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Sample records for cholecystolithiasis

  1. Relationship between cholecystolithiasis and polypoid gallbladder

    Institute of Scientific and Technical Information of China (English)

    吴爱姣; 李英奇; 杜理安

    2003-01-01

    Objective: To study the relationship between cholecystolithiasis and polypoid gallbladder( PLG),260 patients with polypoid gallbladder were investigated. The patients were divided into 2 groups: group A (PLG combined with cholecystolithiasis) and group B( without cholecystolithiasis) . The clinical pathological characteristics were analyzed. The intestinal epithelium metaplasia and atypical hyperplasia of the gallbladder mucosa were observed under light microscope. Results: Intestinal epithelium metaplasia and atypical hyper-plasia of gallbladder mucosa were found in 47 of the 260 cases. The pathological lesions included 16 gallbladder carcinoma, 11 adenomatosis polyp, 5 myoadenoma, 7 cholesterol polyp, 4 inflammatory polyp and 4 adenomatosis hyperplasia, which occurred in 26 and 21 patients in group A and group B , i.e. 44.0% and 10.3% respectively. The difference between group A and group B was statistically significant (P < 0.01).Conclusion : Cholecystolithiasis and the succeeding inflammatory reaction is a risk-factor for the polypoid gallbladder to develop tumour.

  2. Relationship between cholecystolithiasis and polypoid gallbladder

    Institute of Scientific and Technical Information of China (English)

    吴爱姣; 李英奇; 杜理安

    2003-01-01

    Objective: To study the relationship between cholecystolithiasis and polypoid gallbladder(PLG), 260 patients with polypoid gallbladder were investigated. The patients were divided into 2 groups: group A (PLG combined with cholecystolithiasis) and group B(without cholecystolithiasis). The clinical pathological characteristics were analyzed. The intestinal epithelium metaplasia and atypical hyperplasia of the gallbladder mucosa were observed under light microscope. Results: Intestinal epithelium metaplasia and atypical hyperplasia of gallbladder mucosa were found in 47 of the 260 cases. The pathological lesions included 16 gallbladder carcinoma, 11 adenomatosis polyp, 5 myoadenoma, 7 cholesterol polyp, 4 inflammatory polyp and 4 adenomatosis hyperplasia, which occurred in 26 and 21 patients in group A and group B , i.e. 44.0% and 10.3% respectively. The difference between group A and group B was statistically significant (P<0.01). Conclusion: Cholecystolithiasis and the succeeding inflammatory reaction is a risk-factor for the polypoid gallbladder to develop tumour.

  3. [Biliary ileus--potential complication of cholecystolithiasis].

    Science.gov (United States)

    Okolicány, R; Prochotský, A; Skultéty, J; Sekác, J; Mifkovic, A

    2008-11-01

    Biliary ileus is a rare complication of cholecystolithiasis. The condition occurs predominantly in the elderly with incidence rates of 1-4%, according to the literature data. Most commonly, it develops as a complication of cholelithiasis which remained untreated or was managed conservatively, or as a complication of a gallbladder decubitus necrosis. The condition results in a cholecysto-duodenal fistula. In this case, the cholecystolithiasis is latent or is clinically manifested in a third of the patients. A total of 1560 cholecystectomies (1345 L-CHE and 215 conventional CHE) were performed in our clinic during a five-year period. Biliary ileus was an indication for operation only in two subjects, during the studied period. In the both cases, the diagnosis was established intraoperatively, although upon re-examination of the visualization modalities views (upright native abdominal views, CT scans) the authors concluded that the primary cause of the ileus could have already been identified, based on the above views.

  4. Endoscopic-Laparoscopic Cholecystolithotomy in Treatment of Cholecystolithiasis Compared With Traditional Laparoscopic Cholecystectomy

    OpenAIRE

    Zhang, Yang; Peng, Jian; Li, Xiaoli; Liao, Mingmei

    2016-01-01

    The study aimed to compare the application values of endoscopic-laparoscopic cholecystolithotomy (ELC) and laparoscopic cholecystectomy (LC) for patients with cholecystolithiasis. It did a retrospective analysis of 107 patients with cholecystolithiasis who underwent ELC and 144 patients with cholecystolithiasis who underwent LC. There is no significant difference in operating time and expenses when comparing ELC with LC (P>0.05). ELC showed significantly less blood loss during operation compa...

  5. Endoscopic-Laparoscopic Cholecystolithotomy in Treatment of Cholecystolithiasis Compared With Traditional Laparoscopic Cholecystectomy.

    Science.gov (United States)

    Zhang, Yang; Peng, Jian; Li, Xiaoli; Liao, Mingmei

    2016-10-01

    The study aimed to compare the application values of endoscopic-laparoscopic cholecystolithotomy (ELC) and laparoscopic cholecystectomy (LC) for patients with cholecystolithiasis. It did a retrospective analysis of 107 patients with cholecystolithiasis who underwent ELC and 144 patients with cholecystolithiasis who underwent LC. There is no significant difference in operating time and expenses when comparing ELC with LC (P>0.05). ELC showed significantly less blood loss during operation compared with LC (PLC (PLC. The contractile function of gallbladder was close to normal (Pthickness of gallbladder wall significantly decreased (PLC.

  6. [Biliary ileus--a rare complication of cholecystolithiasis].

    Science.gov (United States)

    Lakyová, L; Radonak, J; Vajó, J; Toncr, I; Kudlác, M

    2007-10-01

    The diagnosis of ileus caused by biliary stones occurs very rarely, with the range of 2 % worldwide. This complication of cholecystolithiasis caused by the stone fistulation into gastrointestinal tract and its subsequent obstruction occurs mostly in elderly and has a high mortality rate. During the course of ten years (1996-2006) in the 2nd surgical clinic FNLP in Kosice, 1640 cholecystectomies and 255 operations, due to the obstruction ileus, were performed. Biliary ileus was recorded in four cases. In two cases, the reason being an obstruction caused by a travelled stone into jejunum, one event was caused by a mechanic wedge of a stone in duodenum and in the last event rectosigma was obturated. The diagnostic is relatively difficult because of a nonspecific symptomatology and often negative anamnesis of previous problems with gallstones. According to literature, the most reliable diagnostic method is computer tomography (CT). In our case, abdominal ultrasonography was successful, which pointed out this diagnosis. Gastroscopy localized the place of obstruction, but not its cause and X-ray image showed aerobilia two times. By the use of magnetic resonance cholangiopancreatography (MRCP) the diagnosis was not positively confirmed. Only in one out of four cases, there was a suspicion of the diagnosis of the biliary ileus, which makes its detectability 25%. The aim of this retrospective analysis is the comparison of diagnostic method-options and their range of success in the diagnosis of acute abdomen in our clinic and the entries in the world literature.

  7. Anaesthesiological considerations in small-incision and laparoscopic cholecystectomy in symptomatic cholecystolithiasis : implications for pulmonary function. A randomized clinical trial

    NARCIS (Netherlands)

    Keus, F.; Ali, U. Ahmed; Noordergraaf, G. J.; Roukema, J. A.; Gooszen, H. G.; van Laarhoven, C. J. H. M.

    2007-01-01

    Background: Upper abdominal surgery, including laparoscopic cholecystectomy (LC), is associated with post-operative pulmonary dysfunction. LC has, by consensus, become the treatment of choice for symptomatic cholecystolithiasis. Small-incision cholecystectomy (SIC), a procedure that does not require

  8. Detection of nanobacteria in serum, bile and gallbladder mucosa of patients with cholecystolithiasis

    Institute of Scientific and Technical Information of China (English)

    WEN Yu; YANG Jing; E. Olavi Kajander; Neva Ciftcioglu; LI Yong-guo; YANG Zhu-lin; WANG Xue-jun; WEI Hong; LIU Wei; MIAO Xiong-ying; WANG Qun-wei; HUANG Sheng-fu

    2005-01-01

    @@ In 1990, nanobacterium was found and named by Kajander.1 With distinct mineralizing ability, nanobacteria are thought to play a role in extraskeletal calcifying diseases. It have been found in many human tissues, but whether they exist in the bile or gallbladder mucosa remains unclear. The present study was undertaken to investigate by ELISA, bacterial culturing, immunohistochemical staining and transmission electron microscopy (TEM), whether nanobacteria exist in serum, bile or gallbladder mucosa of healthy people and patients with cholecystolithiasis.

  9. Segmental Adenomyomatosis of Gallbladder: CT Assessment of the Patterns of Cholecystolithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Yeon Hwa; Yu, Jeong Sik; Chung, Jae Joon; Kim, Joo Hee; Cho, Eun Suk; Kim, Dae Jung; Ahn, Jhii Hyun; Kim, Ki Whang [Dept. of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2011-05-15

    To clarify the relationship between the pattern of cholecystolithiasis and the gross features of segmental adenomyomatosis of the gallbladder. Fifty-five consecutive patients with segmental adenomyomatosis with calcified gallbladder stones defined on CT were retrospectively analyzed in terms of (i) stone location (fundal vs. neck compartment) and (ii) size of the largest stone as a function of the extent of segmental mural thickening (type A, limited at the narrow segment; type B, partially extended in the fundal direction; type C, involving the entire fundal compartment). The extent of segmental mural thickening in patients with cholecystolithiasis was compared with a control group (n = 48) lacking stones. Stones were found more frequently in the fundal compartment in 48 patients compared to the neck compartment in 12 patients (p<0.001). The mean size of the largest stone in type C (5.4 {+-} 4.9 mm) was larger than in type A (2.3 {+-} 2.2 mm) (p=0.033). In patients with cholecystolithiasis, type C segmental thickening was predominant (69%) compared to the control group (42%) (p=0.012). In addition to a higher prevalence of stones, a wide extent of mural thickening combined with large stone size in the fundal compartment suggests the contribution of segmental adenomyomatosis to stone formation and chronic inflammation.

  10. Effect of laparoscopic cholecystectomy on inflammatory factors and immunoglobulin in elderly chronic cholecystitis complicated with cholecystolithiasis

    Institute of Scientific and Technical Information of China (English)

    Tian-Xue Wen; Hao Wang

    2016-01-01

    Objective:To investigate the effect of laparoscopic cholecystectomy on inflammatory factors and immunoglobulin in elderly chronic cholecystitis complicated with cholecystolithiasis. Methods: A total of 80 senile chronic cholecystitis complicated with cholecystolithiasis patients were randomly divided into observation group (n=40) and control group (n=40). The observation group was were treated with laparoscopic cholecystectomy while the control group was were treated with open cholecystectomy. Using nephelometry to detect the serum CRP, IgA, IgG and IgM levels, using enzyme-linked immunosorbent assay to detect the IL-6 level. The levels of inflammatory factors (CRP, IL-6) and immunoglobulin indexes (IgA, IgG and IgM) were compared before and after operation between the two groups.Results:Compared with before operation, the inflammatory factors (CRP, IL-6) had no significant difference in observation group, the inflammatory factors (CRP, IL-6) were increased significantly in control group, and there was significant difference on inflammatory factors (CRP, IL-6) in two groups after operation; compared with before operation, the levels of immunoglobulin indexes (IgA, IgG and IgM) had no significant difference in observation group, the levels of IgA, IgG and IgM were decreased significantly in control group, and the levels of IgA, IgG and IgM had significant difference after treatment between the two groups.Conclusion: Laparoscopic cholecystectomy had almost no effect on inflammatory factors and immune function in elderly chronic cholecystitis complicated with cholecystolithiasis.

  11. Open, small-incision, or laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis: An overview of Cochrane Hepato-Biliary Group reviews (Review)

    NARCIS (Netherlands)

    Keus, F.; Gooszen, H.G.; Laarhoven, C.J.H.M. van

    2010-01-01

    BACKGROUND: Patients with symptomatic cholecystolithiasis are treated by three different techniques of cholecystectomy: open, small-incision, or laparoscopic. There is no overview on Cochrane systematic reviews on these three interventions. OBJECTIVES: To summarise Cochrane reviews that assess the e

  12. Nonalcoholic fatty liver disease increases the risk of cholecystolithiasis%非酒精性脂肪性肝病增加胆囊结石患病风险

    Institute of Scientific and Technical Information of China (English)

    刘瑛; 张弛; 王敏; 熊璞; 陈晶; 王霞; 李华珠; 杨晓春; 周桂莲

    2011-01-01

    目的:探讨胆囊结石与非酒精性脂肪性肝病(Nonalcoholic fatty liver disease,NAFLD)的关系.方法:选择2006年4月7日-2010年1月9日湖南省人民医院体检个体共4 076例,排除过量饮酒、乙肝标志物阳性、严重感染及代谢综合征(Metabolic syndrome,MS)资料不全者,共2830例纳入研究,其中1 367例在1~3年后再次体检.记录肝脏B超结果.结果:①体检人群中,胆囊结石患者合并NAFLD患病率明显高于非胆囊结石患者(43.20%vs 33.76%,P<0.05),NAFLD患者合并胆囊结石患病率亦明显高于非NAFLD患者(11.03% vs 7.67%,P<0.05);②随访1~3年后,NAFLD组(n=430)的胆囊结石发病率高于非NFALD组(n=834)(3.72%vs 1.68%,P<0.05),NAFLD发生胆囊结石的OR值为2.264 (95%CI,1.094-4.683;P<0.05).结论:①胆囊结石与NAFLD易合并存在.②NAFLD可增加胆囊结石患病风险.%Objective:To investigate the relationship between nonalcoholic fatty liver disease(NAFLD) and cholecystolithiasis. Methods:Ultrasonography was used to diagnose NAFLD in 4 076 subjects attending routine health examination in the People's Hospital of Hunan Province from April 2006 to January 2010.Total 2 830 subjects were enrolled in this study excluding those with excessive drinking,hepatitis B markers,and severe infection,and whose data to diagnose metabolic syndrome were missing.There were 1367 patients who received the routine health examination again during 3 years.The result of ultrasonography was recorded. Results: ①In the subjects undergoing routine health examination in People's Hospital of Hunan Province,the prevalence of NAFLD in patients with cholecystolithiasis was significantly higher than that in those without cholecystolithiasis (43.20% vs 33.76%, P< 0.05).Similarly,the prevalence of cholecystolithiasis in patientswith NAFLD was also higher than that in those without NAFLD (11.03% vs.7.67%,P<0.05).②In a following up of 1 367 patients for 1 to 3 years,we found that

  13. Experience on Laparoscopic Cholecystectomy for Complicated Cholecystolithiasis: with A Report of 75 Cases%复杂性胆囊结石腹腔镜治疗体会

    Institute of Scientific and Technical Information of China (English)

    王崇高; 蔡永东; 胡昇庠; 赵新潮; 江秋生; 郑后珍; 刘福生

    2012-01-01

    injury in one case and messy anatomy between right hepatic duct and cystic duct in another case. One case was found cerebrovascular accident after operation. No complications such as postoperative hemorrhea, biliary fistula, peritoneal abscess and intestinal obstruction occurred. Conclusion Laparoscopic cholecystectomy is safe, feasible and effective in the treatment of the complicated cholecystolithiasis based on the managements of sufficient preoperative preparation, careful intraop-erative operating, timely conversion to laparotomy and conscientious postoperative managements.

  14. Comparison of stress reaction of laparoscopic and open operation in the treatment of elderly patients with cholecystolithiasis%老年胆囊结石患者腹腔镜与开放手术应激反应的比较

    Institute of Scientific and Technical Information of China (English)

    赵国华

    2015-01-01

    Objective:To explore the stress reaction of laparoscopic and open operation in the treatment of elderly patients with cholecystolithiasis.Methods:72 cases of elderly patients with cholecystolithiasis were selected.They were divided into the laparoscope group and open operation group.We compared serum CRP concentration,cortisol,IL-6 and IL-10 concentration of the two groups.Results:In the laparoscope group,serum IL-6 concentration was lower than the open operation group;IL-10 was significantly higher than that in the open operation group;the concentration of CRP and cortisol concentration at the first day after operation were obviously lower than the open operation group(P<0.05).Conclusion:Laparoscopic surgery in the treatment of elderly patients with cholecystolithiasis had many advantages,such as small trauma,less pain,faster recovery and so on.Compared with open surgery,the postoperative stress reaction of patients was light,and it can be used as the first choice for elderly patients with cholecystolithiasis.%目的:探讨腹腔镜和开放手术对老年胆囊结石患者应激反应的影响。方法:收治胆囊结石老年患者72例,分为开腹组和腹腔镜组,比较两组患者的血清CRP浓度、皮质醇浓度、IL-6和IL-10浓度。结果:腹腔镜组的血清IL-6浓度低于开腹组,IL-10明显高于开腹组,CRP 浓度和术后第1天的皮质醇浓度明显低于开腹组(P<0.05)。结论:腹腔镜手术治疗老年胆囊结石患者具有创伤小、痛苦小、恢复快等优点,患者的术后应激反应比开放手术轻,可以作为老年胆囊结石的首选手术方式。

  15. Effect contrastive study for treatment of cholecystolithiasis by minimally invasive cholecystolithotomy with gallbladder reservation combined tauroursodeoxycholic acid and laparoscopic cholecystectomy%微创保胆取石术联合牛磺熊去氧胆酸与腹腔镜胆囊切除术治疗胆囊结石的疗效对比

    Institute of Scientific and Technical Information of China (English)

    李泽伟

    2015-01-01

    目的:探讨微创保胆取石术联合牛磺熊去氧胆酸治疗胆囊结石的疗效,并与腹腔镜胆囊切除术疗效对比。方法选取2011年4月~2013年4月我院治疗的胆囊结石患者80例,随机分为研究组和对照组各40例,研究组采用微创保胆取石术联合牛磺熊去氧胆酸治疗。对照组给予常规腹腔镜胆囊切除手术治疗。观察两组患者手术时间、术中出血量、术后住院时间及饮食恢复时间;手术前与术后1年研究组患者症状、胆囊壁厚度、胆囊收缩功能及复发情况。结果研究组术中出血量明显少于对照组,术后饮食恢复时间明显缩短(P <0.05)。随访1年后,研究组症状发生率明显降低,胆囊壁厚度明显变薄,胆囊收缩功能明显改善(P <0.05);且胆囊结石复发率仅为5.0%。结论微创保胆取石术联合牛磺熊去氧胆酸治疗胆囊结石患者疗效优于腹腔镜胆囊切除术,术后能明显改善胆囊收缩功能,降低复发率。%Objective To investigate the curative effect of minimally invasive cholecystolithotomy with gallbladder reservation combined tauroursodeoxycholic acid in the treatment of cholecystolithiasis,and contrast with laparoscopic cholecystectomy. Methods 80 patients with cholecystolithiasis from 2011 April to 2013 April in our hospital were randomly divided into study group and control group with 40 cases in each group,the study group were treated with minimally invasive cholecystolithotomy with gallbladder reservation combined tauroursodeoxycholic acid treatment. The control group was given conventional laparoscopic cholecystectomy treatment.The operation time,intraoperative bleeding volume,postoperative hospitalization time and time to resume diet of patients in two groups and symptoms,gallbladder wall thickness,gallbladder contraction function and recurrence rate of patients in study group before operation and 1 year after operation were observed

  16. 腹腔镜胆囊切除术与开腹胆囊切除术疗效比较%Clinical effect of laparoscopic cholecystectomy and laparotomy surgical treatment with cholecystolithiasis

    Institute of Scientific and Technical Information of China (English)

    张全轴

    2015-01-01

    目的:比较腹腔镜胆囊切除术与开腹胆囊切除术的临床治疗效果。方法收治胆囊结石患者102例,其中采取四孔法腹腔镜胆囊切除术(腔镜组)50例,采取传统开腹胆囊切除术(对照组)52例,比较两组患者的手术时间、术中出血量、术后首次下床时间、术后通气时间、引流管拔除时间、术后住院时间以及术后并发症发生率。结果腔镜组手术时间平均(61.36±10.23) min,术中出血量(21.04±5.44)ml,术后通气时间(1.70±0.64) d,引流管拔除时间(2.26±0.44) d,术后平均住院时间(3.26± 0.44)d。对照组手术时间平均为(80.08±8.44) min,术中出血量为(76.12±7.43) ml,术后通气时间为(3.08±0.75)d,腔镜组上述指标均优于对照组,差异均有统计学意义(P<0.05)。结论在具备良好的腹腔镜手术技术的基础上行腹腔镜胆囊切除术是安全有效的,值得在基层医院推广。%Objective To compare the clinical effect of laparoscopic cholecystectomy and laparotomy surgical treatment with cholecystolithiasis.Methods A total of 102 patients diagnosed as gallbladder stone in our hospital were selected and randomly divided into experimental group and control group.50 cases in experimental group were treated with four-hole laparoscopic cholecystectomy, 52 cases in control group were received conventional open cholecystectomy.The clinical effect were observed and compared by the two groups.Results In the experimental group, the mean operative time (61.36 ±10.23) min, the bleeding amount (21.04 ±5.44) ml, postoperative ventilation time (1.70 ±0.64) d, drainage tube removal time (2.26 ±0.44) d, the mean postoperative hospital stay time (3.26 ±0.44) d, the results were better than the control group, the difference was statistically significant(P<0.05).Postoperative complications had no statistically significant

  17. 新疆地区维吾尔族、汉族和哈萨克族三个民族胆囊结石的流行病学分析%An epidemiological analysis of cholecystolithiasis for the three major nationality of Uygur, Han, Kazak in the Xinjiang Uygur Autonomous Region

    Institute of Scientific and Technical Information of China (English)

    刘江伟; 吕复君; 吕辉琴; 韩永华; 庞国栋; 蒋银花; 卢静

    2013-01-01

    ObjectiveTo investigate the prevalence and relative factors of cholecystolithiasis for the three major nationality of Uygur, Han, Kazak in the Xinjiang Uygur Autonomous Region.MethodsThe typical sampling after the stratified random sampling method was adopted to investigate the family member of Xinjiang Region. A unified questionnaire was applied and the appointment of abdominal ultrasonic was used to examine the liver and gallbladder. ResultsThe overall prevalence of cholecystolithiasis was 15.0% in sampling population of Xinjiang Region,with a higher rate in South Xinjiang and North Xinjiang (17.5% and 13.5%,χ2=4.47,P=0.03 ).The prevalence of Uygur, Han, Kazak and other nationality were 20.8%, 13.1%, 11.5%, 16.8%, respectively. The prevalence of Uygur was significantly higher than that of Han and Kazak(χ2=37.90,P=0.00;χ2=42.23,P=0.00). Multiple logistic regression analysis indicated that sex, age, nationality, history of diabetes mellitus, family history of gallbladder disease, birthplace, pickled vegetable, milk, mutton, drinking water, number of bearing, the younger age of give birth to the first child, the delayed age of menopause, irregular menstruation. However, the vegetable, fruits and spring water were independent protective factor.ConclusionsXinjiang is an region of the higher prevalence of cholecystolithiasis, which varied with different regions and nations. The prevalence of cholecystolithiasis in South Xinjiang was significantly higher than those in North Xinjiang. The prevalence of Uygur was prominently higher than that of Han and Kazak.The diet and living environment of Kazak may have some protective factors against the formation of cholecystolithiasis, which deserve to further investigate.%目的:了解新疆维吾尔自治区维吾尔族、汉族、哈萨克族3个主要民族胆囊结石的患病率及其相关因素。方法采用典型抽样然后再多阶段分层随机抽样的方法。应用统一制定的新疆地区胆囊疾病危险

  18. 两种微创方式治疗胆囊结石合并胆总管结石的临床疗效比较%Comparison of Clinical Effectiveness on Two Kinds of Minimally Invasive Treatment for Cholecystolithiasis with Choledocholithiasis

    Institute of Scientific and Technical Information of China (English)

    陈盛; 郑江华; 区应亮; 陈伟; 江寅; 简志祥; 王卫东

    2012-01-01

    目的 比较腹腔镜胆囊切除术(LC)+腹腔镜胆总管切开胆道镜探查取石术(LCBDE)和内镜逆行胰胆管造影/内镜下括约肌切开取石术(ERCP/EST)+ LC两种微创术式在治疗胆囊结石合并胆总管结石中的临床疗效.方法 回顾性分析2008年1月至2011年7月期间广东省人民医院肝胆胰外科收治的127例胆囊结石合并胆总管结石患者,比较2组的胆总管直径、结石清除率、住院时间、住院费用及并发症发生率.结果 127例患者中,85例采用LC+ LCBDE治疗,其中54例采用一期缝合胆总管,28例放置T管引流;42例患者采用ERCP/EST+ LC治疗.LC+LCBDE和ERCP/EST+ LC两种术式结石清除率[100% (82/82)比97.37% (37/38),P=0.317]及术后并发症发生率[4.71% (4/85)比4.76% (2/42),P=1.000]方面差异均无统计学意义;在住院时间[中位数(四分位数)]和住院费用[中位数(四分位数)]方面LC+LCBDE一期缝合胆总管组均明显少于ERCP/EST+ LC组[住院时间:11 (5)d比17 (9)d,P<0.001;住院费用:27 054(8 452)元比31 595(11 743)元,P=0.005].结论 LC+LCBDE和ERCP/EST+LC均是治疗胆囊结石合并胆总管结石的有效方法,但是LC+LCBDE尤其是LC+LCBDE一期缝合在住院时间和住院费用方面较ERCP/EST+LC有较明显的优势;并且LC+ LCBDE对于结石大小、数量没有限制,能够在保留乳头功能条件下,一次麻醉解决两个问题,因此我们认为对于合适病例可考虑LC+LCBDE为首选的治疗方法.%Objective To evaluate the clinical effectiveness of laparoscopic cholecystectomy and laparoscopic common bile duct exploration (LC+LCBDE) and endoscopic retrograde cholangiopancreatography/endoscopic sphinc-terectomy with LC (ERCP/EST + LC) in treatment for cholecystolithiasis with choledocholithiasis. Methods From January 2008 to July 2011, 127 patients suffered from cholecystolithiasis with choledocholithiasis underwent either LC + LCBDE (85 cases, LC + LCBDE group) or ERCP/EST + LC (42

  19. Contrastive study for treatment of cholecystolithiasis by minimally invasive cholecystolithotomy with gallbladder reservation combined tauroursodeoxycholic acid and laparoscopic cholecystectomy%微创保胆取石术联合牛磺熊去氧胆酸与腹腔镜胆囊切除术治疗胆囊结石的对比研究

    Institute of Scientific and Technical Information of China (English)

    张宏; 潘耀振; 张浩; 詹磊; 孙诚谊

    2014-01-01

    目的:探讨微创保胆取石术联合牛磺熊去氧胆酸与腹腔镜胆囊切除术治疗胆囊结石的疗效。方法统计贵阳医学院附属医院2011年5月至2012年5月收治的微创保胆取石治疗胆结石患者100例和腹腔镜胆囊切除治疗胆结石患者173例,保胆患者作为治疗组术后均口服牛磺熊去氧胆酸,胆囊切除患者作为对照组术后给予常规抗炎支持治疗,所有患者术后平均随访时间为1年,统计各组患者胆石症状改善情况和治疗组患者的胆囊壁厚、胆囊功能水平和结石复发率。结果治疗组患者手术前胆绞痛、腹胀、右上腹不适发生率分别为47.1%、21.8%、100%,胆囊壁厚为(3.42±0.49)mm,手术后1年胆绞痛、腹胀、右上腹不适发生率分别为2.3%、9.2%、2.3%,胆囊壁厚为(2.57±0.69)mm;胆囊结石患者组胆囊排空指数为43.11±20.82,保胆取石术后两年患者组胆囊排空指数为56.00±10.77,正常组胆囊排空指数为56.65±13.45,患者手术前后胆石症状、胆囊壁厚的差异均具有统计学意义(P<0.05),保胆取石术后两年患者组胆囊排空指数与正常组差异无统计学意义(P>0.05),而与胆囊结石组患者组差异有统计学意义(P<0.05);术后1年治疗组患者腹泻、腹胀、右上腹不适症状发生率分别为2.3%、9.2%、2.3%,对照组患者腹泻、腹胀、右上腹不适症状发生率分别为33.6%、25.5%、17.3%,两组之间胆石症状的差异均具有统计学意义(P<0.05),治疗组患者术后胆固醇结石复发率有降低趋势。结论保胆取石术后口服牛磺熊去氧胆酸对术后患者胆囊功能的恢复及预防胆囊胆固醇结石的复发有重要意义。%Objective To explore the therapeutic effects for treatment of cholecystolithiasis by minimally invasive cholecystolithotomy with gallbladder reservation combined tauroursodeoxycholic acid and laparoscopic

  20. Clinical observation of laparoscopic common bile duct exploration to treat cholecystolithiasis combined with choledocholithiasis%腹腔镜胆道探查术治疗胆囊结石合并胆总管结石的临床观察

    Institute of Scientific and Technical Information of China (English)

    王福荣; 邵文生; 黄小玲; 陈果; 李伟

    2013-01-01

    目的 探讨腹腔镜胆道探查术治疗胆囊结石合并胆总管结石的临床疗效.方法 将128例胆囊结石合并胆总管结石患者随机分为观察组和对照组各64例,两组患者均行全身麻醉,观察组患者接受腹腔镜胆道探查术治疗胆囊结石合并胆总管结石,对照组患者接受传统手术治疗胆囊结石合并胆总管结石,两组患者术后常规抗感染治疗.比较两组患者的手术情况、术后恢复情况、住院时间及费用、术后并发症情况以及术后残石率等情况.结果 与对照组比较,观察组患者切口显著缩小(P<0.01),手术时间、下床时间、术后通气时间、肠鸣音恢复时间、导尿管留置时间、术后住院时间及住院总时间显著缩短(均P<0.01),术中失血量显著减少(P<0.01),而住院总费用增加(P<0.01).观察组切口感染显著低于对照组(P<0.05),但是两组术后并发症整体比较差异无统计学意义(P>0.05).两组患者术后残留结石差异无统计学意义(P>0.05).结论 腹腔镜胆道探查术治疗胆囊结石合并胆总管结石创伤小,恢复快,安全可靠,疗效确切,值得临床推广应用.%Objective To explore the clinical effect of laparoscopic common bile duct exploration to treat cholecystolithiasis combined with choledocholithiasis.Methods A total of 128 patients with cholecystolithiasis combined with choledocholithiasis,who visited the General Surgery department of our hospital in January 2010~ December 2011,were divided randomly into Observation Group and Control Group.Cases in Observation Group received laparoscopic common bile duct exploration,and cases in Control Group received traditional operation.Cases in both groups received traditional anti-infection treatment after operation.The operation conditions,recovery of operation,hospital stays and expense,as well as complication after operation and residual bile duct stones were compared in both groups.Results he cut size was

  1. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis

    NARCIS (Netherlands)

    Keus, F.; de Jong, J. A. F.; Gooszen, H. G.; van Laarhoven, C. J. H. M.

    2006-01-01

    Background Cholecystectomy is one of the most frequently performed operations. Open cholecystectomy has been the gold standard for over 100 years. Laparoscopic cholecystectomy was introduced in the 1980s. Objectives To compare the beneficial and harmful effects of laparoscopic versus open cholecyste

  2. Surgical aspects of symptomatic cholecystolithiasis and acute cholecystitis

    NARCIS (Netherlands)

    Keus, F.; Broeders, I. A. M. J.; van Laarhoven, C. J. H. M.

    2006-01-01

    Indications for cholecystectomy are limited to clearly symptomatic gallstones. Relatively high failure rates of pain relief are probably caused by incorrect selection of patients for the operation. Contraindications for (laparoscopic) cholecystectomy are related to anaesthesiological considerations.

  3. Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis

    NARCIS (Netherlands)

    Keus, F.; de Jong, J. A. F.; Gooszen, H. G.; van Laarhoven, C. J. H. M.

    2006-01-01

    Background Cholecystectomy is one of the most frequently performed operations. Open cholecystectomy has been the gold standard for over 100 years. Small-incision cholecystectomy is a less frequently used alternative. Laparoscopic cholecystectomy was introduced in the 1980s. Objectives To compare the

  4. Randomized clinical trial of small-incision and laparoscopic cholecystectomy in patients with symptomatic cholecystolithiasis

    NARCIS (Netherlands)

    Keus, Frederik; Werner, Johanna E. M.; Gooszen, Hein G.; Oostvogel, Henk J. M.; van Laarhoven, Cornelis J. H. M.

    2008-01-01

    Objective: To evaluate the primary and clinical outcomes in laparoscopic and small-incision cholecystectomy. Design: Blinded randomized single-center trial emphasizing methodologic quality and generalizability. Setting: General teaching hospital in the Netherlands Patients: A total of 257 patients u

  5. Systematic review: open, small-incision or laparoscopic cholecystectomy for symptomatic cholecystolithiasis.

    NARCIS (Netherlands)

    Keus, F.; Gooszen, H.G.; Laarhoven, C.J.H.M. van

    2009-01-01

    BACKGROUND: Laparoscopic cholecystectomy has become the method of choice for gallbladder removal, although evidence of superiority over open and small-incision cholecystectomy is lacking. AIM: To compare the effects of open, small-incision and laparoscopic cholecystectomy techniques for patients wit

  6. Systematic review: open, small-incision or laparoscopic cholecystectomy for symptomatic cholecystolithiasis

    DEFF Research Database (Denmark)

    Keus, F; Gooszen, H G; Van Laarhoven, C J H M

    2009-01-01

    Laparoscopic cholecystectomy has become the method of choice for gallbladder removal, although evidence of superiority over open and small-incision cholecystectomy is lacking.......Laparoscopic cholecystectomy has become the method of choice for gallbladder removal, although evidence of superiority over open and small-incision cholecystectomy is lacking....

  7. Systematic review : open, small-incision or laparoscopic cholecystectomy for symptomatic cholecystolithiasis

    NARCIS (Netherlands)

    Keus, F.; Gooszen, H. G.; Van Laarhoven, C. J. H. M.

    2009-01-01

    Laparoscopic cholecystectomy has become the method of choice for gallbladder removal, although evidence of superiority over open and small-incision cholecystectomy is lacking. To compare the effects of open, small-incision and laparoscopic cholecystectomy techniques for patients with symptomatic cho

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

    Institute of Scientific and Technical Information of China (English)

    LOU Wei; YAN Li-min; HE Guo-sen

    2004-01-01

    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.

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

    Institute of Scientific and Technical Information of China (English)

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

    2006-01-01

    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.

  10. [Focused surgical bedside ultrasound: E-FAST (focused assessment with sonography in trauma) - abdominal aortic aneurysm - cholecystolithiasis - acute appendicitis].

    Science.gov (United States)

    Studer, Maria; Studer, Peter

    2014-06-04

    Ultrasound is an easy to learn and highly efficient diagnostic tool to complete the clinical examination and improve bedside decision-making. In the trauma room, surgeons are often required to make a quick decision as to whether or not a patient needs an emergency intervention or whether further diagnostics are required. For this reason, education of surgeons in performing focused emergency ultrasound is pivotal. The goal of ICAN is to improve and expand the education of surgeons in Switzerland. This article provides a short review of the most frequent surgical pathologies encountered in the emergency room.

  11. Randomized clinical trial of small-incision and laparoscopic cholecystectomy in patients with symptomatic cholecystolithiasis: primary and clinical outcomes.

    NARCIS (Netherlands)

    Keus, F.; Werner, J.E.; Gooszen, H.G.; Oostvogel, H.J.M.; Laarhoven, C.J.H.M. van

    2008-01-01

    OBJECTIVE: To evaluate the primary and clinical outcomes in laparoscopic and small-incision cholecystectomy. DESIGN: Blinded randomized single-center trial emphasizing methodologic quality and generalizability. SETTING: General teaching hospital in the Netherlands. PATIENTS: A total of 257 patients

  12. 中国人群胆囊疾患和结直肠癌关系的Meta分析%Meta-analysis on the correlation of cholecystectomy or cholecystolithiasis to risk of colorectal cancer in Chinese population

    Institute of Scientific and Technical Information of China (English)

    徐艺可; 张风兰; 冯涛; 李晋; 王云海

    2009-01-01

    背景与目的:有研究报道胆囊切除后更易发生结直肠癌,但关于胆囊疾患与结直肠癌的关系尚无定论.本研究对中国人群中胆囊疾患包括胆囊结石和胆囊切除与结直肠癌的关系的相关文献进行Meta分析,旨在了解中国人群中胆囊疾患与结直肠癌的关联性并定量计算关联性的大小.方法:基于观察性研究的Meta分析规范(MOOSE声明)进行研究及撰写.计算机检索有关数据库并辅以手工检索已有文献的参考文献.对纳入研究的文献采用Newcastle-Ottawa量表进行质量评价.提取文献原始数据,采用Revman 5.0统计软件对数据进行Meta分析,计算合并OR值和95%可信区间(95%CI).结果:最终纳入26篇文献,经Meta分析发现胆囊疾患、胆囊结石、胆囊切除术均与结直肠癌相关;比值比分别为3.00(2.30~3.91)、2.85(2.13~3.81)、2.68(1.93~3.72).对患者性别和发病部位的亚组进行分析,除了男性亚组分析中胆囊疾患与结直肠癌无明显关系以外,其余亚组分析显示二者关系仍然显栽著.结论:中国人群胆囊疾患可能与结直肠癌相关.

  13. 胆囊结石患者血清、胆汁与胆囊黏膜中纳米细菌的分布研究%Nanobacteria in serum,bile and gallbladder mucosa of cholecystolithiasis patients

    Institute of Scientific and Technical Information of China (English)

    文宇; 李永国; 杨竹林; 王学军; 魏红; 刘威; 谭爱玲; 苗雄鹰; 王群伟; 黄生福; E.OlaviKajander; NevaCiftcioglu

    2003-01-01

    目的探讨纳米细菌在正常人群血清及胆囊结石患者血清、胆汁和胆囊黏膜中的分布情况. 方法 (1)采用ELASA方法测定338例正常人群和76例胆囊结石患者血清中纳米细菌的感染情况;(2)对57例胆囊结石和18例非胆囊结石患者的胆囊胆汁进行纳米细菌培养,并采用免疫组化染色和透射电镜扫描进行鉴定;(3)随机选取其中40例胆囊结石患者胆囊黏膜进行免疫组化染色,观察相应胆汁和胆囊黏膜中纳米细菌分布的差异. 结果 (1)正常人群和胆囊结石患者血清中纳米细菌感染率分别为8.0%和31.6%,两者间差异有显著性(χ2=29.90, P0.05).(3)14例胆囊结石患者胆囊黏膜感染纳米细菌,阳性率为35.0%,其主要分布在黏膜或黏膜下层及钙化灶. 结论正常人群血清中纳米细菌感染率为8.0%,胆囊结石患者血清、胆汁和胆囊黏膜中存在着纳米细菌感染;胆囊壁的钙化或纤维化可能与纳米细菌感染有关.

  14. 小切口胆道镜下保胆取石的临床探索%Clinical Study of Lithotomy with Cholecyst Conservation under Choledochoscope by Small Incision for the Treatment of Cholecystolithiasis

    Institute of Scientific and Technical Information of China (English)

    杜成雄; 冯上利; 许可

    2011-01-01

    Objective To explore the clinical feasibility and value of lithotomy with cholecyst conservation under choledochoscope by small incision for the treatment of gallbladder stones. Methods 25 cases of simple gallstone patients underwent the lithotomy with cholecyst conservation under choledochoscope by small incision. All cases were confirmed the diagnosis of non-sediment type gallstones without extrahepatic bile duct stones by preoperative B-ultrasonography or CT, and the gallbladder wall thickness was less than 0. 5cm and postprandial cholecyst contraction was greater than 30%. And the patients were willing to bear the risk of the gallstone recurrence. Before operation, the surface positioning of the gallbladder was performed by B-ultrasonography. Under continuous epidural anesthesia, a 2 ~4cm small incision was cut in the margin of the rib and then the fundus of gallbladder was cut open for 1 cm. Under direct vision by the choledochoscope, the bile cyst stones were taken out and then the bottom of the gallbladder incision was sutured by continuous suture with muscular layer embedded. Thus, the functional gallbladder got retained. Results The mean operation time was 42 (35-65) min and blood loss was minimal. No transit cholecystectomy. 1 case suffered from a small amount of fluid at the gallbladder area and was cured by conservative treatment. There was no bile leakage, bleeding, wound infection, nor other complications. No perioperative death. No recurrence case during the 15 to 40 months follow-up. Conclusion It is safe and feasible of the lithotomy under choledochoscope by small incision for the treatment of gallbladder stones, with advantages of small trauma, safe, rapid postoperative recovery and functional gallbladder remain.%目的 探索小切口保胆取石术治疗胆囊结石的临床可行性及其价值.方法 25例单纯性胆囊结石患者,术前B超或CT证实为非泥沙型胆囊结石,胆囊壁厚小于0.5cm且高脂餐后胆囊收缩大于30%,无肝内外胆管结石,胆囊功能良好,患者愿意承担术后可能胆囊结石复发的风险.经术前B超胆囊底体表定位后,在连续硬膜外麻醉下行肋缘下2~4cm小切口,切开胆囊底部1cm,在胆道镜直视下取尽结石,再用可吸收线全层连续缝合胆囊底部切口并浆肌层包埋,保留有功能胆囊.结果 手术时间平均42 (35~ 65) min,术中出血极少.无中转胆囊切除.1例出现胆囊区少量积液,经保守治疗治愈,未出现胆漏、出血、伤口液化感染等并发症,无死亡病例.均获随访,平均22( 15 ~40)月,未出现复发病例.结论 保胆取石治疗胆囊结石创伤性小、安全性高、术后恢复快,并且可保留有功能胆囊,是安全、可行的.

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

    DEFF Research Database (Denmark)

    Monrad, H; Grønvall, S; Højgaard, L

    1994-01-01

    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 extracorporeal shock wave lithotripsy (ESWL) treatment...

  16. Laparoscopic vs. small incision cholecystectomy : Implications for pulmonary function and pain. A randomized clinical trial

    NARCIS (Netherlands)

    Keus, F.; Ali, U. Ahmed; Noordergraaf, G. J.; Roukema, J. A.; Gooszen, H. G.; Van Laarhoven, C. J. H. M.

    2008-01-01

    Background: Upper abdominal surgery, including laparoscopic cholecystectomy (LC), is associated with post-operative pulmonary dysfunction. LC has, by consensus, become the treatment of choice for symptomatic cholecystolithiasis. The small-incision cholecystectomy (SIC), a procedure which does not re

  17. The Study of Pathological Form of Mucous Membrane and Nucleolus Orgnizing Region on Turgid and Non-Turgid Type of Cholecystolithiasis%充满型及非充满型胆囊结石粘膜病理形态及核仁组成区的研究

    Institute of Scientific and Technical Information of China (English)

    邱修辉; 王子健

    2001-01-01

    目的:探讨充满型及非充满型胆囊结石粘膜组织病理学的差异及相应外科治疗措施.方法:收集1995年10月至1996年10月期间的胆囊结石标本做常规病理染色及嗜银蛋白染色分析.结果:发现充满型及非充满型结石组胆囊粘膜不典型发生率及AgNOR数目均有显著差异.结论:一经诊断为充满型胆囊结石,特别是中老年肥胖妇女,应早期手术切除病变胆囊.

  18. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

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

    2013-01-01

    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...

  19. [Overweight and obesity as the risk factor in perinatology].

    Science.gov (United States)

    Zdziennicki, A

    2001-12-01

    Overweight and obesity have become a frequent phenomenon among pregnant women during last thirty years. They result in increased morbidity rates of different chronic, health- or even life-threatening diseases. Among different perinatal complications associated with obesity the most important are: hypertension, diabetes, varices, cholecystolithiasis, prolonged pregnancy, intrauterine growth retardation. Increased rates of operative deliveries, intrapartal and postpartal infections, thrombotic complications, anaemia, urinary infections and lactation disorders can be observed.

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

    Institute of Scientific and Technical Information of China (English)

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

    2005-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Lingyun Guo

    2014-01-01

    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.

  2. Extracorporeal shock-wave lithotripsy of gallstones. Results and perspectives

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    Staritz, M.; Rambow, A.; Meyer zum Bueschenfelde, K.H.; Floth, A.; Hohenfellner, R.; Mildenberger, P.; Thelen, M.; Goebel, M.

    1987-12-01

    Recently extracorporeal shock-wave lithotripsy became a noteworthy alternative in the treatment of choledocolithiasis and cholecystolithiasis, in particular since the introduction of the second-generation shock-wave technique which allows to dispense with the positioning of the patient in the water bath required sofar and to place the patient on an examination table in freely movable way so as to position the gall stone to be disintegrated in the focus of the shock waves. Despite the beneficial treatment results, extracorporeal shock-wave lithotripsy still needs further improvement as a method especially in terms of the option of 'pulverizing' the stones. (orig./TRV)

  3. [A case of hepatic sarcoidosis presenting with cirrhotic symptoms].

    Science.gov (United States)

    Kaji, Kiichiro; Ogino, Hidero; Hirai, Satoshi; Shimatani, Akiyoshi; Horita, Yosuke; Matsuda, Kouichiro; Hiramatsu, Katsushi; Matsuda, Mitsuru; Shimizu, Koichi; Nakanishi, Yuko; Noda, Yatsugi

    2014-03-01

    A man in 40s with skin sarcoidosis presented with signs and symptoms of liver injury and thrombocytopenia. Enhanced computed tomography and magnetic resonance imaging revealed cholecystolithiasis, hepatic deformation, and giant splenomegaly. Gastrointestinal endoscopy showed esophageal varices. Cholecystectomy, splenectomy, and wedge biopsy of the liver were performed. Histopathology of the liver revealed many granulomas and severe periportal fibrosis without lobular reconstruction. These findings were compatible with hepatic sarcoidosis, but not liver cirrhosis. Here we report a rare case of hepatic sarcoidosis presenting with cirrhotic symptoms.

  4. Risk factors for hilar cholangiocarcinoma: A case-control study in China

    Institute of Scientific and Technical Information of China (English)

    Wen-Ke Cai; Hui Sima; Ben-Dong Chen; Guang-Shun Yang

    2011-01-01

    AIM: To study the association between hilar cholangiocarcinoma (HC) and pre-existing medical conditions.METHODS: Three hundred and thirteen HC patients admitted to the Eastern Hepatobiliary Surgery Hospital (Shanghai, China) in 2000-2005 and 608 healthy controls were enrolled in this study. Association between HC and pre-existing medical conditions was studied with their adjusted odds ratio (OR) calculated by logistic regression analysis.RESULTS: The prevalence of choledocholithiasis (adjusted OR = 2.704, P = 0.039), hepatolithiasis (adjusted OR = 3.278, P = 0.018), cholecystolithiasis (adjusted OR = 4.499, P < 0.0001), cholecystectomy (adjusted OR = 7.012, P = 0.004), biliary ascariasis (adjusted OR =7.188, P = 0.001), liver fluke (adjusted OR = 10.088, P = 0.042) and liver schistosomiasis (adjusted OR = 9.913,P = 0.001) was higher in HC patients than in healthy controls.CONCLUSION: Biliary tract stone disease (choledocholithiasis,hepatolithiasis, cholecystolithiasis) and parasitic liver disease (biliary ascariasis, liver fluke, liver schistosomiasis)are the risk factors for HC in Chinese population.

  5. Extensive subcutaneous emphysema and hypercapnia during laparoscopic cholecystectomy: two case reports.

    Science.gov (United States)

    Abe, H; Bandai, Y; Ohtomo, Y; Shimomura, K; Nayeem, S A; Idezuki, Y

    1995-06-01

    We report two cases of marked hypercapnia of more than 60 mm Hg (PaCO2) and extensive subcutaneous emphysema noted during laparoscopic cholecystectomy. The first case, a 55-year-old man was diagnosed as having cholecystolithiasis and had hypercapnia up to 83.5 mm Hg (PaCO2) during laparoscopic cholecystectomy. The patient resumed spontaneous respiration under controlled ventilation accompanied by persistent bigeminal pulse. Soon after deflation, CO2 returned to normal range, and extensive subcutaneous emphysema was detected in the recovery room. The second patient, a 53-year-old woman, had cholecystolithiasis and also underwent laparoscopic cholecystectomy. Both hypercapnia rising to 61.1 mm Hg (PaCO2) and extensive subcutaneous emphysema appeared just before completion of resection of the gallbladder. Mild hypercapnia during pneumoperitoneum of about 50 mm Hg (PaCO2) has been reported previously. As compared with cases in the literature, the present cases suggest that hypercapnia is due to extensive subcutaneous emphysema. The large absorption surface area in the subcutaneous tissue and the large difference in the partial pressure cause the extensive gaseous interchange of CO2 between subcutaneous tissue and blood perfusing into it at the moment between peritoneal cavity and blood perfused the peritoneum.

  6. [Laparoscopic endoscopy: a new type of combined technique for select patients].

    Science.gov (United States)

    Völgyi, Zoltán; Fischer, Tünde; Szenes, Mária; Tüske, György; Vattay, Péter; Gasztonyi, Beáta

    2010-06-20

    The authors report a new method which was introduced last year in their unit. In a significant part of cholecystolithiasis, choledocholithiasis also exists. The diagnosis is sometimes fairly difficult, in these cases newly developed imaging methods (magnetic resonance cholangiopancreatography, endoscopic ultrasonography) can help. In cases of choledocholithiasis, when preoperative endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful, laparoscopic endoscopy can be performed. Authors describe this method as well as discuss the international literature, and review the cases of their own ten cases with this method. They emphasize the advantages of the new method in a certain subgroup of patients against the traditional sequential approach (preoperative ERCP than laparoscopic cholecystectomy) and also share their technical experiences. Finally, they underline the importance of the team work which supposes the cooperation of the gastroenterologist, surgeon and anesthesiologist in the indication, organization and implementation of the intervention.

  7. [A case of jejunal perforation in gallstone ileus].

    Science.gov (United States)

    Taira, Akiko; Yamada, Masami; Takehira, Yasunori; Kageyama, Fujito; Yoshii, Shigeto; Murohisa, Gou; Yoshida, Kenichi; Iwaoka, Yasushi; Terai, Tomohiro; Uotani, Takahiro; Watanabe, Shinya; Noritake, Hidenao; Ikematu, Yoshito; Kanai, Toshikazu

    2008-04-01

    Gallstone ileus is a rare but important cause of small bowel obstruction in the geriatric population. A 65-year-old man with a twenty year history of cholecystolithiasis was admitted to our hospital with abdominal pain and vomiting. Physical exams showed abdominal defence and rebound tenderness. A plain abdominal X-ray suggested a small bowel obstruction and pneumobilia. CT scan revealed a 2.5-cm gallstone at the jejunum and air in the biliary tree. The patient underwent a emergency laparotomy based on a diagnosis of panperitonitis with a perforation associated with gallstone ileus. Operative findings revealed a jejunal perforation and a impacted stone on the anal side of perforation. Enterolithotomy and jejunal resection were performed with cholecystectomy and repairment of the cholecystoduodenal fistula.

  8. 腹腔镜联合纤维胆道镜行胆总管切开取石一期缝合术效果观察%Observation the Effect of Laparoscope Combine With Fibrocholedochoscope in Choledocholithotomy With Primary Sutura

    Institute of Scientific and Technical Information of China (English)

    高万宏

    2015-01-01

    目的:探讨腹腔镜联合纤维胆道镜在胆总管切开取石一期缝合术中的临床治疗效果。方法随机选取我院2013年1月~2014年12月收治的胆囊结石合并胆总管结石患者40例,将其随机均分为观察组与对照组,对照组应用开腹腔当总管切开取石术开展治疗;观察组应用腹腔镜联合纤维胆道镜行胆总管切开取石一期缝合术开展治疗,对两组患者的临床治疗效果予以对比分析。结果两组患者的平均手术时间、切口感染情况等相比,P<0.05,差异具有统计学意义。结论腹腔镜联合纤维胆道镜行胆总管切开取石一期缝合术,能够有效缩短平均手术时间,降低切口感染发生率。%Objective To investigate the clinical effect of laparoscopic combined with fibrocholedochoscope in choledocholithotomy with primary closure. Methods Selected 40 patients with cholecystolithiasis and choledocholithiasis from January 2013 to December 2014 in our hospital were randomly divided into the observation group and the control group respectively. The control group was given choledocholithotomy through opened the abdominal cavity, the observation group was given choledocholithotomy with primary closure through laparoscope and ifbrocholedochoscope. The clinical therapeutic effects of two groups were compared and analyzed. Results Compared average operation time, wound infection conditions and other matters of the two groups, P<0.05, had difference statistically sigiifcance. Conclusion Choledocholithotomy with primary closure through laparoscope and ifbrocholedochoscope for patients with cholecystolithiasis and choledocholithiasis can shorten patients’ average operation time effectively, reduce patients’ wound infection incidence.

  9. Diagnostic value of magnetic resonance cholangiopancreatography in low choledochal joint and its complications%MRCP对胆囊管低位汇合及其并发症的诊断价值

    Institute of Scientific and Technical Information of China (English)

    赵欣; 谢明; 陈竹卿; 王振山; 张书泽

    2015-01-01

    To investigate the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) for di-agnosing low choledochal joint and its complications. MRCP results of 29 low choledochal joint patients con-firmed were analyzed retrospectively, and then compared with those by endoscopic retrograde cholaniopancreatography (ERCP). MRCP could display clearly the location of low choledochal joint, and the patients with complications involved 4 ones with cholecystolithiasis, 5 ones with cholangiolithiasis, 15 ones with cholecystolithiasis and cholangiolithi-asis, 3 ones with Mirizz syndrome, 2 ones with pancreatitis, 1 case with carcinoma of head of pancreas after cholecystec-tomy and 1 case of Vater ampullary carcinoma. Interoperative and ERCP findings proved that MRCP could be used for the diagnosis of low choledochal joint and its complications with no missed diagnosis. MRCP can be involved for the diagnosis of low choledochal joint and its complications, and thus can be used for preoperative planning and treat-ment of the complications.%目的:探讨磁共振胰胆管成像(magnetic resonance cholangiopancreatography,MRCP)对胆囊管低位汇合及其并发症的诊断价值。方法:回顾性分析29例MRCP检查发现的胆囊管低位汇合病例,与术中或内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)检查结果相对照。结果:MRCP能清晰显示胆囊管汇入位置,并发症包括单纯胆囊结石4例,单纯胆管结石5例,胆囊及胆管均有结石15例,合并Mirizzi综合征3例,合并胰腺炎2例,胆囊切除术后患者合并胰头癌1例,合并乏特氏壶腹癌1例。对照术中或ERCP所见,MRCP术前检查胆囊管低位汇合及其并发症诊断符合率为100%。结论:MRCP可清晰显示胆囊管低位汇合及其并发症,能为术前制订手术方案及并发症处理提供重要信息。

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

    Directory of Open Access Journals (Sweden)

    Guo-feng XIAO

    2011-12-01

    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

  11. Diagnostic role of secretin-enhanced MRCP in patients with unsuccessful ERCP

    Institute of Scientific and Technical Information of China (English)

    László Czakó; Tamás Takács; Zita Morvay; László Csernay; János Lonovics

    2004-01-01

    AIM: To evaluate the value of MR cholangiopancreatography (MRCP) in patients in whom endoscopic retrograde cholangiopancreatography (ERCP) was unsuccessfully performed by experts in a tertiary center.METHODS: From January 2000 to June 2003, 22 patients fulfilled the inclusion criteria. The indications for ERCP were obstructive jaundice (n = 9), abnormal liver enzymes (n = 8),suspected chronic pancreatitis (n = 2), recurrent acute pancreatitis (n = 2), or suspected pancreatic cancer (n = 1).The reasons for the ERCP failure were the postsurgical anatomy (n = 7), duodenal stenosis (n = 3), duodenal diverticulum (n = 2), and technical failure (n = 10). MRCP images were evaluated before and 5 and 10 min after i.v.administration of 0.5 IU/kg secretin.RESULTS: The MRCP images were diagnosed in all 21patients. Five patients gave normal MR findings and required no further intervention. MRCP revealed abnormalities (primary sclerosing cholangitis, chronic pancreatitis, cholangitis, cholecystolithiasis or common bile duct dilation) in 10 patients, who were followed up clinically. Four patients subsequently underwent laparotomy (hepaticojejunostomy in consequence of common bile duct stenosis caused by unresectable pancreatic cancer; hepaticotomy+Kehr drainage because of insufficient biliary-enteric anastomosis; choledochojejunostomy, gastrojejunostomy and cysto-Wirsungo gastrostomy because of chronic pancreatitis, or choledochojejunostomy because of common bile duct stenosis caused by chronic pancreatitis). Three patients participated in therapeutic percutaneous transhepatic drainage. The indications were choledocholithiasis with choledochojejunostomy, insufficient biliary-enteric anastomosis, or cholangiocarcinoma.CONCLUSION: MRCP can assist the diagnosis and management of patients in whom ERCP is not possible.

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

    Institute of Scientific and Technical Information of China (English)

    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

    2009-01-01

    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.

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

    Institute of Scientific and Technical Information of China (English)

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

    2005-01-01

    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.

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

    Institute of Scientific and Technical Information of China (English)

    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

    2005-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Sandra Pedroso de Moraes

    2007-09-01

    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.

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

    Science.gov (United States)

    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

    2016-12-01

    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.

  17. Beclin 1 deficiency correlated with lymph node metastasis, predicts a distinct outcome in intrahepatic and extrahepatic cholangiocarcinoma.

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    Tian-Tian Wang

    Full Text Available Autophagy can be tumor suppressive as well as promotive in regulation of tumorigenesis and disease progression. Accordingly, the prognostic significance of autophagy key regulator Beclin 1 was varied among different tumors. Here, we detected the clinicopathological and prognostic effect of Beclin 1 in the subtypes of intrahepatic cholangiocarcinoma (ICC and extrahepatic cholangiocarcinoma (ECC. Beclin 1 expression level was detected by immunohistochemistry staining in 106 ICC and 74 ECC patients. We found that Beclin 1 was lowly expressed in 126 (70% cholangiocarcinoma patients, consist of 72 ICC and 54 ECC. Moreover, the cholangiocarcinoma patients with lymph node metastasis (N1 had a lower Beclin 1 level than that of N0 subgroup (P=0.012. However, we did not detect any correlations between Beclin 1 and other clinicopathological features, including tumor subtypes, vascular invasion, HBV infection, liver cirrhosis, cholecystolithiasis and TNM stage. Survival analysis showed that, compared with the high expression subset, Beclin 1 low expression was correlated with a poorer 3-year progression-free survival (PFS, 69.1% VS 46.8%, P=041 for cholangiocarcinoma. Importantly, our stratified univariate and multivariate analysis confirmed that Beclin 1 lowly expressed ICC had an inferior PFS as well as overall survival than ECC, particularly than that of Beclin 1 highly expressed ECC patients. Thus, our study demonstrated that Beclin 1low expression, correlated with lymph node metastasis, and might be a negative prognostic biomarker for cholangiocarcinoma. Combined Beclin 1 level with the anatomical location might lead to refined prognosis for the subtypes of ICC and ECC.

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

    Institute of Scientific and Technical Information of China (English)

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

    2008-01-01

    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.

  19. Routine liver function tests and serum amylase determinations after biliary lithotripsy: are they necessary?

    Science.gov (United States)

    Goodacre, B W; Malone, D E; Fache, J S; Rawat, B; Burhenne, H J

    1990-10-01

    Shock-wave-induced soft-tissue damage after biliary extracorporeal shock-wave lithotripsy (BESWL) has been reported. Every patient treated in Vancouver has, therefore, had liver function tests and serum amylase levels measured before and within 6 days after BESWL. All patients had symptomatic cholecystolithiasis with normal pre-BESWL biochemistry. Analysis of 311 patients after treatment with the Siemens Lithostar unit showed elevation of one or more laboratory value in 19% (60/311). Serum aspartate transaminase level was most frequently abnormal (38 cases). The majority of abnormalities were mild, less than two times normal levels. Clinically significant complications occurred in five patients (three pancreatitis, one cholecystitis, one common bile duct obstruction); four of these occurred 1 week or more after treatment. The results of routine laboratory tests could not be used to predict complications. No correlation was seen between abnormal values and number of shock waves administered or peak shock-wave pressure. Of 112 patients surveyed at the time of post-BESWL enzyme measurement, 49 (44%) reported a degree of pain, which was severe in eight cases. Presence of severe pain correlated strongly (p less than .001) with abnormal laboratory findings, however not with the degree of abnormality. As results of these laboratory tests are nonspecific, have not been shown to correlate with the degree of severity of BESWL-induced tissue damage, and do not predict complications, the tests are of little value in the absence of clinical signs and symptoms. These conclusions, however, apply only to the Siemens Lithostar Plus with patients treated in the steep left posterior oblique position. Cost savings can be expected if routine post-BESWL biochemical tests are abandoned.

  20. Endoscopic sphincterotomy in the treatment of cholangiopancreatic diseases

    Institute of Scientific and Technical Information of China (English)

    Zhi-Hua Li; Min Chen; Ji-Kui Liu; Jun Ding; Jia-Hong Dong

    2005-01-01

    AIM: To investigate the therapeutic effect of endoscopicsphincterotomy (EST) in the treatment of choledocholithiasis and stenosing papillitis.METHODS: A total of 1 026 patients undergoing EST during July 1983 to May 2003 at the institute were retrospectively analyzed. Chronic pancreatitis was diagnosed in 63 (6.1%),cholecystolithiasis and choledocholithiasis in 549 (53.5%),stones in residual biliary duct in 249 (24.3%), stenosing papillitis in 228 (22.2%). In patients with simple stenosing papillitis, most incisions were within 0.5-1 cm in length. As for patients with chronic pancreatitis simultaneously, selective pancreatic sphincterotomy was performed, and incision was within 0.5-0.8 cm in length. For stones less than 1 cm, incision was from 1 to 1.5 cm, and for those larger than 1 cm, incision ranged from 1.5 to 3 cm. For stones more than 2 cm in diameter, detritus basket rather than simple incision was chosen. RESULTS: Of the 798 patients with choledocholithiasis, 764 (93.5%) had successful stone clearance, 215 (94.3%)out of 228 cases of stenosing papillitis were cured totally, while 63 had chronic pancreatitis developed from stenosing papillitis, 57 (90.1%) had sound remission of symptoms, though membranous stenosis emerged in 13 of 57 which was treated with balloon dilatation. After the operation, only 21 cases (2.1%) had complications such as severe pancreatitis and incision bleeding. None of the patients died.CONCLUSION: EST is an ideal surgical management with mini-invasion in the treatment of choledocholithiasis and stenosing papillitis.

  1. Transvaginal/Transumbilical Hybrid—NOTES—Versus 3-Trocar Needlescopic Cholecystectomy: Short-term Results of a Randomized Clinical Trial

    Science.gov (United States)

    Knuth, Jürgen; Cerasani, Nicola; Sauerwald, Axel; Lefering, Rolf; Heiss, Markus Maria

    2015-01-01

    Objective: For cholecystectomy, both the needlescopic cholecystectomy (NC) 3-trocar technique using 2 to 3 mm trocars and the umbilical-assisted transvaginal cholecystectomy (TVC) technique have found their way into clinical routine. This study compares these 2 techniques in female patients who are in need of an elective cholecystectomy. Background: Natural orifice transluminal endoscopic surgery (NOTES) is a surgical concept permitting scarless intra-abdominal operations through natural orifices, such as the vagina. Because of the lack of an adequately powered trial, we designed this first randomized controlled study for the comparison of TVC and NC. Methods: This prospective, randomized, nonblinded, single-center trial evaluates the safety and effectiveness of TVC (intervention), compared with NC (control) in female patients with symptomatic cholecystolithiasis. The primary endpoint was intensity of pain until the morning of postoperative day (POD) 2. Secondary outcomes were among others intra- and postoperative complications, procedural time, amount of analgesics used, pain intensity until POD 10, duration of hospital stay, satisfaction with the aesthetic result, and quality of life on POD 10 as quantified with the Eypasch Gastrointestinal Quality of Life Index (GIQLI). Results: Between February 2010 and June 2012, 40 patients were randomly assigned to the interventional or control group. All patients completed follow-up. Procedural time, length of postoperative hospital stay, and the rate of intra- and postoperative complications were similar in the 2 groups. However, significant advantages were found for the transvaginal access regarding pain until POD 2, but also until POD 10 (P = 0.043 vs P = 0.010) despite significantly less use of peripheral analgesics (P = 0.019). In the TVC group, patients were significantly more satisfied with the aesthetic result (P < 0.001) and had a significantly better GIQLI (P = 0.028). Conclusions: Although comparable in terms of

  2. Abdominal color ultrasonography results of 1635 middle-aged and elderly male patients%1635例男性中老年腹部彩超检查结果分析

    Institute of Scientific and Technical Information of China (English)

    徐贤华; 薛雅琴; 赵涛; 肖欣荣; 彭华生; 王万华; 何晓英; 孙梅芹; 陈娟; 钟景烨; 许婷媛; 梁国君

    2011-01-01

    Objective To analyze abdominal color ultrasonograghy results of 1635 middle - aged and elderly male patients received physical examination in 2010, and to discuss the incidence of abdominal diseases among them. Methods The incidence of different abdominal diseases in these middle - aged and elderly patients was investigated. Results Total abdominal disease detection rate was 93.4% ,in which patients with benign prostatic hyperplasia accounted for the highest distribution,followed by liver cysts,renal cysts,fatty liver,cholecystolithiasis and gallbladder polyps. Conclusion Abdominal color ultrasonography is a noninvasive and simple method to detect common diseases of abdominal important organs. It is suitable for routine physical examinations.%目的 对2010年进行年度体检的1635例中老年人腹部彩超检查结果进行分析,探讨该群体的发病规律.方法 统计2010年体检的1635例不同年龄段的中老年人腹部彩超检查中各疾病的发病率.结果 疾病总检出率93.4%,病例分布以前列腺增生最高,其余依次是肝囊肿、肾囊肿、脂肪肝、胆囊结石、胆囊息肉.结论 腹部彩超检查是一种无创性,操作简单,能检查出腹部重要脏器的常见疾病,适合常规体检.

  3. 足浴疗法配合推按运经仪预防内镜微创胆取石术后结石复发的效果观察%Observation the effect of footbath therapy combinating with channel-massage instrument in preventing recurrence of gallstone after lithotomy

    Institute of Scientific and Technical Information of China (English)

    侯晓慧; 李恺; 屈伟荣

    2013-01-01

    Objective:To observe the treatment effect of footbath therapy combinating with channel-massage instrument in preventing recurrence of gallstone after micro invasive lithotomy through endoscope.Methods:To compare the treatment effects between the observation group which use footbath therapy combinating with channel-massage instrument and the control group which use only channel-massage instrument in preventing recurrence of gallstone after micro invasive lithotomy through endoscope.Results:The efficacy of the observation group was better than control group,there was significant difference between two groups (P < 0.05).Conclusion:Foot massage therapy combined with channel-massage treatment effect in preventing recurrence of cholecystolithiasis after nephrolithotomy significantly.%目的:观察足浴疗法配合推按运经仪预防内镜微创保胆取石后胆囊结石复发的疗效.方法:采用足浴疗法配合推按运经仪预防取石后胆囊结石复发为观察组,单纯使用推按运经仪预防取石后胆囊结石复发为对照组,对两组疗效进行观察比较.结果:观察组疗效明显优于对照组,两组比较差异有统计学意义(P<0.05).结论:足浴疗法配合推按运经仪预防取石后胆囊结石复发疗效显著.

  4. Clinical analysis of laparoscopic cholelithotomy and polypectomy of gallbladder for pilots—7 cases attached%飞行人员腹腔镜保胆取石术和息肉切除术临床分析——附七例临床病例

    Institute of Scientific and Technical Information of China (English)

    徐新保; 张洪义; 张辉; 刘承利; 肖梅; 张宏义; 冯志强

    2012-01-01

    Objective To discuss the operative indication,methods and therapeutic effect of treating the cholecystolithiasis and polyps by laparoscopic cholelithotomy and polypectomy for pilots,and to study the effects of treatment on pilot's career.Methods The clinical data of 7 pilots with cholelithiasis and cholecystic polyps,who were treated by laparoscopic cholelithotomy and polypectomy in the period from Apr.2011 to Apr.2012,were analyzed.Four cases out of 7 pilots were the only cholecystolithiasis,including 3 cases of single stone and 1 case of multiple stones.One simple cholecystic polyps case was the cholecystic cholesterol polyps.Two cases were the combination of cholecystolithiasis and cholecystic cholesterol polyps.In all cases,the bottoms of the gallbladders were incised by electrosurgical hook to remove all stones and polyps.The incisions were continuously sutured with 4-0 prolene in 3 cases,and other 4 cases were interruptedly or continuously sutured with 3-0 absorbable lines.Choledochoscope or laparoscope was used to supervise the clearance of stone and polyps.All pilots were temporally grounded and observed for 1-3 months.Results All cases were successfully treated and no further celiotomy was needed to them.The operation time was 80-150 min and pilots' hospitalized stay was 3-7 d.All pilots recovered smoothly.In 3 to 18 months follow up for all pilots,no stone or polyp recurrence was found.Five pilots were qualified for flying while the other 2 were still in observation respectively due to vascular headache and cervical spondylosis.Conclusions Laparoscopic cholelithotomy and polypectomy can preserve gallbladder function,be in favor of maintaining normal digestive function and be beneficial to pilot's recovery for flying.%目的 探讨腹腔镜下飞行人员保胆取石和取息肉的手术适应证、方法和疗效以及对飞行人员术后复飞影响. 方法 2011年4月-2012年4月的7例飞行人员行腹腔镜下保胆取石和取息

  5. 牛磺熊去氧胆酸与熊去氧胆酸对预防保胆术后结石复发的临床研究%A Comparative Clinical Study for the Relapse of Cholelithiasis after Gallbladder-preserving Lithotomy between Tauroursodeoxycholic Acid and Ursodeoxycholic Acid

    Institute of Scientific and Technical Information of China (English)

    陈建飞; 赵期康; 李晋忠; 黄坤全; 刘京山

    2014-01-01

    Objective To evaluate the clinical effect between tauroursodeoxycholic acid ( TUDCA) and ursodeoxycholic acid ( UDCA) on preventing the relapse of cholelithiasis after gallbladder-preserving lithotomy via choledochoscope . Methods A total of 313 patients of cholecystolithiasis in Peking University Shougang Hospital undergoing gallbladder -preserving lithotomy via choledochoscope were divided into TUDCA and UDCA group by odd and even numbers of their medical record .The TUDCA group took 500 mg TUDCA (commodity name: Taurolite, Bruschettini S.r.l., Italy, import approval number: H20070200/H20110233) once per night, for 5 days consecutively, and withdrew the drug for 10 days, 15 days was considered a cycle;the UDCA group took 500 mg UDCA ( commodity name:Ursofalk, Dr.Falk Pharma GmbH, German, import approval number: H20050181) once per night .The total course of treatment of the two groups was 180 d.Nursing and diet therapies were the same in the two groups .The cases were checked at regular intervals after surgery with B ultrasonography and were followed up .The recurrence rate of calculi , the change of the thickness of gallbladder wall and the rate of gallbladder contraction were recorded . Results The two groups were followed up for 12-30 months.The 2-year recurrence rates of cholecystolithiasis were 3.7% and 12.4% respectively in the two groups ( log-rankχ2 =5.304, P =0.021 ). Conclusion The effect of TUDCA is better than that of UDCA in preventing the relapse of cholecystolithiasis for patients with gallbladder-preserving lithotomy via choledochoscope .%目的:评价牛磺熊去氧胆酸( TUDCA)与熊去氧胆酸( UDCA)对保胆取石术后患者预防胆囊结石复发的差异性及其临床价值。方法2010年10月~2011年12月,我院内镜微创保胆手术成功的313例胆囊结石按病历号奇偶分为TUDCA组(n=161)和UDCA组(n=152),术后2周TUDCA组口服牛磺熊去氧胆酸胶囊(商品名:滔罗特,意大利

  6. 免气腹悬吊式与传统气腹式腹腔镜胆囊切除术比较分析%Clinical comparison of gasless laparoscopy using abdominal wall lifting and conventional laparoscopic for cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    吴金柱; 胡江; 梁鲁; 蔡卫华

    2013-01-01

    Objective To analyze the clinical value of gasless laparoscopic cholecystectomy (GLC). Methods The clinical data of 60 patients suffered from cholecystolithiasis, gall bladder polypi or chronic cholecystitis between July 2009 and March 2010 in Baotou center hospital were analyzed. All the patients were divided into GLC group (30 patients) and convention laparoscopic cholecystectomy (CLC) group (30 patients) in randomly. Patients intraoperative data, postoperative recovery, postoperative complications, hospitalized time and related costs were recorded. Results Compared with CLC, the effects were very significant in GLC, which included less adverse effects of intraoperative and postoperative respiratory cycle, faster postoperative recovery time, getting out of bed earlier, lower incidence of postoperative nausea and vomiting (PONV), neck and shoulder pain, lower hospitalization costs. Conclusion GLC can avoid affecting to the respiratory and circulatory function, thus it can avoid the harmful effects of CO2 pneumoperitoneum on the human body and increase operative safety.%目的 分析悬吊式免气腹腹腔镜胆囊切除术(gasless laparoscopic cholecystectomy,GLC)的临床应用价值.方法 对2009年7月至2010年3月包头市中心医院普通外科60例腹腔镜胆囊切除术的临床资料进行分析.将60例慢性胆囊炎、胆囊结石或胆囊息肉病人随机分为GLC组及传统气腹式腹腔镜胆囊切除术(convention laparoscopic cholecystectomy,CLC)组,每组30例,记录术中、术后情况,对比分析并发症的发生率、住院时间及相关费用.结果 GLC对术中、术后呼吸循环和术后恢复的影响较小,具有术后胃肠功能恢复快,术后下床活动早,术后恶心呕吐发生率低,颈肩痛轻,住院费用低的优点.结论 选择GLC避免了对呼吸、循环系统的影响,从而避免了二氧化碳(CO2)气腹对人体的不良影响,增加了手术安全性.

  7. The clinical application of harmonic scalpel in laparoscopic cholecystectomy in patients with cirrhosis%超声刀在肝硬化患者腹腔镜胆囊切除术中的应用价值

    Institute of Scientific and Technical Information of China (English)

    徐琳; 王峰; 宗光全; 刘仁民; 张宇飞

    2013-01-01

    Objective:To investigate the clinical application value of harmonic scalpel in laparoscopic cholecystectomy (LC) for patients with cirrhosis. Methods:From Apr. 2008 to Apr. 2012,48 patients who suffered from cholecystolithiasis and cirrhosis were randomly divided into harmonic saclpel group and conventional electric coagulation group. The related indices of perioperative period were comparatively analyzed between 2 groups. Results;LC was successfully performed in harmonic scalpel group,and 3 patients in conventional electric coagulation griup were converted to laparotomy. The use of the harmonic scalpel was associated with a statistically significant shorter operative time,less estimated intraoperative blood loss,less postoperative abdominal drainage and shorter postoperative hospital stay. No statistically significant difference was found between both groups as regards the conversion rate and the incidence of postoperative complications. Conclusions:The harmonic scalpel provides a superior alternative in terms of shorter operative time,less intraoperative blood loss,and lower incidence of deterioration of liver function in LC for patients with cirrhosis. This procedure is safe and effective,can avoid the injury of bile duct,and has better clinical application value.%目的:研究超声刀在肝硬化患者腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中的临床应用价值.方法:选取2008年4月至2012年4月收治的48例胆囊结石合并肝硬化患者,随机分为超声刀组与常规电凝组,对比分析两组患者围手术期相关指标.结果:超声刀组均顺利完成LC,常规电凝组3例中转开腹.超声刀组手术时间、术中出血量、术后腹腔引流量及术后住院时间均明显低于常规电凝组,差异有统计学意义;中转率及术后并发症发生率超声刀组优于电凝组,但差异无统计学意义.结论:肝硬化患者LC术中应用超声刀可有效缩短手术时间、减少手术出血量、保

  8. 免气腹悬吊式腹腔镜与常规腹腔镜胆囊切除术术后呕吐的研究%A Comparative Study of Vomiting after Gasless Laparoscopic Cholecystectomy of Abdominal Wall Lifting and Conventional Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    王淑贤; 于跃利; 陈彪; 董玉红

    2014-01-01

    Objective:To compare and analyse the patients′ state of postoperative nausea and vomiting(PONV)after gas-less laparoscopic cholecystectomy of abdominal wall lifting(GLC)and convention laparoscopic cholecystectomy(CLC). Meth-ods:60 patients hospitalized for chronic cholecystitis,cholecystolithiasis and gall bladder polypi in the First Affiliated Hospital of Baotou Medical College from July 2009 to March 2010 were randomly divided into GLC group(group A)and CLC group(group B),with 30 patients in each group. Results:The incidence of PONV went down with time in two groups. The incidence of PONV in group B was higher than that in group A at various stages. There was significant difference( P ﹤ 0. 05)in the incidence of nausea within 24 hours after the operation,and significant difference( P ﹤ 0. 05)in the incidence of vomiting within 12 hours after the operation,between the two groups. Conclution:Compared with that in CLC,The incidence of PONV was lower in GLC.%目的:研究悬吊式免气腹腹腔镜胆囊切除术术后发生恶心、呕吐的情况。方法:随机选择包头医学院第一附属医院2009年5月至2010年5月患有胆囊炎、胆囊结石或胆囊息肉入院的患者,随机分为免气腹腹腔镜胆囊切除术组(A 组)30例、传统腹腔镜胆囊切除术组(B 组)30例。结果:术后两组恶心、呕吐发生率随时间而降低,B 组各时间段恶心、呕吐发生率均高于 A 组,在术后24 h 内两组恶心发生率差异均有统计学意义( P ﹤0.05),在术后12 h 内两组呕吐发生率差异均有统计学意义( P ﹤0.05)。结论:免气腹腹腔镜胆囊切除术恶心、呕吐发生率低于传统腹腔镜胆囊切除术。

  9. AGE AND GENDER PECULIARITIES OF DEVELOPMENT OF GALLSTONE DISEASE

    Directory of Open Access Journals (Sweden)

    N. A. Hohlacheva

    2016-01-01

    Full Text Available Goal. Study of the role of risk factors in mechanized gall stone formation depending on sex and age of patients. Material and methods We examined 210 patients with stage I gallstone disease (GSD. In verification of diagnosis used an ultrasound study of the hepatobiliary system, multi-grade duodenal sounding with subsequent macroscopic, microscopic, chemical and physical examination of bile. In the portions “b” and “C” bile was determined the total concentration of bile acids, cholesterol, with the subsequent calculation it consists of cholesterol ratio. Estimation of surface tension of bile viscosity and bile. In the studied blood levels of total cholesterol, lipoproteins of very low density, lowdensity lipoproteins, high density lipoproteins, triglycerides, were determined the coefficient of atherogenicity. To assess the degree of accumulation of body fat was used the Quetelet index. Studied the relative risk of anamnestic risk factors of GSD. Results. The features of biliary lithogenesis based on gender and age of patients. High value PR for the gall stone formation are female gender — 3,16, Mature and elderly age (older than 50 of 3.67. In young women, gall-stone formation is mainly due to the increase of cholesterol level of bile, at the age of 50 years with a decline in zhelchnokamennaja pool, increased viscosity and surface tension of bile. The most important risk factors of cholecystolithiasis are also gender differences: if women is multiple pregnancies and (or childbirth (more than 3 — OR 4,62, overweight (BMI over 26 — OR is 4.57 and the violation of the principles of good nutrition (eating disorders, overeating or starvation, the use of large quantities of animal fats — OR 3,94, for men it’s physical inactivity — OR a 4.25, the increase in KA — PR 3.87 and burdened by GSD genetics — OR of 2.05. Conclusion. The data obtained can be used in the organization of dispensary work with patients with hepatobiliary

  10. 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.

    Institute of Scientific and Technical Information of China (English)

    陈永友

    2012-01-01

    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.

  11. Laparoscopic cholecystectomy with undissected calot triangle and remained partial gall bladder wall%不解剖胆囊三角并保留部分胆囊壁的腹腔镜胆囊切除术

    Institute of Scientific and Technical Information of China (English)

    刘国生; 蔺晖琦; 徐恒; 尹照成; 黄眷杰; 许瑞云

    2014-01-01

    Objective To evaluate the curative effect of laparoscopic cholecystectomy (LC)with undissected calot triangle and remained partial gall bladder wall in patients with chronic cholecystitis/cholecys-tolithiasis combined with highly fibrotic gall bladder wall. Methods Eighty-nine cases of chronic cholecysti-tis/cholecystolithiasis combined with highly fibrotic gall bladder wall received LC of four hole method. During operation,retrograde method was used,with undissected calot triangles and remained partial gall bladder walls. The effect of this surgical method was analyzed. Results Seventy-eight cases (87.6%)of all patients underwent the operation successfully. The operating time was 30~90 min,with an average of 45 min. Bleeding amount was 20~50 ml,with an average of 30 ml. The hospitalized time was 4~7 d,with an average of 5 d.Seven cases with opaque operative field underwent LC with ultrasound assistance successfully. Three cases were converted to open cholecystectomy because of tissue adhesion. One case with iatrogenic common bile duct inju-ry converted to open cholecystectomy,and then received bile total pipe anastomosis and T-tube drainage. Three of 85 cases only received LC with mild biliary fistula and were cured by the continuous negative pressure drain-age. 3 cases with transient mild diarrhea were resolved spontaneously in 1 to 3 months after operation. All pa-tients were cured without other surgical complications. Conclusions LC with undissected calot triangle and re-mained partial gall bladder wall can effectively treat patients with chronic cholecystitis/cholecystolithiasis com-bined with highly fibrotic gall bladder wall,but open cholecystectomy should be considered if there are serious tissue adhesions.%目的:探讨不解剖胆囊三角并保留部分胆囊壁的腹腔镜胆囊切除术(LC)治疗慢性胆囊炎/胆囊结石并胆囊壁高度纤维化患者的疗效。方法89例慢性胆囊炎/胆囊结石并胆囊壁高度纤维化的患者均

  12. 以外科手术为主的3种不同方式治疗胆囊结石的疗效对比分析%The curative effect analysis of 3 different surgical ways for gallstone treatment

    Institute of Scientific and Technical Information of China (English)

    王三贵; 乔铁; 刘衍民; 田晓; 叶锡银; 李挺山; 罗小兵; 马瑞红; 江志沅

    2012-01-01

    目的 探讨以外科手术为主的3种不同方式治疗胆囊结石,对比分析多项指标,评价3种治疗方式的临床效果.方法 233例胆囊结石患者根据制定的人选标准,共分成3组:腹腔镜胆囊切除术(LC)组50例,对照Ⅰ组91例,对照Ⅱ组92例.对照Ⅰ组和对照Ⅱ组行内镜微创取石保胆术,对照Ⅱ组在对照Ⅰ组基础上,术后第2日起加用自制的中药利胆护胆汤.3组术后均给予消炎、对症治疗,术后每3个月随访一次.临床效果评价指标包括手术时间、术中出血量、胆漏、胆总管损伤、反流性胃炎食管炎、胆总管结石复发率等10项指标.结果 LC组和内镜微创保胆取石术均未发现胆总管损伤且在手术时间上没差异.但在手术出血量、胆漏、术后患者的消化功能、反流性食管炎、胆总管结石发生率5个指标上,内镜微创保胆取石术优于LC;内镜微创保胆取石术2年后,对照Ⅱ组的胆囊壁厚度、胆囊收缩功能、胆囊结石复发率优于对照Ⅰ组.结论 内镜微创取石保胆手术治疗胆裳结石,其手术出血量、术后消化道症状和并发症较LC少.术后加用中药护胆治疗,能降低胆囊结石复发率,具有较好的应用前景.%[Objective] To investigate the surgical operation based on 3 different ways for the treatment of cholecystolithiasis and evaluate the multiple indexes and 3 kinds of treatment clinical effect. [Methods] 233 cases of patients with gallbladder stones according to established criteria for inclusion, were divided into three groups: La-paroscopic cholecystectomy (LC) group in 50 cases, control group of 91 cases, control group of 93 cases. Control group one and group two rows of minimally invasive endoscopic stone extraction and biliary surgery, according to Ⅰ group in Ⅱ according to groups based on the second postoperative day, with homemade medicine Lidan protecting gallbladder decoction. After operation, the 3 groups were given anti

  13. Paraneoplastic Scleroderma: Are There Any Clues?

    Science.gov (United States)

    Jedlickova, Hana; Durčanská, Veronika; Vašků, Vladimír

    2016-04-01

    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

  14. The Relationship Between the Age of Choledocholith and the Biology Feature and the Type of Traditional Chinese Medicine Syndrome%1133例胆总管结石发生年龄与生物学特征及中医证型关系探讨

    Institute of Scientific and Technical Information of China (English)

    刘志新; 李昊燃; 盛天骄; 王长洪; 林一帆; 朱虹; 巩阳; 刘杨; 陆宇平; 高文艳; 季芳; 雷春红

    2012-01-01

    between choledocholith and the biology feature and type of syndrom of TCM were analyzed. Result: The high incidence of choledocholithiasis was 40~93 (94.4% ), among them,patients aged 21~40 were 6.9% , aged 41~60 were 31. 5% and aged 61~93 were 61.6%. There was significance difference between each age range( P < 0.01). The result of differentiation of symptoms and signs display that deficiency of liver - Yang and deficiency of liver - Qi were mainly in age 61 ~93(41.4% ,30. 5% ), deficiency of liver - Qi and stagnation of Qi due to depression of the liver were maily in age 41 ~60(32.8% ,31.9% ), stagnation of Qi due to depression of the liver and deficiency of liver - blood were maily in age 21 ~40(35.9% ,33. 3% ), there were significance differences between each age range( P <0. 01). Besides the high incidence it showed easy relapse, more big stone and complicating cholecystolithiasis and calculus of intrahepatic duct in advanced age ( P <0.01). Conclusion; Choledocholith more easily develops in middle and advanced age, and showed easy relapse, more big stone and complicating cholecystolithiasis and calculus of intrahepatic duct. The lithogene-sis has the closs relationship to deficiency of liver - blood, stagnation of Qi due to depression of the liver, deficiency of liver - Qi and dificiency of liver - Yang with the age growing. Prevention and treatment should be benefiting vital energy and warming Yang in advanced - age, dispersing the depressed liver - energ and removing stasis together with benefiting vital energy and warming Yang in middle - age, keeping blood and softening liver together with dispersing the depressed liver — energ and removing stasis in lower - age.

  15. 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

    Directory of Open Access Journals (Sweden)

    André de Moricz

    2010-06-01

    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

  16. 升清胶囊对胆汁促成核蛋白及生化指标影响的临床研究%Clinical study on effects of Shengqing capsule on nucleoprotein α1-acid glycoprotein and biochemical indicators of bile in patients with cholelithiasis

    Institute of Scientific and Technical Information of China (English)

    杨吉勇; 张静喆

    2012-01-01

    Objective To investigate effects and clinical significance of Chinese herbal drugs Shengqing capsule on nucleoprotein α1~acid glycoprotein and biochemical indicators of bile in patient with cholelithiasis. Methods A retrospective analysis was conducted in 40 patients with cholecystolithiasis or cholangiolithiasis definitely diagnosed by B-mode ultrasonic diagnostic equipment or computerized tomography between June 2007 and March 2009. T tube was placed via biliary drainage operation or ERCP+ENBD in biliary surgery. All patients were randomly divided into experimental group and control group, each group had 20 patients. Two groups received conventional treatments (including antibiotic treatments), and experimental group took Shengqing capsule after the first day of operation, T tube patients took Shengqing capsule for 14 d, ENBD patients took Shengqing capsule for 5 d. Then, bile from T tube and ENBD were collected on 1st, 3rd, 5th, 14th after operation respectively, and α1-acid glycoprotein, total bilirubin, un-conjugated bilirubin, cholesterol, phospholipid, total bile acid, calcium of bile were detected. Results Shengqing capsule reduced AAG in experimental group, there was a significant difference between two groups (/k0.05). Compared with control group, Shengqing capsule in experimental group reduced TBIL、 UCB、 CH、 Ca2* (P<0.05), and increased PL ? TBA of bile (P<0.05). Conclusion Shengqing capsule can reduce nucleoprotein AAG content in patients bile with cholelithiasis significantly, which improve biochemical indicators efficiently, and inhibit the formation of calculus in bile.%目的 探讨中药升清胶囊对胆汁中重要的促成核蛋白α1-酸性糖蛋白(α1-acid glycoprotein,AAG)及生化指标的影响及其临床意义.方法 对2007年6月至2009年3月期间收治的40例胆囊结石或肝内外胆管结石患者进行回顾性分析.术前经B超或CT等检查确诊.术中行胆道手术放置T管或行内镜逆行胰胆管造影和

  17. Clinical Analysis of 38 Elderly Patients with Acute Perforation of Gallbladder%老年急性胆囊穿孔38例临床分析

    Institute of Scientific and Technical Information of China (English)

    李恒力; 王艳静; 许丙辉; 刘昭明; 齐双玉

    2013-01-01

    Objective To explore the surgical treatment for acute perforation of gallbladder in elderly patients.Methods Clinical data of 38 elderly patients with acute perforation of gallbladder during January 2008 and June 2012 were retrospectively analyzed.Results All patients had different degrees of abdominal pain,and some patients ran a fever with peritoneal irritation sign and jaundice.All patients underwent B-mode ultrasonography examinations before operation,and 13 patients (34.2%) were misdiagnosed.Six patients were misdiagnosed as having cholecystolithiasis combined with cholecystitis,three misdiagnosed as having peptic ulcer perforation,two misdiagnosed as having acute pancreatitis and two misdiagnosed as having acute ileus.The 38 patients were confirmed perforation of gallbladder by surgical treatment.In 16 patients with postoperative complications,there were 5 patients with pulmonary infection,3 patients with incision infection,2 patients with subphrenic abscess,1 patient with multiple organ failure (MOF),1 patient with liver abscess,1 patient with toxic shock,1 patient with heart failure,1 patient with acute pulmonary embolism and 1-patient with deep venous thrombosis of the lower extremity.Four patients died,and fatality rate was 10.5%.Conclusion The acute perforation of gallbladder in elderly patients is atypical and tends to be misdiagnosed,and B-mode ultrasonography may be helpful in diagnosis.Surgical treatment should be performed as quickly as possible after confirming diagnosis.Postoperative complications have a close relation with combined diseases,which needs more attention.%目的 探讨老年急性胆囊穿孔的外科治疗方法.方法 回顾性分析2008年1月-2012年6月我院收治的38例老年胆囊穿孔的临床资料.结果 全组均有不同程度腹痛,部分患者伴发热、腹膜刺激征、黄疸,术前均行B超检查,13例误诊,误诊率34.2%.误诊为胆囊结石并胆囊炎6例,消化性溃疡穿孔3例,急性

  18. 腹腔镜胆囊切除术中转开腹的原因分析及时机选择%The reason for conversion to open surgery and the opportunity selection of laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    王维帅

    2012-01-01

    Objective: To study the reason for conversion to open surgery and the opportunity selection of laparoscopic cholecystectomy (LC). Methods: The patients who underwent LC successfully for cholecystolithiasis and cholecystitis were distributed into the LC group,and the open choleeysteetomy(OC) group was divided into intended conversion group and forced conversion group according to the opportunity of conversion, then the risk factors of conversion 、 intraoperative and postoperative relative index were observed and recorded. Results:Compared withthe LC group,the OC group contained more cases who had underwent epigastrium operation ever before or been suffering of acute cholecystitis, had higher WBC count and thicker gall bladder wall. The intended conversion group was superior to the forced conversion group in operation duration, blood loss, transfusion rates, postoperative drainage, recovery of gastrointestinal function 、offbed time as well hospital stay. Conclusions: History of epigastrium operation, attack of acute cholecystitis, higher WBC count and thicker gall bladder wall are major risk factors of conversion to open surgery. It is of important clinical value to select correct opportunity to conversion according to the intraoperative search.%目的:研究腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中转开腹的原因及时机.方法:将成功施行LC 的胆囊炎合并胆囊结石患者归入LC组,中转行开腹胆囊切除术(open cholecystectomy,OC)的患者归入OC组,进一步根据中转开腹的时机分为主动中转组与被动中转组,以观察LC中转开腹的危险因素及术中、术后各项指标.结果:OC组上腹部手术史例数、急性胆囊炎发作例数、白细胞计数、胆囊壁厚度均大于LC组;主动中转组手术时间、术中出血量、输血例数、术后引流量、排气时间、下床时间、术后住院时间均明显优于被动中转组.结论:上腹部手术史、急性胆囊炎发作、白

  19. 高原地区和非高原地区腹腔镜胆囊切除术的比较%Comparison of Laparoscopic Cholecystectomy between the Highland and Non-highland Area

    Institute of Scientific and Technical Information of China (English)

    黄韬; 罗彪; 刘佳; 杜景平

    2011-01-01

    Objective To explore the characteristics of patients undergoing laparoscopic cholecystectomy in highland area, in order to carry out better perioperative management. Methods We collected and analyzed the general information, preoperative diagnosis and complications of 367 patients living in highland area and 167 patients living in inland between February 2009 and May 2010. There was no significant difference between the two groups in sex, age and course of disease (P>0. 05). Cholecystolithiasis was the main disease followed by gallbladder polyps, and there was no difference between them in the kind of diseases (P>0. 05). The incidence of hypertension, coronary heart disease, hereditary persistence of fetal hemoglobin and sinus bradycardia was higher in patients in highland area than that in patients in non-highland area (P0. 05). Conventional laparoscopic cholecystectomy was conducted in both two groups. Comparative analysis of treatment outcome and postoperative complications was done. Results The rate of conversion from laparoscopic surgery to laparotomy in Tibetan patients (7. 1%) was higher than that in patients in non-highland area (2. 4%) (P 0.05). Conclusions Laparoscopic cholecystectomy for patients in highlardarea should be converted to laparotomy when necessary. Appropriate perioperative management is helpful in reducing the incidence of postoperative complications.%目的 探讨高原地区腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)患者的特点,以便更好地进行围手术期处理.方法 对2009年2月-2010年5月收治的长期生活在西藏高原地区的患者(高原组)367例和非高原地区患者(非高原地区组)167例的一般资料、术前诊断、合并症情况进行回顾性分析,两组患者性别、年龄及病程比较,差异无统计学意义(P>0.05),有可比性.两组患者诊断均以胆囊结石为主,其次为胆囊息肉,诊断构成比较,差异无统计学意义(P>0.05);两组患者合并症比较,

  20. 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

    Institute of Scientific and Technical Information of China (English)

    张正东; 国维克

    2012-01-01

    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

  1. 十二指肠镜联合腹腔镜治疗胆囊和胆总管结石的临床分析%Duodenoscopy combined with laparoscopy in the treatment of gallstone and choledocholithiasis

    Institute of Scientific and Technical Information of China (English)

    周政; 黄志刚; 王光明; 刘有理; 章社民

    2016-01-01

    time,the average hospital stay and complications were comparatively ana-lyzed between the two groups.Results In 26 patients of minimally invasive double endoscopic group,the choledocholithiasis were all removed,and the nasal biliary drainage was given after surgery.Another four cases failed because of too large stones,and bile duct stent were retained.Twenty-five patients underwent LC operation with three holes within 1 week.There were 10 patients complicated with pancreatitis,and two older patients complicated with basic diseases such as hypertension.They received LC treatment after 2 weeks.In minimally invasive double endoscopic group,there were advantages of minor trauma,less bleeding and fast recovery,but patients were likely to be complicated with pancreatitis.In laparotomy group,there were great trauma,more bleeding,vulnerability to complication of incision infection,longer recovery time,and 12 patients failed to remove stones completely.Conclusions The ERCP combined with LC operation for the treatment of cholecystolithiasis and choledocholithiasis have the advantages of better effect,less trauma,fewer complica-tions and fast recovery,which achieved satisfactory clinical effect.

  2. An investigation on the misdiagnosis of acute pancreatitis in China%急性胰腺炎误诊文献分析

    Institute of Scientific and Technical Information of China (English)

    刁宗礼; 阴桢宏; 王婧; 张淑文; 王宝恩

    2009-01-01

    Objective To study the present situation of misdiagnosed acute pancreatitis(AP)in China and to im prove the identification of AP.Methods One hundred and forty.four documents of Chinese-language cases studies involving the misdiagnosis of AP published from 1988 to 2007 were identified by searching in the China National Knowledge Infrastructure(CNKI).Retrospective study of misdiagnosed diseases,clinical manifestations,risk fac tors and accessory examinations etc,Was made in 1098 patients with AP.Results(1)The patients related to the departments of internal medicine,surgery,obstetrics and gynecology,and pediatrics and so on.The misdiagnosed diseases were over 63 kinds.The first five places successively were:cholelithiasis combined with biliary infection (182 times),acute gastroenteritis(158 times),coronary heart disease(108 times),acute appendicitis(102 times),and intestinal obstruction(90 times).(2)Abdominal pain(878 cases)is the main manifestation in AP, and the first five regions of abdominal pain successively were:upper-middle abdomen(434 cases),whole abdomen (220 cases),right lower quadrant(79 cases),right upper quadrant(74 cases),left upper quadrant(71 cases). (3)Cholecystolithiasis(145 cases)was the first risk factor,and followed the order of fat meal(106 cases)>chronic cholecystitis(72 eases)>alcohol(67 times).(4)The number of cases diagnosed by operation was the most,up to 378;others successively were serum and urine amylase examinations(35 1 CtLSe8)and abdominal CT scan(135 cases),and abdominal ultrasound imaging(59 cases).Conclusions(1)The main causes of misdiag nasis were superficial understanding of predisposing condition,lack of correct analysis on clinical manifestations, and mistakes in the analysis Oil the accessory examinations.(2)Although amylase in serum or urine has limitation in diagnosis,it still Was the main method of diagnosis;and it Was necessary to be examined by abdominal CT or sur gical exploration for patients who were highly

  3. The expression of p53 and k-ras in gallbladder diseases%胆囊良恶性疾病中p53和k-ras的表达和意义分析

    Institute of Scientific and Technical Information of China (English)

    王延召; 张庆余; 于则利; 张立军

    2009-01-01

    Objective To detect the expression of p53 and k-ras in benign and malignant gallbladder diseases.Method ABC immunohistochemistry was used to detect p53 and k-ras protein in 101 specimens of chronic cholecystisis with cholecystolithiasis(group A),20 with cholesterol polyp(group B),22 with adenoma of gallbladder(group C),25 with primary gallbladder cancer(PGC)(in which there were 5 with atypical hyperplasia and carcinoma in situ)(group D)in this study.The relationship between p53 or/and k-ras expression and clinicopathologic data were analyzed.Resuit p53 and k-ras expressions were detected in both benign and malignant specimens,with the positive rates increasing from cholesterol polyp,to chronic cholecystisis to adenoma of gallbladder to carcinoma in situ and PGC(p53 was 62.8% in patients with benign lesions,and 92.0%in malignant lesion x2=8.16,P=0.004;k-ras was positive in 66.4% patients with benign lesions,and 92.0% in malignant lesions x2=6.65,P=0.01).In benign lesions the p53 expressions in group C was higher than that in group A and B(x2=6.90 and 6.02,P=0.009 and 0.014).There was higher expression of p53 in chronic chylecystisis with a history more than 10 years than those less than 10 years(80.0%vs.52.9%,x2=8.28,P=0.004).k-ras in cases less than 60 years old was higher than those after 60 years of age(70.4%vs.46.8%,x2=5.79,P=0.016).Conclusion The higher expression rate of p53 in cholecyst adenoma may predict carcinogenesis,while k-ras is negatively correlated with patients'age,which may bespeak the development of carcinoma in patients younger than 60 years old.%目的 研究p53和k-ras蛋白在胆囊良性病变和胆囊癌组织中的表达及其差异,探讨其阳性表达的临床意义.方法 收集并应用免疫组织化学ABC法检测经手术治疗、病理证实的患者标本,按病种不同分为4组:A组:101例胆囊结石、慢性胆囊炎;B组:20例胆固醇息肉;C组:22例胆囊腺瘤;D组:25例胆囊癌(含5例重度非典型增生

  4. 超声诊断在腹腔镜胆囊切除术中的应用及价值%Application and value of ultrasonic diagnosis in laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    张吉红; 郑坤城; 黄伟勇; 钟发珍

    2015-01-01

    Objective To observe the clinical application value of preoperative ultrasonography in laparoscopic cholecystectomy( LC)in patients. Method 121 cases of LC patients according to the degree of difficulty of operation were divided into surgery difficult group and sur-gical easy group,and were on ultrasonic diagnosis in operation,observe and record the two groups of gallbladder morphology and size,the thickness of gallbladder wall and gallstones polyps,the neck of gallbladder calculus incarcerated,whether there is whether adhesion around the gallbladder and gallbladder fossa the existence of effusion. Results The ultrasound diagnosis and surgery all patients coincidence rate was 99. 17%(120/121),4 cases of gallbladder ultrasound suggested the presence of sticky even in patients who have adhesion in 2 cases of gall-bladder triangle at the common bile duct,cystic duct,common hepatic duct is difficult to separate,anatomical structure is difficult to distin-guish and converted to laparotomy,the conversion rate was 1. 65%(2/121). The gallbladder wall thickness and easy operation difficult group group were(3. 3 ± 0. 62)cm and(3. 3 ± 0. 62)cm group(t=12. 097,P<0. 05);all the patients had no serious complications,and recovered after discharged from hospital. Conclusion Preoperative administration of LC patients undergoing abdominal ultrasonic diagnosis,the acute and chronic cholecystitis and cholecystolithiasis and gallbladder polypoid lesions be diagnosed,the degree of difficulty and can accurately assess the operation,this method has important clinical value for LC.%目的:观察术前超声检查对施行腹腔镜胆囊切除术( LC)患者的临床应用价值。方法:将121例LC患者依据手术难易程度分为手术困难与手术容易两组,并均于术前行超声诊断检查,观察并记录两组胆囊形态与大小,胆囊壁厚度以及胆囊结石息肉情况,胆囊颈管是否存在结石嵌顿、胆囊周边是否粘连以及胆囊窝是

  5. 过夜腹腔镜胆囊切除术的临床价值%Clinical value of overnight laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    徐靖; 赵永捷; 王西墨; 江涛; 王宏磊

    2012-01-01

    目的 探讨过夜腹腔镜胆囊切除术(OLC)的临床价值.方法 回顾性分析2008年10月至2010年12月天津市人民医院收治的149例胆囊结石或胆囊息肉患者的临床资料.所有患者在上午接受LC,术后24 h内出院,术后4~6h对患者一般情况进行改良的Aldrete评分,术后3d进行电话随访,术后7d门诊复查.采用t检验比较OLC和同期住院LC患者住院费用.结果 149例患者施行OLC,130例患者Aldrete评分≥9分;118例视觉模拟量表(VAS)评分≤4分,31例VAS评分>4分,对该31例患者密切监测,均给予吗啡镇痛治疗,疼痛随之缓解.手术当天未出现明显异常,144例患者于术后24h内出院,5例患者因为发热、腹腔积液、腹痛等原因转入普通住院病房.本组患者术后并发症发生率为2.0% (3/149);病死率为0.术后患者随访率为100.0% (149/149),无患者出院后因手术原因再住院治疗者.术后平均无工作能力时间为5.2 d(2~7 d).本组患者平均住院费用为(7888±396)元,明显低于本单位同期住院LC患者的住院费用(12121士960)元(t=38.97,P<0.05).结论 OLC安全、可行,而且符合现行的医疗保险政策.%Objective To evaluate the feasibility and outcome of overnight laparoscopie cholecystectomy (OLC).Methods The clinical data of 149 patients with cholecystolithiasis or gallbladder polyps who were admitted to the Tianjin People's Hospital from October 2008 to December 2010 were retrospectively analyzed.All the patients underwent LC in the morning and were discharged 24 hours later.Modified Aldrete scoring was done 4-6hours after LC.Patients were contacted by telephone 3 days after LC and reexamined in the out-patient department 7 days after LC.The hospital cost of patients who underwent OLC or LC was compared using the t test.Results OLC was successfully performed on 149 patients,and the modified Aldrete scores of 130 patients were above 9.The visual analogue scale (VAS) of 118 patients were under

  6. 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

    Institute of Scientific and Technical Information of China (English)

    杨慧慧; 李会兵; 刘爽; 刘贤英

    2016-01-01

    /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.

  7. Clinical characteristics of acute pancreatitis in pregnancy%妊娠合并急性胰腺炎的临床特征分析

    Institute of Scientific and Technical Information of China (English)

    殷春丽; 张玉泉; 张晓彬; 彭丽华; 柴国君; 李闻

    2015-01-01

    Objective To investigate the pathogenesis and therapeutic strategies of acute pancreatitis in pregnancy (APIP). Methods A retrospective analysis was performed in terms of the characteristics, treatment managements, and clinical outcomes in 12 patients with APIP admitted to Chinese PLA General Hospital from January 2010 to November 2014. The control group consisted of 24 acute pancreatitis patients without pregnancy aged 22-39 years during the same period. Results The content of serum triglyceride in APIP group was significantly higher than control group [(4.62±5.21) mmol/L vs (1.91±1.90) mmol/L, P=0.003]. However, there were no differences between two groups in white blood cell count, hemoglobin concentration, serum total cholesterol, serum calcium and fasting blood glucose. Also, there were no significant differences in the incidence of premorbid high-fat diet, as well as in the incidence of cholecystolithiasis and length of stay in hospital between two groups. In APIP group, 10 patients were cured clinically without any complications, one case was complicated with pancreatic pseudocyst as well as secondary diabetes mellitus, and one patient died of multiple organ dysfunction syndrome (MODS). One case had a fetal death due to intrauterine distress followed by cesarean section, one case underwent labor induction in the course of pancreatitis and one case requested automatic termination of pregnancy after she was cured. Nine infants survived. Conclusion Hyperlipidemia may be one of the risk factors in pathogenesis of APIP. It is necessary to monitor blood lipid and pay attention to diet, especially in avoiding excessive tonic. Clinicians need to take both mothers and fetuses into consideration for individualized treatment.%目的:总结妊娠合并急性胰腺炎(acute pancreatitis in pregnancy,APIP)的发病特点和诊疗经验。方法对2010年1月-2014年11月解放军总医院收治的12例24~40岁 APIP 患者的发病、治疗和转归进行回

  8. 多排螺旋CT在胆源性胆囊-十二指肠瘘诊断中的临床价值%Clinical value of multi-slice computed tomography in the diagnosis of biliary gallbladder-duodenal fistula

    Institute of Scientific and Technical Information of China (English)

    王均庆; 郑庆华; 陆风旗; 张雷; 张追阳; 丁忠; 余迅

    2015-01-01

    Objective To summarize the characteristics and clinical value of multi-slice spiral computed tomography (MSCT) examination in the biliary gallbladder-duodenal fistula.Methods The imaging data of 28 patients with gallbladder-duodenal fistula who were admitted to the Wuxi No.2 Hospital of Nanjing Medical University between June 2012 and March 2015 were retrospectively analyzed.All the 28 patients received MSCT examinations,and the imaging changes were observed and analyzed,including the location of lesions,figures of fistulous tract,shrinking or enlarging gallbladder,pneumotosis and stones of gallbladder or bile duct.Results Of the 28 patients,fistula located at the duodenal bulb were detected in 14 patients,junction of the bulb and the descending part of the duodenum in 2 patients,ascending duodenum in 7 patients,horizontal part in 5 patients.Indirect signs of biliary gallbladder-duodenal fistula included that gallbladder volume in 28 patients was significantly reduced,cross sectional area of gallbladder was 2 cm × 1 cm-6 cm × 2 cm,and gallbladder wall was thickened with an average thickness of 5 mm (range,4-9 mm).Adhesion of gallbladder and duodenum,unclear boundary,structure disorder and visible effusion surrounding gallbladder were detected.Among 21 patients with biliary gas,19 patients had pneumotosis of gallbladder and 17 had biliary pneumatosis.Biliary stones were detected in 23 patients including cholecystolithiasis in 19 patients,gallbladder neck stones in 6 patients,common bile duct stones in 13 patients and intra-and extra-hepatic cholangiolithiasis in 1 patient.The diverticulum signs appeared in the duodenum of 11 patients.The direct signs of MSCT in the biliary gallbladder-duodenal fistula included that fistulous tract of 13 patients clearly showed and some were dumbbell-shaped.Two and 2 patients were complicated with gallstone ileus and multiple liver abscesses,respectively.The diagnostic results of MSCT in 28 patients were compared with the results

  9. 腹腔镜与开腹胆囊切除术对老年患者术后应激反应和疲劳综合征影响的对比研究%The comparative study of the influence of laparoscopic and open cholecystectomy on elderly patients ' post-operative stress response and fatigue syndrome

    Institute of Scientific and Technical Information of China (English)

    张风华; 王海久; 杨志奇; 胡涛; 朱振新

    2011-01-01

    Objective:To comparatively analyze the influence of laparoscopic and open cholecystectomy on elderly patients' post-operative stress response and fatigue syndrome,trying to offer objective proof for the superiority of laparoscopic cholecystectomy in curing the elderly patients with cholecystolithiasis. Methods: The researcher screened 40 elderly gallbladder calculi patients, and then divided them into 2 operation groups: laparoscopic cholecystectomy ( LC) group and open cholecystectomy (OC) group. Each group consisted of 20 patients. The day before the operation was marked T0 ,the first day after operation was T, ,the second day after operation T2 ,the third day after operation T3. T0 ,T1 ,T2 ,T3 were chosen as the observation points. Various indicators, both in pre-operation and post-operation, were examined, such as interleukin-6 ( IL-6 ) , interleukin-10 (IL-10), C-reactive protein (CRP), white blood cell ( WBC) ,cortisol and postoperative fatigue score,etc. The operation time,intraoperative blood loss,post-operation analgesic using rate, the post-operative fever time,and the hospital stay were compared and analyzed between the 2 groups. Results:In post-operation,there appeared the obvious IL-6 increase in the two groups. And the increase amounted to the peak in the T1. In the T, and T2 of post-operation, IL-6 densities in LC were lower than those of 0C;In post-operation, the IL-10 density of patients in two groups began to decline both starting from T,. IL-10 densities in LC were at the lowest level in the T2 while in OC they were at the lowest level in the T3. IL-10 density levels measured in the T2 and T3 in LC were significantly higher than those of OC; post-operative CRP levels in both groups reached their peaks in the T1. Meanwhile, in the different post-operative periods CRP density levels in OC were significantly higher than those of LC,besides in the T3 ,they were higher than pre-operative level;the WBC in LC increased in the T1 and T2 ,the level of T3