph node and invasion of regional tissues ( Plt; 0. 05 , Plt; 0. 01 ) . The consistence of CA19-9 and CA125 expressivelevels was found in gallbladder adenocarcinoma (χ2 = 44. 69 , Plt; 0. 01) . Conclusion The expressions of CA19-9 andCA125 may be important tumor markers to reflect the carcinogenesis , progression , biological behaviors and prognosis of gallbladder adenocarcinoma.
ObjectiveTo explore the clinical characteristic, operation time, and methods of elderly calculous cholecystitis. MethodsThe data of 386 cases of elderly calculous cholecystitis in our hospital from January 2008 to April 2014 were retrospectivly analyzed. ResultsIn 386 patients, 234 cases were chronic cholecystitis, 152 cases were acute calculous cholecystitis; there were preoperative complications in 174 cases (45.08%); 234 cases of chronic calculous cholecystitis patients underwent elective operation, 35 cases in 152 cases of acute phase underwent operation at 72 h, the remaining 117 cases underwent operation in within 2 weeks of onset. Laparoscopic cholecystectomy (LC) were in 283 cases, including transfer laparotomy operation in 8 cases; underwent conventional open cholecystectomy in 103 cases. Postoperative complications occurred in 49 cases, the complication rate was 12.69%, including incision infection, pulmonary infection, acute urinary retention, urinary tract infection, biliary fistula and so on. Three hundreds and eighty-four cases were cured, 2 cases died, for cholecystolithiasis complicated with severe acute cholangitis, died from multi organ failure in 3 days after operation. ConclusionsThe clinical characteristics of elderly calculous cholecystitis is unique. To strictly grasp the operation indication, selection of operation time, take individual operation method with the disease, and strengthen treatment of perioperative period are the key to improve the cure rate and the operation success rate of elderly cholecystitis.
Objective To summarize the clinical therapeutic efficacy of emergent laparoscopic cholecystectomy （LC） and emergent open cholecystectomy （OC）. Methods One hundred and thirty-three patients with acute cholecystitis from March 2011 to June 2012 in this hospital were randomly divided into emergent LC （ELC） group and emergent OC （EOC） group. The examination and treatment before and after operation were the same. The clinical data before and during operation， postoperative complications， and recovery conditions were observed and compared. Results There was no obvious difference of the clinical data before operation between the ELC group and EOC group （P＞0.05）. Also， there were no significant differences of the operation time， biliary duct injury rate， postoperative bleeding rate， and reoperation rate in two groups （P＞0.05）. The time of postoperative anal exsufflation， time of out-of-bed activity， and postoperative hospital stay in the ELC group were significantly shorter than those in the EOC group （P＜0.05）， the poor incision healing rate in the ELC group was significantly lower than that in the EOC group （P＜0.05）， and the intraoperative blood loss in the ELC group was significantly less than that in the EOC group （P＜0.05）. Conclusions ELC as compared with EOC， are less intraoperative blood loss， less postoperative complications， more rapid recovery， and do not increase operation time. In a hospital with skilled LC technique， ELC is safe and feasible， has obvious advantages of minimal invasion.
【摘要】 目的 总结腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）治疗结石嵌顿性急性胆囊炎的疗效。 方法 2001年8月-2009年11月，采用LC治疗187例结石嵌顿性急性胆囊炎。 结果 179例顺利完成 L C手术；8例术中改为开腹手术。其中3例术后发生胆瘘，均经乳胶管引流胆汁，7～14 d后拔管；其余患者均痊愈出院。 结论 LC治疗结石嵌顿性急性胆囊炎安全可行，但应遵循个体化原则，熟练镜下操作技巧及正确处理方法是获得满意疗效关键。
Objective To investigate the diagnostic value of CT scanning and MR imaging on acute cholecystitis. Methods The CT or MR imaging data of 21 patients with proved acute cholecystitis were retrospectively reviewed. Eleven patients were examined with contrast-enhanced multi-detector-row spiral CT scanning and other 10 cases underwent contrast-enhanced MR imaging. Results Nineteen patients showed obscure gallbladder outlines （90.5%）. The gallbladder wall demonstrated even thickening in 15 patients （71.4%） and irregular thickening in 6 cases （28.6%）. All patients showed inhomogeneous enhancement of the gallbladder wall （100%）. The bile was hyper-dense or hyper-intense on T1W image in 11 cases （52.4%）. Ten cases had free peri-cholecystic effusion （47.6%）, and 16 cases had peri-cholecystic adhesive changes or fat swelling （76.2%）. Patchy or linear-like transient enhancement of the adjacent hepatic bed in the arterial phase was seen in 16 cases （76.2%）. Twelve patients developed pleural effusion, or ascites, or both （57.1%）. Gallbladder perforation complicated with peritonitis was seen in one case, micro-abscess formation and pneumocholecystitis was observed in another case, and one case had gallbladder diverticulum. Conclusion Wall blurring, pericholecystic adhesion or fat edema, and transient enhancement of adjacent hepatic bed in the arterial phase are the imaging findings specifically associated with acute cholecystitis, which are readily appreciated on contrast-enhanced multi-phasic CT and MR scanning.