Sample records for cholecystolithiasis

  1. Ultrasonography versus roentgenography in suspected cases of cholecystolithiasis.

    Lal, A; Dahiya, R S; Dadoo, R C; Kumar, A


    The present study was carried out to evaluate the relative merits of ultrasonography and roentgenography in 50 cases of suspected cholecystolithiasis. The accuracy rate with roentgenography (plain X-ray abd, OCG and IVC) in the diagnosis of cholecystolithiasis was 92.5% where as it was 95% with ultrasonography. Oral cholecystography should be done in patients with normal ultrasound examination if the symptoms are strongly suggestive of cholecystolithiasis. PMID:1639451

  2. Gallstone ileus-a rare complication of cholecystolithiasis: a case report

    Gallstone ileus is a rare, serious and usually specific to elderly age complication of cholecystolithiasis associated with very high mortality. It occurs when a concrement from the gallbladder becomes incarcerated in the lumen of the digestive tract. In this report, a case of gallstone ileus is presented, where a concrement moved through a cholecystoduodenal fistula to the lumen of the small intestine. A 80-year-old woman who suffered from cholecystolithiasis and diabetes mellitus was admitted to hospital with abdominal pain, flatulence and loss of appetite which lasted a few days. In ultrasonography of the abdomen, a gallbladder hydrops was found and the patient was qualified to cholecystectomy. The night before the planned surgery, the patient reported her abdominal complaints to more intense, and vomiting occurred. Abdominal ultrasonography was repeated, revealing wide intestinal loops with the gallbladder poorly visible; the examiner also noticed a hyperechogenic shadow in the stomach and in conclusions suggested the possibility of perforation. In CT imaging, one concrement in the jejunum and several ones in the colon were found to confirm the diagnosis. During the surgery, perforations of the gallbladder and pylorus were found and a gallstone wedged in the lumen of the jejunum blocking the Passage. Cholecystolithiasis, as a disorder common in our population, should be considered in differential diagnosis of intestinal obstruction. Gallstone ileus as a rare but highly dangerous complication of cholecystolithiasis is more often seen in elderly patients with rich medical past. None of radiological methods used separately is able to give a full diagnosis- only their combination leads to an accurate diagnosis. That is why only rapid and well selected path of imaging diagnostics (ultrasonography, plain abdominal radiogram, CT imaging), good anamnesis and cooperation with a clinician is the way to obtain a therapeutic success. (author)

  3. 十二指肠镜腹腔镜序贯治疗肝外胆系结石71例疗效观察%Combined use of duodenoscopy and laparoscopy for treatment of cholecystolithiasis with choledocholithiasis

    尹卫民; 孙喜太; 周建新


    目的 探讨胆囊结石合并胆总管结石的微创治疗方法.方法 总结2005年1月-2009年12月采用十二指肠镜乳头括约肌切开(EST)取石,再行腹腔镜胆囊切除(LC)治疗胆囊结石合并胆总管结石71例的治疗经验.结果 71例中70例获得了成功,无残留结石和严重并发症发生.结论 十二指肠镜腹腔镜联合治疗胆囊结石合并胆总管结石,具有手术创伤小、恢复快、并发症少等优点,是一种安全有效的微创治疗方法.%Objective To study the minimal invasion way for treatment of cholecystolithiasis with choledocholithiasis.Methods From Jan. 2005 to Dec. 2009, 71 patients were adopted to analyze the clinical data that admitted and received the therapeutical procedures, endoscopic sphincterotomy ( EST ) to extract common bile duct stones, and then, laparoscopic cholecystectomy( LC ) were performed. Results Of the 71 patients, 70 cases were successfully treated with EST and LC. Neither residual stones nor serious complications were observed. Conclusion EST combined with LC sequential treatment of cholecystolithiasis with choledocholithiasis is a safe and effective method with the advantage of minimal invasion, rapid recovery and less complication.

  4. 腹腔镜手术治疗胆囊结石合并胆总管结石的临床观察%Clinical Analysis of Laparoscopic Operation for the Treatment of Cholecystolithiasis and Choledocholithiasis



    目的探讨腹腔镜手术治疗胆囊结石合并胆管结石临床疗效及应用价值。方法选择我院治疗的胆囊结石合并胆管结石患者76例作为研究对象,采取随机数字表法分为观察组和对照组,每组各38例,对照组给予开腹手术,观察组采用腹腔镜手术,观察两组治疗情况。结果观察组患者切口短于对照组,并发症发生率低于对照组,围手术期胃肠功能恢复指标均好于对照组,经统计学分析比较,差异具有统计学意义(<0.05)。结论采用腹腔镜手术治疗胆囊结石合并胆管结石疗效可靠,值得在临床上大力推广使用。%Objective To investigate the combined laparoscopic surgery gal bladder bile duct stones clinical ef icacy and value. Methods Patients with gal bladder stones with bile duct stones treated 76 cases in our hospital as the research object,taken randomly divided into observation group and control group,38 cases in each group,the control group received open surgery, laparoscopic observation group surgery,were observed therapy.Results The observation group patients incision was shorter than the control group, the incidence of complications was lower than that of control group, the peri operation period of gastrointestinal function recovery index were bet er than the control group, the statistical analysis and comparison, with statistical y significant dif erence ( <0.05). Conclusion The curative ef ect of laparoscopic operation in treatment of cholecystolithiasis with calculus of bile duct and reliable, and is worthy of popularizing in clinical use.

  5. Heterotopic pancreas in gall bladder associated with chronic cholecystolithiasis

    Elhence, Poonam; Bansal, Rani; Agrawal, Nivesh


    Heterotopic pancreatic tissue in the gallbladder is a very uncommon lesion, which is an incidental finding in most cases. We report here, a case of an 18-year-old, post puerperal female, suffering from right upper quadrant abdominal pain with a clinical diagnosis of chronic cholecystitis, in whom heterotopic pancreatic tissue was found in the gall bladder.

  6. Data Mining Rules for Ultrasonic B-Type Detection and Diagnosis for Cholecystolithiasis

    LOUWei; YANLi-min; HEGuo-sen


    This paper presents realistic data mining based on the data of B-type ultrasonic detection and diagnosis for cholrcystolithiasis (gallbladder stone in biliary tract) recorded by a district central hospital in Shanghai during the past several years. Computer simulation and modeling is described.

  7. Acute biliary pancreatitis and cholecystolithiasis in a child:one time treatment with laparoendoscopic "Rendez-vous" procedure

    Gaetano La Greca; Michele Di Blasi; Francesco Barbagallo; Manuela Di Stefano; Saverio Latteri; Domenico Russello


    Acute biliary pancreatitis (ABP) is rare in childhood and endoscopic sphincterotomy should be avoided in the child due to the risk of both early and late complications but, when necessary, the optimal timing between endoscopic procedure and cholecystectomy is still uncertain.A nine years old child with acute biliary pancreatitis underwent successfull laparo-endoscopic "Rendez-Vous" procedure in which endoscopic drainage of the common bile duct and laparoscopic cholecystectomy were performed simultaneously. This is the first case reported of laparo-endoscopic Rendez-Vous in a child. The excellent outcome of this patient and the review of the literature concerning other available options for the treatment of such cases suggest that this procedure offers great advantages, especially in children, of reducing the required number of treatments, the risk of ineffectiveness, the number of anaesthesia, the length of hospital stay and the risk of iatrogenic morbidity.

  8. 肝硬化门静脉高压合并胆囊结石的相关因素分析%The related factors of cirrhosis portal hypertension with cholecystolithiasis



    OBJECTIVE To understand conditions of ventilator-associated Pneumonia (VAP) in ICU and to better control occurrence of VAP. METHODS The incidence and infection control were investigated in retrospective way in the patients who accepted ventilation from January 2009 to April 2010. RESULTS There were 183 investigated patients and 65 case-times of them were diagnosed hospital infection with the total infection rate of 35.52%. The incidence of VAP was no-correlated with sex (x2 = 0.656, P> 0.05); Mechanical ventilation time was longer, VAP happened easier. The patients who with severe pneumonia, cerebrovascular disease, severe head injury, had higher incidence of VAP. The pathogens of VAP were opportunistic pathogens such as Acinetobacter baumannii, Staphylocouus aureus, Burkholderia ccpacia, Pseudomonas aeruginosa. CONCLUSION Taking effective prevention and control measures is needed to reduce the incidence of VAP.%目的 探讨肝硬化门静脉高压合并胆囊结石的相关因素分析.方法 选自某院收入的肝硬化门静脉高压患者共153例,患者根据是否有肝硬化门静脉高压合并胆囊结石分为两组,A组为肝硬化门静脉高压未合并胆囊结石组(116例),B组为肝硬化门静脉高压合并胆囊结石组(37例).收集两组患者的性别、年龄、既往史、肝功能Child-Pugh评分等相关资料,数据进行统计学对比.结果 对照组中E2为(13.26±4.37) pg/ml,观察组中E2为18.75±5.24,两组对比差异有统计学意义,P≤0.05.对照组的Child-pugh分级中的A级30例、B级67例,观察组的Child-pugh分级中的A级9例,B级15例,两组对比差异无统计学意义.对照组的Child-pugh分级中的C级21例(18.1%),观察者为13例(35.1%),两组对比差异有统计学意义,P≤0.05.结论 肝功能Child-Pugh分级及雌激素水平(E2)为导致患者肝硬化门静脉高压合并胆囊结石的危险因素.

  9. Chronic cholecystitis

    ... foods may relieve symptoms in people. However, the benefit of a low-fat diet has not been proven. Alternative Names Cholecystitis - chronic Images Cholecystitis, CT scan Cholecystitis, cholangiogram Cholecystolithiasis Gallstones, cholangiogram Cholecystogram References Wang ...

  10. Decreased SCF/c-kit signaling pathway contributes to loss of interstitial cells of Cajal in gallstone disease

    Tan, Yu-Yan; Ji, Zhen-Ling; ZHAO, GANG; Jiang, Jia-Rui; Wang, Dong; Wang, Jing-Min


    Cholecystolithiasis is a common disease, and gallbladder dysmotility is considered as a pivotal pathogenesis. Interstitial cells of Cajal (ICCs) serve as pacemakers and mediators of neuromuscular transmission for gastrointestinal motility. Reduction of ICCs has been reported in gallstone diseases. However, there are no reasonable mechanisms for the cholecystolithiasis-associated loss of ICCs in humans. Stem cell factor (SCF) and its ligand c-kit are essential for normal development and surviv...

  11. Oral cholecystography compared to cholescintigraphy for evaluation of cystic duct patency prior to ESWL treatment

    In a prospective, blinded study of 109 patients with cholecystolithiasis, oral cholecystography and 99Tcm-EHIDA cholescintigraphy were compared in terms of reliability for demonstrating cystic duct patency: one of the prerequisites for extracorporal shock wave lithotripsy (ESWL) treatment of cholecystolithiasis. Patients with a positive result on one or both tests were regarded as having cystic duct patency. Patients with negative and uncertain result of both tests or one of each were regarded as having no cystic duct patency. Concordance between the two tests was obtained in 93 of 109 patients. The diagnostic reliability of cholescintigraphy and oral cholecystography were 95 and 86%, respectively (P < 0.05), suggesting a more precise determination of gallbladder filling with scintigraphy. (author)

  12. Oral cholecystography compared to cholescintigraphy for evaluation of cystic duct patency prior to ESWL treatment

    Monrad, H.; Groenvall, S.; Hoegaard, L. (Copenhagen Univ. (Denmark). Hvidovre Hospital)


    In a prospective, blinded study of 109 patients with cholecystolithiasis, oral cholecystography and [sup 99]Tc[sup m]-EHIDA cholescintigraphy were compared in terms of reliability for demonstrating cystic duct patency: one of the prerequisites for extracorporal shock wave lithotripsy (ESWL) treatment of cholecystolithiasis. Patients with a positive result on one or both tests were regarded as having cystic duct patency. Patients with negative and uncertain result of both tests or one of each were regarded as having no cystic duct patency. Concordance between the two tests was obtained in 93 of 109 patients. The diagnostic reliability of cholescintigraphy and oral cholecystography were 95 and 86%, respectively (P < 0.05), suggesting a more precise determination of gallbladder filling with scintigraphy. (author).

  13. Gallstones: a comparison of real-time ultrasonography and cholecystography with surgical correlation.

    Stokes, E W; Hallgren, S E; Duran, L


    Real-time ultrasonography is more accurate and technically more efficient than gray scale ultrasonography in establishing the diagnosis of cholecystolithiasis. In prospective studies accuracy may be as high as 96%, and reflects the use of specific sonographic diagnostic criteria. Retrospective studies, however, reveal a lower accuracy rate of 90%, suggesting that practicing radiologists are not ready to accept these restricting criteria. On the other hand, oral cholecystography (OCG) is well tolerated and gives a reproducible, reliable result independent of technical expertise. It is 96% accurate in detecting the presence of gallstones and carries a sensitivity of .97. Both studies are prone to overinterpretation, which skews specificity and adversely affects diagnostic accuracy. In this retrospective review of 234 consecutive cases of cholecystectomy, real-time ultrasound was 90% accurate with a sensitivity of .96 in determining the presence of cholecystolithiasis. Oral cholecystography was 95% accurate with a sensitivity of .97. PMID:3303363

  14. The importance of imaging methods in gallstone disease. Die Bedeutung bildgebender Verfahren beim Gallensteinleiden

    Kersjes, W. (Institut fuer Klinische Strahlenkunde, Klinikum der Johannes-Gutenberg-Universitaet Mainz (Germany)); Thelen, M.


    The available surgical and non-surgical therapy options for treatment of gallstone disease are presented. Conventional cholecystectomy is regarded as standard therapy of symptomatic cholecystolithiasis. Other modes of therapy may be indicated under certain circumstances, depending on the results of imaging procedures. In this context conventional X-ray examination, oral and intravenous cholecystography, sonography, computed tomography, endoscopic retrograde cholangiography/cholecystography, and magnetic resonance imaging are discussed, and their influence on therapeutic decisions is explained. (orig.)

  15. The importance of imaging methods in gallstone disease

    The available surgical and non-surgical therapy options for treatment of gallstone disease are presented. Conventional cholecystectomy is regarded as standard therapy of symptomatic cholecystolithiasis. Other modes of therapy may be indicated under certain circumstances, depending on the results of imaging procedures. In this context conventional X-ray examination, oral and intravenous cholecystography, sonography, computed tomography, endoscopic retrograde cholangiography/cholecystography, and magnetic resonance imaging are discussed, and their influence on therapeutic decisions is explained. (orig.)

  16. A randomized controlled trial to compare a restrictive strategy to usual care for the effectiveness of cholecystectomy in patients with symptomatic gallstones (SECURE trial protocol)

    de Reuver, P. R.; van Dijk, A. H.; Wennmacker, S. Z.; Lamberts, M. P.; Boerma, D.; Den Oudsten, B. L.; Dijkgraaf, M G W; Donkervoort, S. C.; Roukema, J.A.; Westert, G.P.; Drenth, J.P.H.; van Laarhoven, C. J. H.; Boermeester, M A


    Background Five to 22 % of the adult Western population has gallstones. Among them, 13 to 22 % become symptomatic during their lifetime. Cholecystectomy is the preferred treatment for symptomatic cholecystolithiasis. Remarkably, cholecystectomy provides symptom relief in only 60-70 % of patients. The objective of this trial is to compare the effectiveness of usual (operative) care with a restrictive strategy using a standardized work-up with stepwise selection for cholecystectomy in patients ...

  17. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy

    Donatsky, Anders Meller; Bjerrum, Flemming; Gögenür, Ismayil


    BACKGROUND: Laparoscopic cholecystectomy (LC) is the treatment of choice for symptomatic cholecystolithiasis. Despite the many advantages over open surgery, many patients complain about referred pain to the shoulder during the postoperative course. The purpose of this review was to evaluate...... different intraoperative surgical methods to minimize shoulder pain (SP). METHODS: A search of the literature was conducted using PubMed, Excerpta Medica Database (EMBASE), and Cochrane database of systematic reviews. Eligibility criteria were: randomized clinical trials or meta-analysis evaluating...

  18. Prevalence of cholelithiasis in patients with chronic inflammatory bowel disease

    Wolfgang Kratzer; Mark M Haenle; Richard A Mason; Christian von Tirpitz; Volker Kaechele


    AIM: To investigate the effect of chronic inflammatory bowel disease (CIBD) specific risk factors for cholecystolithiasis,as duration and involvement pattern of the disease and prior surgery in patients with Crohn's disease (CD) and ulcerative colitis (UC).METHODS: A total of 222 patients with CD (135 females,87 males; average age, 35.8±11.8 years; range 17-81 years)and 88 patients with UC (39 females, 49 males; average age, 37.2±13.6 years; range 16-81 years) underwent clinical and ultrasound examinations. Besides age, sex and degree of obesity, patients' CIBD specific parameters, including duration and extent of disease and prior operations were documented and evaluated statistically using logistic regression.RESULTS: The overall prevalence of gallbladder stone disease in patients with CD was 13% (n = 30). Only age could be shown to be an independent risk factor (P = 0.014).Compared to a collective representative for the general population in the same geographic region, the prevalence of cholecystolithiasis was higher in all corresponding age groups. Patients with UC showed an overall prevalence of gallbladder stone disease of only 4.6%.CONCLUSION:Only age but not disease-specific factors such as duration and extent of disease, and prior surgery are independent risk factors for the development of cholecystolithiasis in patients with CIBD.

  19. Cholelithiasis, cholecystectomy and risk of hepatocellular carcinoma: A meta-analysis

    Lingyun Guo


    Full Text Available Available evidence of the relationship between cholelithiasis, cholecystectomy, and risk of liver cancer and hence we conducted a meta-analysis to investigate the relationships. PubMed, EMBASE, and ISI Web of Knowledge were searched to identify all published cohort studies and case-control studies that evaluated the relationships of cholelithiasis, cholecystectomy and risk of liver cancer and single-cohort studies which evaluated the incidence of liver cancer among patients who understood cholecystectomy (up to February 2013. Comprehensive meta-analysis software was used for meta-analysis. A total of 11 observational studies (six cohort studies and five case-control studies were included in this meta-analysis. The result from meta-analysis showed that cholecystectomy (risk ratio [RR]: 1.59, 95% confidence interval [CI]: 1.01-2.51, I2 = 72% and cholecystolithiasis (RR: 5.40, 95% CI: 3.69-7.89, I2 = 93% was associated with more liver cancer, especially for intrahepatic cholangiocarcinoma (ICC (cholecystectomy: RR: 3.51, 95% CI: 1.84-6.71, I2 = 26%; cholecystolithiasis: RR: 11.06, 95% CI: 6.99-17.52, I2 = 0%. The pooled standardized incidence rates (SIR of liver cancer in patients who understood cholecystectomy showed cholecystectomy might increase the incidence of liver cancer (SIR: 1.57, 95% CI: 1.13-2.20, I2 = 15%. Based on the results of the meta-analysis, cholecystectomy and cholecystolithiasis seemed to be involved in the development of liver cancer, especially for ICC. However, most available studies were case-control studies and short-term cohort studies, so the future studies should more long-term cohort studies should be well-conducted to evaluate the long-term relationship.

  20. Endoscopic sphincterotomy for common bile duct stones during laparoscopic cholecystectomy is safe and effective

    Jakobsen, Henrik Loft; Vilmann, Peter; Rosenberg, Jacob


    Management strategy for common bile duct (CBD) stones is controversial with several treatment options if stones in the CBD are recognized intraoperatively. The aim of this study was to report our experience with same-session combined endoscopic-laparoscopic treatment of gallbladder and CBD stones....... We retrospectively evaluated 31 patients with cholecystolithiasis and CBD stones undergoing same-session combined endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and endoscopic stone extraction and laparoscopic cholecystectomy. Same-session ERCP and sphincterotomy were...... pancreatitis postoperatively and no other morbidity or mortality. In conclusion, same-session ERCP with stone extraction and laparoscopic cholecystectomy seems to be a safe and effective treatment strategy for CBD stones....

  1. [Complicated course of a laparoscopic cholecystectomy].

    Dralle, H; Neu, J; Köckerling, F; Klee, F; Büchler, M W


    The case presented deals with the complicated course of a laparoscopic cholecystectomy in a 45-year-old female patient due to cholecystolithiasis. The patient complained that during the operation an injury to the small intestine occurred, which was only operatively treated at midday of the despite massive pain and insufficient pain treatment. The intervention was claimed to have resulted in mental and physical suffering. The case is assessed by two independent experts in the sense of a "scientifically founded comment" with respect to the decision of the arbitration board and taking the surgical standards into consideration. PMID:26315012

  2. Cholesterolosis and chronic cholecystitis: comperative analysis of state of gall-bladder wall.

    Shcherbinina M.B.


    Full Text Available The mechanisms of lipid infiltration of gall-bladder (GB wall in case of cholesterolosis are not known now. The aim of this work was studying the morphologic peculiarities of forming cholesterolosis comparing with state of chronic cholecystitis by anatomical parts of GB using system stereometric analysis. There was performed the histological examination of 2 groups of GB removed by standart laparoscopic cholecystectomy due to cholecystolithiasis. The first group contains GB with diffuse reticular form of cholesterolosis (n=28, the second group contains GB with chronic inflammation without signs of activation (n=21. Using G.G.Avtandilov’s recommendations there were determined the volume interrelations of stroma and epithelium (stromal-epithelial index, cellular content of lamina propria of GB mucosa (neutrophyles, eosinophyles, lymphocytes, plasmocytes, xantom cells, lymphocytes-plasmocytes index. The results were evaluated by t-criterion of Student, changes were statistically evident if р<0,05. There was also used the correlative analysis with estimation of correlation coefficient t. There was established that in case of GB cholesterlolsis the morphologic changes in GB wall had dystrophic character and might accompany with not marked sclerotic changes in mucosa. In case of chronic cholecystitis the inflammatory process lead to atrophic-sclerotic changes. In case of cholecystolithiasis with diffuse reticular form of GB cholesterolosis or chronic cholecystitis the prevalent localization of pathology is corpus and fundus of organ.

  3. Cholelithiasis and the risk of intrahepatic cholangiocarcinoma: a Meta-analysis%胆道结石并发肝内胆管癌风险的Meta分析

    朱征海; 蔡浩; 顾盐炎; 赵万文; 胡伟东; 陈超波


    目的 明确肝外胆管结石及胆囊结石并发肝内胆管癌(Intrahepatic cholangiocarcinoma,ICC)风险,为胆道结石的临床治疗提供参考.方法 计算机检索PubMed、EmBase以及CBM等数据库,查找胆道结石以及胆囊结石并发ICC风险的队列研究或者病例对照研究.应用STATA软件对所获得研究数据行Meta分析,根据研究间异质性选择固定效应模型或者随机效应模型.采用Egger检验评估发表偏倚.结果 共有6篇病例对照研究纳入分析,包括123 713例患者,其中ICC 4 753例,无瘤对照118 960例.Meta分析结果显示,胆管结石为ICC发病的高危因素(OR:17.64,95% CI:11.14 ~27.95),除外肝内胆管结石,肝外胆管结石导致的ICC发病风险仍较高(OR:11.79,95% CI:4.17~ 33.35).此外,胆囊结石也是ICC发病危险因素(OR:2.07,95% CI:1.17 ~3.67).结论 肝外胆管结石与胆囊结石均为ICC发病的重要危险因素.%Objective To clarify the association of pre-existing choledocholithiasis or cholecystolithiasis and the development of intrahepatic cholangiocarcinoma(ICC).Methods A computerized literature search was performed in Pubmed,EmBase and CBM.Cohort and case control studies on the risk of choledocholithiasis or cholecystolithiasis developing ICC was included.Meta-analysis was performed using STATA version 12.0.Either a fix or random effect model was used according to heterogeneity among studies.Egger's test was performed to assess publication bias.Results A total of 6 case control studies fulfilled our inclusion criteria including 123,713 patients,4,753 for ICC and 118,960 for tumor free controls.Bile duct stone contributed to the development of ICC (OR:15.64,95% CI 9.33-26.23).Apart from hepatolithiasis,there was still a high risk of ICC development for choledocholithiasis (OR:11.05,95 % CI:4.02 ~ 30.37).Cholecystolithiasis is also a risk factor for ICC (OR:2.35,95 % CI:1.28 ~ 4.31).Conclusion Both choledocholithiasis and

  4. Robustness assessments are needed to reduce bias in meta-analyses that include zero-event randomized trials

    Keus, F; Wetterslev, J; Gluud, C;


    OBJECTIVES: Meta-analysis of randomized trials with binary data can use a variety of statistical methods. Zero-event trials may create analytic problems. We explored how different methods may impact inferences from meta-analyses containing zero-event trials. METHODS: Five levels of statistical...... methods are identified for meta-analysis with zero-event trials, leading to numerous data analyses. We used the binary outcomes from our Cochrane review of randomized trials of laparoscopic vs. small-incision cholecystectomy for patients with symptomatic cholecystolithiasis to illustrate the influence of...... confidence limits, the intervention-effect estimates, and heterogeneity for all outcomes. CONCLUSIONS: The statistical method may influence the inference drawn from a meta-analysis that includes zero-event trials. Robustness assessments are needed to reduce bias in meta-analyses that include zero...

  5. The usefulness and limitations of ultrasonography for the diagnosis of adenomyomatosis of the gallbladder.

    Cilingiroğlu, K; Dağoğlu, T; Demirkol, K; Günay, S


    Ultrasonography has been popular for the diagnosis of gallbladder diseases since the mid-1970s. Although this technique has replaced oral cholecystography (OCG) for the diagnosis of cholecystolithiasis, it has not gained popularity in the diagnosis of adenomyomatosis of the gallbladder (AMMG). We examined 141 patients with clinically suspected gallbladder disease. Ultrasonography (previously done by a radiologist) had produced no positive findings. On ultrasonographic re-evaluation by the same radiologist, but in the presence of a surgeon from our study group, 64 cases of AMMG were detected. OCG revealed the diagnosis of AMMG in 13 other cases. In the study group there were no false-positive results. However, the false-negative rate of sonography in diagnosing AMMG was 16.9%. Thus, in our opinion ultrasonography is a worthwhile technique in diagnosing AMMG done by a surgeon. PMID:2180093

  6. Pancreatic Heterotopia in the Gallbladder Associated with Chronic Cholecystitis: A Rare Combination

    Mubarak Al-Shraim


    Full Text Available Context Pancreatic heterotopia is a rare pathologic entity, previously reported in the stomach, duodenum and jejunum. It is mostly asymptomatic and rarely gives rise to complications. Localization of pancreatic heterotopia in the gallbladder is extremely rare and can be associated with cholecystitis or cholecystolithiasis. Case report We herein describe a case of a 39-year-old man who presented with biliary type pain with ultrasonographic evidence of a gallbladder polyp. Laparoscopic cholecystectomy was performed with uneventful recovery. Pathologic examination of the gallbladder detected a heterotopic focus of pancreatic tissue in its wall, associated with chronic cholecystitis with no gallstones. Conclusion Pancreatic heterotopia of the gallbladder is a very rare entity with unknown clinical significance. Awareness of this condition may facilitate its recognition which may shed more light on its clinical significance

  7. Laparoscopic cholelithotomy and polypectomy of gallbladder polyps for cholelithiasis and/or cholecystic polyps: An analysis of 53 cases%腹腔镜保胆取石术和息肉切除术临床分析53例

    徐新保; 张辉; 张洪义; 刘承利; 何晓军; 肖梅; 张宏义; 冯志强


    AIM: To discuss the indications, methods, and therapeutic effect of laparoscopic cholelithotomy and polypectomy in treating cholecystolithiasis and polyps.METHODS: The clinical data for 53 patients with cholelithiasis and cholecystic polyps who were treated by laparoscopic cholelithotomy and polypectomy between January 2009 and September 2011 were analyzed. Of the 53 patients, 39 suffered from only cholecystolithiasis (including 12 with a single stone and 27 with multiple stones), 8 suffered from cholecystic polyps (including 3 with adenomatous polyps and 5 with cholesterol polyps), and 6 simultaneously suffered from cholecystolithiasis and cholecystic polyps. Of 39 patients suffering from cholecystolithiasis, 2 had liver cirrhosis, 1 had primary hepatocellular carcinoma, and 3 had acute cholecystitis. Before the stones were removed, the bottom of the gallbladder was incised in 37 of 39 cases with cholelithiasis, and the neck of the gallbladder was incised in the remaining two patients. Of 8 patients with cholecystic polyps, 5 had cholesterol polyps and underwent polyp removal, and the other 3 had adenomas of the gallbladder and underwent partial cholecystectomy around the adenoma. In six patients with combined cholecystolithiasis and cholecystic polyps, the bottom of the gallbladder was excised to remove the stones and polyps. The incisions were sutured continuously with a 4/0 prolene suture in 10 cases, and interrupted or continuous suturing was performed with a 3/0 absorption suture in the other 43 cases. Both choledochoscopy and laparoscopy were used in 33 cases, and only laparoscopy was used in the other 20 patients during operation to see if the stones and polyps had been removed. Celiac drainage tube was placed under the right hepatic lobe in 19 cases during operation and was removed one to five days later. Thirty-three patients with cholecystolithiasis took choleretic drugs for one week to 4 weeks after operation, and the other 12 cases with

  8. Laparoscopy Aligned with Choledochoscope Treatment 10 Cases of Gallbladder Stone and Choledocholithiasis%腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石10例

    王怀明; 吴波; 折占飞


    ABSTRAC:Objective To summarize the clinical experience of laparoscopy combined with choledochoscopy via cystic duct or the common bile duct in treatment of cholecystolithiasis and choledocholithiasis.Methods A retrospective analysis of our hospital in 2013 June -2014 year in March 10 cases of hospitalized by laparoscopy combined with choledochoscopy via cystic duct or the common bile duct and clinical data of the treatment of gallstone patients with common bile duct stones.Results In 10 patients 8 patients successfully underwent laparoscopic cholecystectomy + via the cystic duct choledochoscopic lithectomy, 2 patients with cholecystitis in heavy, cystic duct inflammation fibrosis significantly, transcystic duct exploration failure, laparoscopic cholecystectomy + laparoscopic common bile duct incision, choledochofiberscopy, "T" tube drainage, all patients recovered well, without obvious complications.Conclusion Laparoscopy combined with choledochoscopy in treatment of cholecystolithiasis complicated with choledocholithiasis is safe, minimally invasive, short hospitalization time advantages, especially transcystic duct exploration has more advantages.%目的:总结腹腔镜联合胆道镜经胆囊管或胆总管治疗胆囊结石合并胆总管结石的临床经验。方法回顾分析我院2013年6月至2014年3月住院治疗的10例采用腹腔镜联合胆道镜经胆囊管或胆总管治疗胆囊结石合并胆总管结石病人的临床资料。结果10例病人中8例病人成功行腹腔镜胆囊切除术+经胆囊管胆道镜取石术,2例病人因胆囊炎症重,胆囊管炎症纤维化明显,经胆囊管取石失败,行腹腔镜胆囊切除术+腹腔镜下胆总管切开、胆道镜取石术、“T”管引流术,所有病人均恢复顺利,无明显并发症。结论腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石具有安全、微创、住院时间短的优点,尤其经胆囊管取石更具优势。

  9. Effects of +G_z exposure on gallbladder emptying function,cholecystokinin,and somatostatin in rabbits with high cholesterol diets

    Guo-feng XIAO


    Full Text Available Objective The present study explores the effects of +Gz exposure on the gallbladder emptying function,cholecystokinin(CCK,and somatostatin(SS in rabbits with high cholesterol diets and investigates its mechanism in the occurrence of cholecystolithiasis.Methods Twenty-four male New Zealand rabbits were randomly divided into the high cholesterol diet(control group,n=8 and high cholesterol diet plus +Gz exposure groups.The latter was divided into the four-and six-week +Gz exposure groups(n=8 based on the exposure time.Radioimmunoassay was used to determine the CCK and SS contents of the gallbladder at the end of the experiment in the fourth and sixth weeks and to calculate the gallbladder volume and maximum emptying ratio.A microcomputer biodynamic pressure monitor was used to record the hydrostatic pressure in the gallbladder to measure its capacity.Moreover,the bile properties and formation of concretion were observed with the naked eye,and polarized light microscopy was used to observe cholesterin crystallization on the gallbladder wall.Results The gallbladder capacity increased upon +Gz exposure for four and six weeks,indicating that the maximum emptying ratio(E% decreased,the empty and residual volumes improved,and the pressure increased(P < 0.05.After +Gz exposure for four and six weeks,the CCK contents in the experimental groups were evidently lower than that in the control group and gradually decreased(P < 0.05 as the +Gz exposure time increased.On the other hand,after +Gz exposure for four and six weeks,the SS contents in the experimental groups were higher than that in the control group and gradually improved(P < 0.05 as the +Gz exposure time increased.After +Gz exposure for four and six weeks,bile was turbid and sticky with cholesterol crystals and without visible concretion.Conclusions Therefore,+Gz exposure may cause abnormal gallbladder emptying functions,decrease CCK content,increase SS content,and thus cause bile stasis

  10. Are histological alterations observed in the gallbladder precancerous lesions?

    Adriana Lúcia Agnelli Meirelles-Costa


    Full Text Available INTRODUCTION: Gallbladder cancer, which is characterized by rapid progression and a poor prognosis, is a complex disease to treat. Unfortunately, little is known currently about its etiology or pathogenesis. A better understanding of its carcinogenesis and determining risk factors that lead to its development could help improve the available treatment options. METHOD: Based on this better understanding, the histological alterations (such as acute cholecystitis, adenomyomatosis, xanthogranulomatous cholecystitis, polyps, pyloric metaplasia, intestinal metaplasia, dysplasia, cancer and others in gallbladders from 1,689 patients who underwent laparoscopic cholecystectomy for cholecystolithiasis were analyzed. The association of these gallbladder histological alterations with clinical data was studied. RESULTS: Gender analysis revealed a greater incidence of inflammatory changes in males, while dysplasia and cancer were only found in women. The incidence of cholesterolosis was greater in the patients 60 years of age and under, and the incidence of adenomyomatosis and gangrene was greater in the elderly patients. A progressive increase in the average age was observed as alterations progressed through pyloric metaplasia, intestinal metaplasia, dysplasia and then cancer, suggesting that the metaplasia-dysplasia-carcinoma sequence may occur in gallbladder cancer. Gallbladder histological alterations were also observed in asymptomatic patients. CONCLUSION: The results of this study suggest that there could be an association between some histological alterations of gallbladder and cancer, and they also suggest that the metaplasia-dysplasia-carcinoma sequence could in fact be true in the case of gallbladder cancer. Nevertheless, further studies directed towards a perfect understanding of gallbladder carcinogenesis are required.

  11. Pregnancy is not a risk factor for gallstone disease: Results of a randomly selected population sample

    Thomas Walcher; Bernhard Otto Boehm; Wolfgang Kratzer; Mark Martin Haenle; Martina Kron; Birgit Hay; Richard Andrew Mason; Alexa Friederike Alice von Schmiesing; Armin Imhof; Wolfgang Koenig; Peter Kern


    AIM: To investigate the prevalence, risk factors, and selection of the study population for cholecystolithiasis in an urban population in Germany, in relation to our own findings and to the results in the international literature.METHODS: A total of 2 147 persons (1 111 females,age 42.8±12.7 years; 1 036 males, age 42.3±13.1 years)participating in an investigation on the prevalence of Echinococcus multilocularis were studied for risk factors and prevalence of gallbladder stone disease.Risk factors were assessed by means of a standardized interview and calculation of body mass index (BMI). A diagnostic ultrasound examination of the gallbladder was performed. Data were analyzed by multiple logistic regression, using the SAS statistical software package.RESULTS: Gallbladder stones were detected in 171study participants (8.0%, n = 2 147). Risk factors for the development of gallbladder stone disease included age, sex, BMI, and positive family history. In a separate analysis of female study participants, pregnancy (yes/no)and number of pregnancies did not exert any influence.CONCLUSION: Findings of the present study confirm that age, female sex, BMI, and positive family history are risk factors for the development of gallbladder stone disease. Pregnancy and the number of pregnancies,however, could not be shown to be risk factors. There seem to be no differences in the respective prevalence for gallbladder stone disease in urban and rural populations.

  12. Optimal diagnostic strategy for infantile cholestasis in pediatric surgery

    The initial goal in treatment for infantile cholestasis is to exclude surgical cholestasis, especially biliary atresia (BA). In this study, we retrospectively reviewed the diagnostic course of infantile cholestasis. Between 2000 and 2009, a total of 44 infants with cholestasis were referred to our department. The median age at admission was 54 days (range: 0-143 days). The medical charts of these infants were reviewed. The initial diagnostic approach was ultrasonography followed by the qualitative detection of bilirubin in stool. The 35 infants with acholic stool and/or a small or absent gallbladder on ultrasonography were subsequently examined by hepatobiliary scintigraphy (HBS). Twenty-nine infants with negative scintigraphy findings underwent intraoperative cholangiography (lOC), and BA was finally confirmed in 24 of 44. A choledochal cyst was noted in 2, Alagille syndrome in 2, cytomegalovirus infection in 2, panhypopituitarism in 2, multiple hemangiomas of the liver in 1, and cholecystolithiasis in 1. The remaining 10 infants were diagnosed as having neonatal hepatitis. The sensitivity and specificity of HBS for BA were 100% and 54.5%, respectively. HBS is a useful modality for detection of BA with a sensitivity of 100%. The indication for IOC should depend on these scan results. (author)

  13. Pyoderma gangrenosum in an abdominal surgical site: a case report.

    Ogata, Kenichi; Takamori, Hiroshi; Ikuta, Yoshiaki; Tanaka, Hideyuki; Ozaki, Nobuyuki; Hayashi, Hiromitsu; Ogawa, Katsuhiro; Doi, Koichi


    Pyoderma gangrenosum (PG) is an uncommon, ulcerative skin disease that is often associated with systemic diseases. Herein, we report a development of PG in a surgical site after cholecystectomy that was difficult to discriminate from surgical site infection. The patient was a 74-year-old man who had previously been diagnosed with myelodysplastic syndrome (MDS). Laparoscopic cholecystectomy was planned under diagnosis of cholecystolithiasis, but we converted to open cholecystectomy. The surgical wound was partially erythematous 4 days after surgery. In spite of opening the wound, cleansing it with sterile saline, and administration of antibiotics, inflammation spread with erosion. The clinical manifestations and histopathologic features of biopsy specimen indicated that diagnosis of PG associated with MDS was most likely. Administration of glucocorticoids made a rapid response of skin inflammation. The differential diagnosis of postoperative wound healing complications that were unresponsive to conventional wound local care and antibiotic therapy should include PG, especially in patients with systemic diseases such as MDS. PMID:26943446

  14. Prevalence of clonorchiasis in patients with gastrointestinal disease: A Korean nationwide multicenter survey

    Ho Gak Kim; Jimin Han; Myung-Hwan Kim; Kyu Hyun Cho; Sang Soo Lee; Im Hee Shin; Gwang Ha Kim; Jae Seon Kim; Jin Bong Kim; Tae Nyeun Kim; Tae Hyo Kim; Jae Woo Kim; Ji Kon Ryu; Yong Bum Yoon; Young-Soo Moon; Jong Ho Moon; Sung Jae Park; Chan Guk Park; Sung-Jo Bang; Chang Heon Yang; Kyo-Sang Yoo; Byung Moo Yoo; Kyu Taek Lee; Dong Ki Lee; Jae Bok Chung; Byung Seok Lee; Seung Ok Lee; Woo Jin Lee; Chang Min Cho; Young-Eun Joo; Gab Jin Cheon; Young Woo Choi


    AIM: To investigate prevalence of Clonorchis sinensis in patients with gastrointestinal symptoms, and the relation of the infection to hepatobiliary diseases in 26 hospitals in Korea. METHODS: Consecutive patients who had been admitted to the Division of Gastroenterology with gastrointestinal symptoms were enrolled from March to April 2005. Of those who had been diagnosed with clonorchiasis, epidemiology and correlation between infection and hepatobiliary diseases were surveyed by questionnaire. RESULTS: Of 3080 patients with gastrointestinal diseases, 396 (12.9%) had clonorchiasis and 1140 patients (37.2%) had a history of eating raw freshwater fish. Of those with a history of raw freshwater fish ingestion, 238 (20.9%) patients had clonorchiasis. Cholangiocarcinoma was more prevalent in C. sinensis-infected patients than noninfected patients [34/396 (8.6%) vs 145/2684 (5.4%),P = 0.015]. Cholangiocarcinoma and clonorchiasis showed statistically significant positive cross-relation ( P = 0.008). Choledocholithiasis, cholecystolithiasis,cholangitis, hepatocellular carcinoma, and biliary pancreatitis did not correlate with clonorchiasis.CONCLUSION: Infection rate of clonorchiasis was still high in patients with gastrointestinal diseases in Korea, and has not decreased very much during the last two decades. Cholangiocarcinoma was related to clonorchiasis, which suggested an etiological role for the parasite.

  15. Neuroendocrine brake for the treatment of morbid obesity. Preliminary report

    Aureo Ludovico de Paula


    Full Text Available Objectives: To demonstrate the preliminary results of a newtechnique named neuroendocrine brake, for surgical treatment ofmorbid obesity. Methods: In November 2003, three patientsunderwent the neuroendocrine brake operation performed by thelaparoscopic approach. The mean age was 46.4 years; all patientswere female. Mean BMI was 42.3 kg/m2. The patients selectedpresented some relative or absolute contraindications to the useof gastrointestinal bypass techniques, including gastric ulcer anda family history of gastric malignancy(1 and chronic anemia (2.All patients had associated diseases, including type II diabetesmellitus (2, hypertension (2, obstructive sleep apnea (1,dyslipidemia (3, cholecystolithiasis (1, gastric ulcer (1 andchronic anemia (2. The laparoscopic technique consisted of anileal interposition at the proximal jejunum and longitudinalgastrectomy. Results: There was no conversion to open surgery orpostoperative complications. Sixteen months later, the meanpercentage of initial body weight loss was 44.6% and the meanBMI was 24.3 kg/m2. Glucose, triglyceride and cholesterol levelswere normalized, and sleep apnea showed remission. Conclusion:In spite of the reduced number of patients and short term followup, the good results suggest that the neuroendocrine brake maybecome an option for surgical treatment of morbid obesity in thenear future.

  16. Patients' quality of life after laparoscopic or open cholecystectomy

    CHEN Li; TAO Si-feng; XU Yuan; FANG Fu; PENG Shu-you


    Objective: This study was aimed at evaluating and comparing the quality of life in patients who underwent laparoscopic and open cholecystectomy for chronic cholecystolithiasis. Methods: The study included 25 patients with laparoscopic cholecystectomy (LC group) and 26 with open cholecystectomy (OC group). The quality of life was measured with the Gastrointestinal Quality of Life Index (GLQI) preoperatively, thereafter regularly at 2, 5, 10 and 16 weeks after the operation. Results:The mean preoperative overall GLQI scores were 112.5 and 110.3 in LC and OC group respectively (P>0.05). In the LC group, the mean overall GLQI score reduced slightly to 110.0 two weeks after the operation (P>0.05). The LC group showed significant improvement in overall score and in the aspects of symptomatology, emotional and physiological status from 5 to 16 weeks postoperatively. In the OC group, the GLQI score reduced to 102.0 two weeks after surgery (P0.05). The patients experienced significant improvements of GLQI sixteen weeks after OC operation (P<0.01~0.05). Within the 10 postoperative weeks, the LC group had significantly higher GLQI scores than the OC group (P<0.05). Conclusions: LC can improve the quality of life postoperatively better and more rapidly than OC. The assessment of quality of life assessment is a valid method for measuring the effects of surgical treatment.

  17. Tumores de cólon - primeiro achado do adenocarcinoma de pâncreas: relato de caso Colon tumors - first find of the pancreatic adenocarcinoma: case report

    Sandra Pedroso de Moraes


    malnourished, with abdominal distention and diffuse abdominal pain on clinical examination. Laboratorial exams showed hyperglycemia, x-ray revealed intense abdominal distention, abdominal ultrasound revealed cholecystolithiasis and upper digestive endoscopy showed pangastritis. The computed tomography just confirmed the cholecystolithiasis. A colonoscopy was performed and revealed three tumors located in the rectum, transverse colon and ileocecal valve that were biopsed and just showed inflammatory cells. As the symptoms persist he underwent laparoscopic cholecystectomy that was converted to the open technique when it was observed white flat lesions in the diaphragm peritoneum, the biopsies revealed adenocarcinoma. In the fifth postoperatory day the patient developed obstructive symptoms and underwent right colectomy with double terminal colostomy and pancreas biopsy that showed adenocarcinoma with immunohistochemical profile proving the pancreas as the source. The patient died within one month. CONCLUSION: The normal findings in radiological exams do not dismiss a diagnostic hypothesis and when the source of a tumor is not well established the clinical patterns should be considered and the immunohistochemical profile is essential to confirm the diagnosis.

  18. Gallbladder small cell carcinoma: a case report and literature review.

    Adachi, Toshiyuki; Haraguchi, Masashi; Irie, Junji; Yoshimoto, Tomoko; Uehara, Ryohei; Ito, Shinichiro; Tokai, Hirotaka; Noda, Kazumasa; Tada, Nobuhiro; Hirabaru, Masataka; Inoue, Keiji; Minami, Shigeki; Eguchi, Susumu


    Gallbladder small cell carcinoma (SCC) comprises only 0.5 % of all gallbladder cancer and consists of aggressive tumors with poor survival outcomes against current treatments. These tumors are most common in elderly females, particularly those with cholecystolithiasis. We report the case of a 79-year-old woman with gallbladder small cell carcinoma. The patient had intermittent right upper quadrant abdominal pain and was admitted to our hospital due to suspected acute cholecystitis. She regularly received medical treatment for diabetes, hypertension, and dyslipidemia. On initial laboratory evaluation, the levels of aspartate aminotransferase (AST), total bilirubin, and C-reactive protein (CRP) were markedly elevated. She underwent computed tomography (CT) for screening. CT images showed a thick-walled gallbladder containing multiple stones and multiple 3-cm-sized round nodular lesions, which were suggestive of metastatic lymph nodes. After percutaneous transhepatic gallbladder drainage was performed, endoscopic ultrasound-guided fine needle aspiration of enlarged lymph nodes resulted in a diagnosis of small cell carcinoma or adenocarcinoma. However, we could not identify the primary lesion before the surgery because of no decisive factors. We performed cholecystectomy because there was a possibility of cholecystitis recurrence risk and also partial liver resection because we suspected tumor invasion. The final pathological diagnosis was neuroendocrine carcinoma of the gallbladder, small cell type. The tumor stage was IVb, T3aN1M1. The patient died 13 weeks after the surgery. In the present paper, we review the current available English-language literature of gallbladder SCC. PMID:27457076

  19. Serum leptin and soluble leptin receptor in non-alcoholic fatty liver disease

    Xiao-Dong Huang; Yan Fan; Hen Zhang; Ping Wang; Jing Ping Yuan; Ming-Jie Li; Xi-Yan Zhan


    AIM: To determine the role of leptin system in non-alcoholic fatty liver disease (NAFLD) development by delineating the changes in serum levels of leptin and soluble leptin receptor (sOB-R).METHODS: Blood samples were collected from 30 consecutive patients with liver-biopsy-proven NAFLD and 30 patients with cholecystolithiasis (stationary phase) as controls. Serum leptin levels were determined by radioimmunoassay and concentration of sOB-R was measured by ELISA. Body mass index (BMI) was calculated for all subjects, and serum insulin, C-peptide, and lipoprotein levels were also detected.RESULTS: Mean serum leptin level and BMI in the NAFLD group were significantly higher than in the controls (both P < 0.001), but mean sOB-R level was lower in the NAFLD group when compared to the controls. Both men and women in the NAFLD group had higher mean serum leptin levels and lower sOB-R levels than did the men and women in the control group (all P < 0.001). There was a significant negative correlation between serum leptin and sOB-R levels (r = -0.725, P < 0.001). Multivariate analysis showed that the percentage of hepatocyte steatosis, sex, BMI, and homeostasis model assessment of insulin resistance (HOMA IR) were independently related to serum leptin levels.CONCLUSION: Elevated serum leptin seems to be a feature of steatosis, and serum leptin seems to increase as hepatocyte steatosis develops. An enhanced release of ieptin is accompanied by an decrease in sOB-R concentration, which suggests higher resistance of peripheral tissues towards the action of leptin.

  20. Laparo-endoscopic "Rendezvous" to treat cholecysto-choledocolithiasis: Effective, safe and simplifies the endoscopist's work

    Gaetano La Greca; Francesco Barbagallo; Michele Di Blasi; Andrea Chisari; Rosario Lombardo; Rosario Bonaccorso; Saverio Latteri; Andrea Di Stefano; Domenico Russello


    AIM: To investigate our clinical experience with combined laparo-endoscopic Rendezvous (RV) for the treatment of patients affected by gallstones and common bile duct (CBD) stones and especially to study the never evaluated opinion of the endoscopist concerning the difficulty of the intraoperative endoscopic procedure during the RV in comparison with standard endoscopic retrograde cholangio-pancreatography (ERCP).METHODS: Eighty consecutive patients affected by cholecystolithiasis and diagnosed or suspected CBD stones were treated with a standardized "tailored"RV. The relevant technical features, the feasibility, the effectiveness in stone clearance, the safety but also the simple evaluation of difficulty and agreement of the endoscopist were analyzed with a questionnaire.RESULTS: The feasibility was 97.5% and the effectiveness 100% concerning CBD clearance and solution of coexisting problems at the papilla. Minor morbidity was 3.3%, the operating time was prolonged by a mean of 14 min, the mean hospital stay was 3.8 d and only one stone's recurrence occurred. The endoscopist evaluated the procedure to be simpler than standard ERCP-ES in 81.2% of the cases.CONCLUSION: Simultaneous RV carries high effectiveness and safety at least comparable to those reported for other options. The endoscopist is very often satisfied with this approach because of the minimization of some steps of the endoscopic procedure and avoidance of relevant iatrogenic risk factors. If the mandatory collaboration between surgeons and endoscopists is guaranteed, this approach can often be preferable for the patient, the surgeon, the endoscopist and the hospital.

  1. A comparative study of the systemic inflammatory response syndrome after the laparoscopic exploration of common bile duct versus open surgical procedure%腹腔镜与开腹胆道探查术后全身炎症反应综合征情况对比研究

    汪新天; 吴金术; 陈晨; 蒋波


    目的 探讨腹腔镜与开腹胆总管探查手术创伤与术后全身炎症反应综合征(SIRS)发生的关系.方法 收集腹腔镜胆总管探查术患者(腔镜组,n=32)和开腹胆总管探查术患者(开腹组,n=43)临床资料,分析不同手术方式与患者术后SIRS发生率的关系.结果 与开腹组相比,腔镜组患者术后SIRS发生率明显降低、SIRS持续时间缩短(P<0.05),术后住院时间缩短(P<0.01).两组患者手术时间、麻醉时间及失血量差异无显著性(P>0.05).结论 腹腔镜胆总管探查术患者术后SIRS发生率低,手术创伤小.%[Objective] To compare the influence of the laparoscopic exploration of common bile duct and open surgical procedure on the systemic inflammatory response syndrome. [Methods] 75 cases with cholecystolithiasis and choledocholithiasis were divided into laparoscopic group (32 cases) and open surgery group (43 cases). The clinical data of the two groups were compared and analyzed retrospectively. [ Results ] The incidence rate and persistence time of SIRS were lower on the laparoseopic group. The postoperative hospital stay was longer in the open group than that in the laparoscopic group. [Conclusion] The patient who performed LCBDE have lesser surgical trauma and lower incidence of SIRS.

  2. Laparoscopic cholecystectomy in children:with a report of 14 cases%小儿腹腔镜胆囊切除术14例报告

    邓天工; 孔繁华; 李卫清; 秦芳蕖


    目的:探讨小儿胆囊结石的诊断、围手术期处理特点、术式选择及术中注意事项.方法:回顾分析2003年11月至2011年7月为14例结石性胆囊炎患儿行腹腔镜手术的临床资料.结果:14例手术均获成功,手术时间平均24 min,平均住院6.7d,无手术并发症发生.结论:小儿结石性胆囊炎发病率较低,且有其自身的病理生理特点,围手术期应施行个体化处理措施.腹腔镜胆囊切除术患者创伤小、康复快,可作为治疗小儿结石性胆囊炎的首选术式.%Objective: To discuss the diagnosis, perioperation management characteristic, the rugery mode selection and intraop-erative announcement of the children cholecystolithiasis. Methods: A retrospectively analysis on the clinical data of 14 children with calculus cholecystitis who underwent LC from Nov. 2003 to Jul. 2011 was performed. Results: Forteen cases of surgery were performed successfully, the average surgery time,hospitalization was 24 min,6. 7 days respectively,no complications occurred. Conclusions:The incidence rate of children acalculous cholecystitis is low. The disease with pathology physiology characteristic should be treated by individual measures,LC can be the first choice to cure children acalculous cholcaytitis.

  3. Clinical evaluation of 3D-CT cholangiography for preoperative examination in laparoscopic cholecystectomy

    Kinami, Shinichi; Yao, Tadashi; Kurachi, Madoka; Ishizaki, Yoshio [Inami Public General Hospital, Toyama (Japan)


    Three-dimensional-computed tomography (3D-CT) cholangiography is a 3D shaded surface display image of the biliary tract obtained by using helical CT after intravenous cholangiography or cholangiography per percutaneous transhepatic cholangio-drainage tube. We investigated whether 3D-CT cholangiography could provide a useful image, for preoperative examination in laparoscopic cholecystectomy. Sixty-five patients with biliary diseases were examined by 3D-CT cholangiography. Helical scanning was performed on a Proceed Accell (GE Medical Systems, Waukesha, WI, USA). Three-dimensional images were created using an independent workstation. A clear image of the common bile duct was obtained for all patients (100%) by 3D-CT cholangiography. The gallbladder was well visualized in 54 (93%) and the cystic duct was shown to be opacified in 55 (95%) of the 58 patients with a gallbladder. Thirty-one patients were diagnosed as having gallstones by 3D-CT cholangiography (sensitivity, 72.1%; specificity, 100%; accuracy, 79.3%), while 43 were diagnosed as having cholecystolithiasis by ultrasonography. The advantages of 3D-CT cholangiography were a low level of invasiveness, easily obtained images compared to those obtained with endoscopic retrograde cholangiography (ERC), good opacification, and provision of a three-dimensional understanding of the biliary system, especially of the cystic duct. When combined with ultrasonography and routine liver function tests, 3D-CT cholangiography was considered very useful for obtaining information before laparoscopic cholecystectomy. It allowed the omission of ERC in many patients who were considered to have no common bile duct stone, by employment of 3D-CT cholangiography. (author)

  4. Clinical evaluation of further-developed MRCP sequences in comparison with standard MRCP sequences

    The purpose of this study was the comparison of technically improved single-shot magnetic resonance cholangiopancreatography (MRCP) sequences with standard single-shot rapid acquisition with relaxation enhancement (RARE) and half-Fourier acquired single-shot turbo spin-echo (HASTE) sequences in evaluating the normal and abnormal biliary duct system. The bile duct system of 45 patients was prospectively investigated on a 1.5-T MRI system. The investigation was performed with RARE and HASTE MR cholangiography sequences with standard and high spatial resolutions, and with a delayed-echo half-Fourier RARE (HASTE) sequence. Findings of the improved MRCP sequences were compared with the standard MRCP sequences. The level of confidence in assessing the diagnosis was divided into five groups. The Wilcoxon signed-rank test at a level of p<0.05 was applied. In 15 patients no pathology was found. The MRCP showed stenoses of the bile duct system in 10 patients and choledocholithiasis and cholecystolithiasis in 16 patients. In 12 patients a dilatation of the bile duct system was found. Comparison of the low- and high spatial resolution sequences and the short and long TE times of the half-Fourier RARE (HASTE) sequence revealed no statistically significant differences regarding accuracy of the examination. The diagnostic confidence level in assessing normal or pathological findings for the high-resolution RARE and half-Fourier RARE (HASTE) was significantly better than for the standard sequences. For the delayed-echo half-Fourier RARE (HASTE) sequence no statistically significant difference was seen. The high-resolution RARE and half-Fourier RARE (HASTE) sequences had a higher confidence level, but there was no significant difference in diagnosis in terms of detection and assessment of pathological changes in the biliary duct system compared with standard sequences. (orig.)

  5. 误诊为急性结石性胆囊炎31例病例分析%The analysis of misdiagnosed as acute calculos cholecystitis in 31 cases.



    Objective To analyze and explore the causes of misdiagnosed as acute calculos cholecystitis. Methods Thirty - one cases misdiagnosed as acute calculous cholecystitis in our hospital from July 2000 to May 2012 were retrospectively analyzed and summarized. Results Thirty - one patients with cholecystolithiasis were misdiagnosed as acute calculous cholecystitis, The final diagnosis of misdiagnosis cases: 6 cases of acute myocardial infarction , 5 cases of herpes zoster, 4 cases of carcinoma of gallbladder, 3 cases of high - position appendicitis, 2 cases of pancreatitis, 2 cases of pneumonia, 2 cases of colon tumor, 2 cases of upper digestive tract perforation, 2 cases of renal calculus, 1 case of dissection of aorta, 1 case of pleuritis, 1 case of ascariasis of biliary tract. Conclusion Dont detailed inquest the case history, examine the body carelessly, lack of relevant knowledge and experience, ignoring the other disease diagnosis while gallstones found were the main causes of misdiagnosis.%目的 分析、总结其他疾病误诊为急性结石性胆囊炎的原因,积累经验.方法 对2000年7月至2012 年5月收治的31例临床误诊为急性结石性胆囊炎病例进行回顾性分析、总结.结果 31例患者均因原有胆囊结石而误诊为急性结石性胆囊炎.误诊疾病的最终诊断为:急性心肌梗死6例(19.35%),带状疱疹5例(16.13%),胆囊癌4例(12.9%),高位阑尾炎3例(9.68%),胰腺炎2例(6.45%),肺炎2例(6.45%),结肠肿瘤2例(6.45%),上消化道穿孔2例(6.45%),右肾结石2例(6.45%),主动脉夹层1例(3.22%),胸膜炎1例(3.22%),胆道蛔虫1例(3.22%).结论询问病史不详细、查体不仔细、缺少对相关疾病鉴别诊断的知识和经验、发现胆囊结石而忽略其它疾病诊断是造成误诊的主要原因.

  6. A prospective evaluation of laparoscopic cholecystectomy in the treatment of chronic cholelithiasis: A five-year experience

    Stanišić Veselin


    Full Text Available Introduction. Laparoscopic cholecystectomy is a method of choice in the treatment of symptomatic cholecystolithiasis because of less postoperative pain, shorter hospitalization and lower cost of treatment. The study was aimed at analysing the outcome of laparoscopic cholecystectomy in patients surgically treated for chronic calculous cholecystitis (symptomatic cholelithiasis. Material and methods. The research was done in the period from December 2003 to December 2008. In the prospective study of 386 patients, we analyzed operative and postoperative complications, the reasons for conversion to open cholecystectomy, duration of hospitalization and mortality. Results. The average duration of laparoscopic cholecystectomy was 31.9±14.5 min: dissection of adhesions 3.2±0.7 min., elements of Calot´s triangle 9.8±3.2 min., gallbladder releasing from its bed 12.8±2.8 min., the abdominal cavity lavage and removal of gall­bladder from the abdomen 6.8±0.9 min. Some operative difficulties emerged in 22 (5.7% patients - 4 (1% during releasing of gallbladder adhesions from the surrounding structures, 9 (2.3% during dissection of elements of the Calot´s triangle, 6 (1.5% during gallbladder releasing from its bed, 3 (0.7% during gallbladder removal from the abdomen. Some post-operative complications, single or associated, occurred in 36 (9.3% patients: perforation of gallbladder 21 (5.4%, bleeding from gallbladder bed 18(4.6%/, injury of extra hepatic bile ducts 1 (0.2%, 9 (2.3% spillage of stones; 3 (0.7% conversions were made. The average duration of preoperative and postoperative hospitalization was 1.1±0.3 and 1.4±0.5 days, respectively. The pathohistological examination revealed 2 (0.5% adenocarcinoma of gallbladder. There were no lethal outcomes. Conclusion. Laparoscopic cholecystectomy is a safe procedure and rational choice in the treatment of biliary dyskinesia and symptomatic biliary calculosis with an acceptable rate of conversion.

  7. Preliminary evaluation of pericholecystic adhesions before cholecystectomy by ultrasonography%腹腔镜胆囊切除术前超声评估胆囊周围粘连的初步研究

    钟洁愉; 宫琳; 张蒂荣; 胡正明


    目的 探讨腹腔镜胆囊切除术前超声预测胆囊周围粘连的可行性和应用价值.方法 选择188例因胆囊结石拟行腹腔镜胆囊切除术的患者,术前超声对可能与胆周粘连程度相关的因素进行评估;与术中情况比较,分析导致胆周粘连的各相关危险因素的优势比.结果 与胆周粘连程度相关的超声观察项目:胆周异常回声、囊壁异常声像、胆囊增大、胆囊缩小伴填充型结石、胆囊颈部结石嵌顿、胆囊折叠及胆囊壁厚.其中,胆周异常回声的优势比最高,与胆周严重粘连密切相关.以囊壁厚度≥5.0 mm作为评估胆周重度粘连的临界值,灵敏度和特异度分别为63%和92%.结论 超声可以较准确地预测胆周粘连的程度,对腹腔镜胆囊切除术有一定的临床指导意义.%Objective To explore the feasibility and diagnostic value of ultrasonography in predicting pericholecystic adhesions before cholecystectomy. Methods One hundred and eighty - eight patients with cholecystolithiasis were examined by ultrasonography before surgery, and the relevant parameters of pericholecystic adhesions were recorded. Compared with the condition in surgery, the risk factors were analyzed, and the diagnostic value was evaluated. Results The ultrasonic factors related to the degree of pericholecystic adhesions were pericholecystic abnormal echo, gallbladder wall abnormal imaging,enlarged gallbladder. contractible gallbladder with packing stones, incarcerated stone in gallbladder neck, folded gallbladder,thickened gallbladder wall. Among them, pericholecystic abnormal echo was the most important positive factor correlated to dense pericholecystic adhesions. Numerical value as equal or greater than 5.0 mm of gallbladder wall thickness was set as cutoff value to diagnose pericholecystic dense adhesions, the sensitivity and specificity were 63% and 92% , respectively. Conclusion Pericholecystic adhesions before laparoscopic cholecystectomy

  8. Paraneoplastic Scleroderma: Are There Any Clues?

    Jedlickova, Hana; Durčanská, Veronika; Vašků, Vladimír


    localized scleroderma was seen in 3 patients and generalized localized scleroderma in one case. All patients had a histological picture consistent with scleroderma, negative ANA and ENA antibodies (Table 1, Figure 1). A 66-year-old woman presented with a 10 months history of sclerodermatous plaques on her neck, trunk, and upper and lower extremities. The skin on her breasts and cheeks was diffusely indurated. Examination showed thrombocytopenia, elevated transaminases, Cancer antigen 19-9 (Ca 19-9), thyroid stimulating hormone (TSH), and anti-thyroid peroxidase antibodies, dysmotility of the lower part of esophagus, hepatosplenomegaly, cholecystolithiasis, and benign polyps of colon. She was given prednisone 40 mg/day but did not return for follow up. After 6 months she was diagnosed with cholangiogenic carcinoma with metastatic disease and died shortly afterwards. A 74-year-old woman had localized scleroderma on the trunk for three years. She was treated with procaine penicillin for positive borrelia Immunoglobulin M (IgM) antibodies. Her condition worsened suddenly with confluent scleroderma plaques on her trunk, extremities, and genital region, and vasoneurosis on her lower extremities; she was started on prednisone 35 mg/day. Examination revealed endometrial cancer. The patient underwent a hysterectomy, adnexectomy, and radiotherapy with curative effect. Scleroderma patches softened with residual hyperpigmentation, and prednisone was stopped two years later. A 80-year-old man had a month-long history of diffuse thickening and toughening of the skin on the forearms and lower legs and scleroderma patches on the thighs and shins. Examination revealed prostate adenocarcinoma, and therapy with antiandrogen bicalutamide and prednisone 15 mg/day was started. Two years after the diagnosis he continues with bicalutamide treatment, prednisone 5 mg q.a.d. and has residual toughening of the skin on his lower legs. A 62-year-old woman with seronegative rheumatoid arthritis presented

  9. 109例胆道结石超声与MRI诊断的对照研究%A comparative study of diagnosis of MRI and ultrasonography in 109 cases of biliary calculi

    邱俊; 裴仁明; 陶振超; 马小苏


    Objective To compare the diagnostic value of ultrasonography and magnetic resonance imaging (MRI)in showing bili-ary calculi.Methods Totally 109 cases of biliary calculi were examined with magnetic resonance imaging(MRI)and ultrasonography before surgery.Final diagnosis was confirmed by surgery.The sensitivity,specificity and accuracy of MRI and US were analyzed.Results Among the 109 patients with biliary calculi,24 patients had cholecystolithiasis,32 patients had common duct stones,7 patients had calculi US of in-trahepatic duct,and there existed two or more sites of stones in 46 patients.The sensitivity,specificity and accuracy of MRI and US in detec-ting cholecystolithiasis were 87.63%,99.17%,92.98%,and 94.01%,95.09%,94.73%,respectively;the sensitivity,specificity and accu-racy of MRI and US in detecting common duct stones were 92.67%,97.33%,94.52%,and 76.44%,77.86%,76.71%,respectively;the sensitivity,specificity and accuracy of US and MRI in detecting calculi US of intrahepatic duct were 73.42%,84.82%,85.71%,and 75.31%,75.91%,75.00%,respectively.Conclusion US,used as a primary screening tool,can improve the diagnostic rate of cholecystoli-thiasis,which must be combined with MRI.In the imaging sequence of MRI and MRCP,the observation combined with T2WI,FIESTA-coronal and MRCP-original image is superior.%目的:比较超声与磁共振成像(MRI)各成像序列对胆道结石的诊断价值。方法根据本院情况,抽取109例单纯胆道结石病例的术前超声与MRI资料。比较两种检查方法诊断胆道结石的准确率、灵敏度和特异度。结果109例胆道系统结石病例中,术中所见24例为胆囊结石,32例为胆总管结石,7例为肝内胆管结石,46例有两个部位以上的结石同时存在。MRI和超声诊断胆囊结石的灵敏度、特异度和准确率分别为87.63%、99.17%、92.98%,94.01%、95.09%和94.73%;MRI和超声诊断胆总管结石的灵敏度、特

  10. Prevalence of Helicobacter spp in chronic cholecystitis and correlation with changes on the histological pattern of the gallbladder Prevalência do Helicobacter spp na colecistite crônica calculosa e correlação com as alterações histológicas da vesícula biliar

    André de Moricz


    Full Text Available PURPOSE: Establish the prevalence of Helicobacter spp in chronic cholecystitis and its correlation with the gallbladder's histological findings. METHODS: 100 patients were operated for chronic cholecystitis with cholecystolithiasis. In pathological examination of the gallbladder, were evaluated the presence of metaplasia, dysplasia, lymphoid follicles, anaplasia and tumors that might be related to the presence of Helicobacter plus the presence of the bacilli Giemsa? by optical microscopy. From the DNA extracted from the gallbladder's bile, PCR was performed by using specific primers for the identification of Helicobacter spp with amplification of the 400bp segment of rRNA gene16S, with positive control DNA from Helicobacter pylori. All the cases negative for isolation of genetic material were excluded. The cases of PCRΘ and GiemsaΘ were used as negative control group. The histological findings were compared to the presence of bacilli and PCR data using a chi-square and Fisher's Exact test (CI = 95.0%, p OBJETIVO: Estabelecer a prevalência do Helicobacter spp nos doentes com colecistopatia crônica calculosa e correlacioná-la com as alterações histológicas da vesícula biliar. MÉTODOS: Foram operados 100 doentes portadores de colecistite crônica calculosa. No anátomo-patológico foram avaliadas a presença de, metaplasias, displasias, folículos linfóides, anaplasias e tumores que pudessem se relacionar à presença do helicobacter e a presença de bacilos Giemsa ? à microscopia. A partir do DNA extraído da bile foi realizada PCR utilizando-se primers específicos para identificação de Helicobacter spp com amplificação de segmento de 400bp do gene16S rRNA, com controle positivo de DNA de Helicobacter Pylori. Os casos negativos para isolamento de material genético na bile foram excluídos. Os casos de PCR e Giemsa negativos foram utilizados como grupo controle. Os achados histológicos foram comparados ao Giemsa e à PCR

  11. Compared haemodynamics effects of laryngeal mask airway and tracheal intubation in patients undergoing laparoscopic cholecystectomy%喉罩与气管插管在腹腔镜胆囊切除术中对血流动力学的影响

    赵占志; 吴慧; 胡松; 许大伟


    Objective To compare the haemodynamics effects of laryngeal mask airway (LMA) and tracheal intubation in patients undergoing laparoscopic cholecystectomy (LC).Methods Sixty patients with cholecystolithiasis were divided into two groups:Laryngeal mask airway group (group A) and tracheal intubation group (group B).Anesthesia induction was performed by intravenous injection with midazolam(0.1 mg/kg),sulfentanyl(0.2 μg/kg),propofol(2 mg/kg),atracurium(0.15 mg/kg).The parameter of ventilation to be as follow,tidal volume 6-8 ml/kg,respiratory frequency 12-14 times/min intermittent positive pressure ventilation (IPPV),CO2 pneumoperitoneum pressure < 12 mm Hg (1 mm Hg =0.133 kPa).SBP,DBP,HR and postoperative complications were recorded before anesthesia induction(T0),three minutes after LMA or endotracheal tube insertion(T1),after pneumoperitoneum (T2),three minutes before departed LMA or endotracheal tube(T3) and three minutes after departed LMA or endotracheal tube (T4).Results In induced phase,awakening hemodynamic changes of laryngeal mask group was tracheal intubation small group,the postoperative complications of laryngeal mask was tracheal intubation less group.Conclusions Compared with group B,group A offered better general anesthesia on LC for LMA insertion,conduced to degrade stress reaction,more stable haemodynamics effects,beneficial ventilation and.reduced dosage.The occurrence of postoperative sore throat is obviously lower in group A.%目的 比较喉罩(LMA)与气管插管用于全身麻醉腹腔镜胆囊切除术(LC)患者血流动力学的影响.方法 选择胆石症患者60例,随机分为喉罩组(A组)和气管插管组(B组).全身麻醉诱导咪唑0.1 mg/kg,舒芬太尼0.2 μg/kg,异丙酚2 mg/kg,阿曲库铵0.15 mg/kg,静脉给药.通气设置为潮气量6~8 ml/kg,频率12~14次/min,间歇正压通气(IPPV),C02气腹(压力<12 mm Hg,1 mm Hg=0.133 kPa).记录两组在诱导前(T0),插喉罩或气管导管后3 min(T1),气腹后(T2),

  12. 头孢曲松钠注射液致儿童假性结石2例%Two cases of pseudo-stone caused by ceftriaxone sodium injection in children

    张威; 赵海涛; 张晓琳


    Example 1: One 11-year-old male patient was hospitalized for Ewing's sarcoma of the distal femur. Then the tumor was cut away and followed by artificial joint replacement surgery. Ceftriaxone sodium injection 2 g once daily was administered to prevent surgical infection. After 12 days, the patient complained about continuous pain at the top right abdominal. The result of B ultrasonic examination indicated cholecystolithiasis. Ceftriaxone was discontinued immediately and the patient received symptomatic treatment and supportive care. The pain disappeared after 3 days. Example 2: One 16-year-old male patient was hospitalized for the right distal fibula bone cysts. Curettage and bone graft surgery was conducted. The patient received ceftriaxone 2 g once daily to prevent infection. At the sixth day of medication, the patient had persistent colic at lower abdominal, the result of B ultrasonic indicated the right kidney stones. Ceftriaxone was discontinued immediately and the patient received symptomatic treatment and supportive care. The symptoms did not relieve until patient had received fiberoptic ERCP. Clinical tips: after medication with ceftriaxone, the ultrasound showed gall bladder or kidney stones might be pseudo-stone. Whether the need of surgical intervention should be taken into account according to clinical conditions before a further step.%例1:患者,男,11岁,因股骨下端尤文肉瘤入院,行瘤段截除人工关节置换术,手术预防用头孢曲松钠注射液(2 g,qd).用药第12天,患者诉右上腹疼痛,疼痛呈持续性,B超检查发现胆囊结石,停用头孢曲松钠,对症支持治疗,3 d后,疼痛症状消失.例2:患者,男,16岁,因右腓骨远端瘤样骨囊肿入院,行病灶刮除植骨术,手术预防用头孢曲松钠注射液(2 g,qd).用药第6天,患者出现下腹持续性绞痛,B超诊断为右肾结石,对症支持治疗,症状未缓解,行纤维镜下取石后疼痛症状消失.提示临床:使用头孢曲松钠后,超声

  13. 糖尿病血糖控制对普外科手术的影响%The effect of recent blood glucose control level of diabetes on prognosis in the patients with general surgery

    林昱; 魏奕娜; 方懿珊


    Objective To investigate the effect of recent blood glucose control level of diabetes on prognosis in the patients with general surgery. Methods To analyze the clinical data of 126 diabetic patients with general surgery and the relatiouship among the average hospitalized length,medical cost and the complications of sugery due to glycosylated hemoglobin. Results Comparing with controls, diabetic patients HbA1c>7.5% had more days longer than those HbA1c<6.5 % at the time of average in-hospital duration, stitch removing, food-taking and using antibiotics after the operation,Diabetics HbA1c<6.5 % with cholecystolithiasis, thyroid adenoma had lower surgery cost than those HbA1c>7.5 %. Conclusion To intensify the control of blood glucose of the patients of limited or selective general surgery as to lower glycosylated hemoglobin<6.5 % is very important for improving prognosis, and decreasing the complications and medical cost of the operation.%目的 了解糖尿病血糖控制对普外科手术的影响.方法 分析126例糖尿病患者普外科手术前糖化血红蛋白(HbA1c)水平与平均住院时间、平均术后拆线时间、使用抗生素时间、手术后并发症以及住院费用等关系.结果 糖尿病患者术前HbA1c>7.5%组平均住院时间、平均术后拆线时间、抗生素使用时间及手术后并发症均明显高于正常对照组和术前HbA1c<6.5%组.糖尿病患者中HbA1c<6.5%组的胆囊结石、甲状腺腺瘤的手术费用明显低于HbA1c>7.5%组的同类手术患者.结论 对于择期及限期手术的糖尿病患者,应加强手术前一段时间的血糖控制,使HbA1c手术时能<6.5%,是保证手术效果和防止手术后并发症以及降低医疗费用的关键.

  14. Analysis on 32 cases of primary suture in laparoscopy combined with electronic choledochoscopy choledocholithotomy%腹腔镜联合电子胆道镜胆总管切开取石一期缝合32例分析

    张茂兴; 潘耀振; 孙科; 吴一杰


    Objective To investigate the feasibility and safety of primary suture in laparoscope combined with electronic choledochoscope choledocholithotomy for treating choledocholithiasis. Methods The clinical data of 32 patients with cholecys-tolithiasis or choledocholithiasis treated by laparoscope combined with electronic choledochoscope choledocholithotomy with pri-mary suture in our hospital from August 2010 to August 2014 were retrospectively analyzed. Results 32 cases were successfully perfromed laparoscopic choledocholithotomy plus electronic choledochoscope with common bile duct primary suture. The opera-tion time was 100-200 min(mean 130min) with the introperative bleeding loss of 15-50 mL(average 30m L). The postoperative fasting time was 1-3 d,the time of gastrointestinal function recovery was 1-2 d and all cases were discharged from the hospital on 6-12 d after operation. 1 case of bile leakage occurred,bile was less than 80mL/d, the bile leakage stopped after 4 d. All the 32 cases were followed up with the follow-up time of 6-9 months. Magnetic resonance cholangiopancreatography showed no residual calculi and biliary stricture. Conclusion With the development of science and technology ,especially the utilization of varieties of novalmedical apparatus/instrumentsand biological materials in clinical field ,Thethe security and feasibility of laparoscopic choledocholithotomy Laparoscopic common bile duct primary suture can increase the safety and feasibility and has the advantages of little trauma,rapid postoperative recovery and short hospitalization duration,which is worth wide application.%目的 探讨腹腔镜联合电子胆道镜胆总管切开取石一期缝合治疗胆总管结石可行性及安全性.方法回顾性分析该院2010年8月至2014年8月行腹腔镜联合电子胆道镜治疗胆囊结石、胆总管结石,一期胆总管缝合的32例患者的临床资料.结果 32例均顺利行腹腔镜胆囊切除加胆总管切开胆道镜探查取石,

  15. Relationship between occult pancreaticobiliary reflux and biliary diseases%隐匿性胰液反流与胆道疾病间的相关性

    杨慧慧; 李会兵; 刘爽; 刘贤英


    Objective To investigate the relationship between occult pancreaticobiliary reflux (OPR) and biliary diseases.Methods Forty-four patients with primary biliary diseases was enrolled,and serum amylase level was determined,and the bile in common bile duct (CBD) was collected to measure the amylase level,then the △ amylase was calculated,which equals bile amylase level minus serum amylase level.OPR was confirmed if bile amylase level was higher than serum amylase level,otherwise it would be defined as the control group.Results Among the 44 patients with primary biliary diseases,the incidence of OPR was 72.7% (n =32).The bile and serum amylase activity of patients with OPR were (1 513 ± 2 725),(44 ± 21)U/L;and they were (18 ± 14) and (38 ± 17) U/L in the control group.The bile amylase level in OPR group was significantly higher than that in the control group,and the difference was statistically significant (P < 0.05),while there was no significant difference in serum amylase activity between the two groups.The incidence of OPR in patients with CBD stones was 100%,and the bile amylase activity was (1 048 ± 1 317) IU/L,and the △ bile amylase activity was (996 ± 1 322) U/L;the incidence of OPR in patients with choledocholithiasis and cholecystolithiasis was 75%,and the bile amylase activity was (2 457 ± 3 312),the △ amylase activity was (2 412 ± 3 320)IU/L;and the corresponding values in patients with gallbladder stones were 80%,(95 ± 82),(57 ± 76)IU/L;and the corresponding values in patients with bile duct cancer were 50%,(73 ± 51),(40 ± 37)U/L.Conclusions The occurrence of OPR is closely related to CBD stones only,CBD stones and gallbladder stones,and it may be one of the main pathogenic factors of bile duct stones.%目的 探讨隐匿性胰液反流(OPR)与胆道疾病间的相关性.方法 收集44例原发性胆道疾病患者,取血检测血清淀粉酶活性,收集胆总管胆汁,测定胆汁淀粉酶活性,计算胆总管的△胆汁

  16. Comparative study between transumbilical single-port laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy%经脐单孔与传统腹腔镜胆囊切除术的比较研究

    张正东; 国维克


    Objective To study feasibility, security of transumbilical single-port laparoscopic cholecystectomy by traditional instrument and to summarize the initial experience. Methods The data of 60 patients with laparoscopic cholecystectomy in our department from May 2010 to August 2011 were analyzed retrospectively. 36 patients underwent TSPLC. 24 patients underwent LC. The diagnosis of chronic cholecystitis were made by ultrasound and CT. Surgical indications include: (1)Non-acute inflammation time cholecysti-tus or cholecystolithiasis. (2)Gallbladder polyp. (3)Non-acute inflammation time gallbladder benign disease. The BMI,associated disease, operating time, intraoperative blood loss, pain scores at 6h and 24h, shoulder and back pain rate, time taken for resumption of oral intake, postoperative hospital stay and wound complications were noted and retrospective analysis was conducted. Results All the operations were successfully completed. The mean operating time was longer in the TSPLC group than in the LC group( P 0. 05 ) . However patient satisfaction was higher in the TSPLC group than in the LC group ( P < 0. 05 ) . No setting at the abdominal cavity drainage tube, no surgical complications such as hemorrhage, cholerrhagia and Biliary duct damage. The average in hospital time is 3 days. Postoperatively from 1 to 3months following up adominal wall scar was not obvious in the TSPLC group. Conclusions Transumbilical single-port laparoscopic cholecystectomy by traditional instrument is technically safe and feasible. It appears to be cosmetically superior compared to standard LC. But it's more difficult to manipulate. Beginners need to go through a certain amount of practice can only master.%目的 探讨传统器械经脐入路单孔腹腔镜胆囊切除术(Transumbilical single-port laparoscopic cholecystectomy,TSPLC)的可行性、安全性并总结初步经验.方法 回顾性分析我院2010年5月~2011年8月行腹腔镜胆囊切除术(laparoscopic cholecystectomy