腹腔镜下胆囊切除治疗炎性胆囊疾病的研究进展

炎性胆囊疾病是临床上常见的一种疾病,发病率较高。炎性胆囊疾病是由细菌或者其他因素引起胆囊感染的一种疾病,学者们将其分为急性胆囊炎和慢性胆囊炎,通过患者的临床经过和表现进行区分。炎性胆囊患者会感到腹部剧烈疼痛,伴随着恶心、发烧、呕吐和黄疸等症状,对人们的身体健康造成了严重的危害。治疗急性胆囊炎最好采用外科手术,实施开腹手术。但开腹手术通常创口较大,非常容易损伤腹壁血管等,术后并发症风险增加,因此治疗效果不佳。在炎性胆囊炎治疗中引入腹腔技术,是为了提高手术效果,通过研究证实手术效果确实更佳。这是由于手术切口相较开腹确实更小,出血量少。因此,本文对腹腔镜下胆囊切除治疗炎性胆囊疾病进行研究,文章内部会对腹腔镜手术进行简述,阐述该手术的适应症、术前准备、手术步骤、手术优势以及并发症,对该手术的并发症进行探究,期望能为临床胆囊炎治疗提供可参考性建议。

针刺肝胆募穴对炎性低张力胆囊运动影响的时效规律初探

目的：比较针刺肝胆募穴对炎性低张力胆囊运动影响的时效规律,为针刺治疗慢性胆囊炎、胆石症确定更佳处方和留针时间提供参考依据。方法：将24例患者随机分为期门组、期门配日月组,每组12人,每次留针60 min,并在B超下观察胆囊运动情况。结果：两组穴位均能促进炎性低张力胆囊的舒缩运动,期门配日月组胆囊舒缩幅度更明显。结论：针刺期门穴、日月穴治疗慢性胆囊炎（低张力型）留针时间以40-50 min,每天针刺2次为宜。

手针与电针对炎性低张力胆囊运动影响的时效规律初探

目的:比较手针与电针对炎性低张力胆囊运动影响的时效规律,为针刺治疗慢性胆囊炎、胆石症确定更佳处方和留针时间提供参考。方法:26例患者随机分为手针组、电针组,每组13例,每次留针60 min,并在B超下观察胆囊运动情况。结果:两种刺激方法均能促进炎性低张力胆囊的舒缩运动,电针组胆囊舒缩运动更明显,持续时间更长。结论:手针以留针30 min为宜,电针以留针50 min为宜,每天针刺2次,效果更佳。

腹腔镜下胆囊切除治疗炎性胆囊疾病的研究进展

炎性胆囊疾病是指发生在胆囊内细菌性和化学性炎症,腹痛、恶心、呕吐、发热、黄疸等是该症患者的主要临床表现和体征,此症还会引发一系列严重并发症,甚至危及患者的生命。腹腔镜下胆囊切除术有着并发症发生率低、创伤面以及出血量少的特点,很多病患经此项治疗均能取得满意成效。为探讨腹腔镜下胆囊切除治疗炎性胆囊疾病的研究进展情况,旨意为相关人员的研究工作提供参考文献。

21例胆囊炎性胆汁团的超声图像分析

胆囊炎性胆汁团是胆囊炎的一种特殊表现,本文就B超检出21例,现报告如下。 1 资料与方法 1991年7月～1993年6月使用东芝SA—38AS型实时电子线阵型超声诊断仪,探头频率3.5MHz诊断胆囊炎性胆汁团21例。男性9例,女性12例,年龄27～63岁,平均41岁,经手术治疗15例,另6例非手术治疗。 2

胆囊颈部结扎在炎性水肿胆囊切除术中的应用24例体会

我院外科2002年1月～2007年12月间，因急性胆囊炎行急诊胆囊切除术中，采用胆囊颈部结扎的改良式顺逆结合法切除炎性水肿胆囊24例，手术顺利，疗效较满意，报告如下。

Risk factors of acute cholecystitis after endoscopic common bile duct stone removal

AIM： To evaluate the risk factors of acute cholecystitis after endoscopic common bile duct （CBD） stone removal. METHODS： A total 100 of patients who underwent endoscopic CBD stone removal with gallbladder （GB） in situ without subsequent cholecystectomy from January 2000 to July 2004 were evaluated retrospectively. The following factors were considered while evaluating risk factors for the development of acute cholecystitis： age, gender, serum bUirubin level, GB wall thickening, cystic duct patency, presence of a GB stone, CBD diameter, residual stone, lithotripsy, juxtapapillary diverticulum, presence of liver cirrhosis or diabetes mellitus, a presenting illness of cholangitis or pancreatitis, and procedure-related complications. RESULTS： During a mean 18-mo follow-up, 28 （28%） patients developed biliary symptoms; 17 （17%） acute cholecystitis and 13 （13%） CBD stone recurrence. Of patients with acute cholecystitis, 15 （88.2%） received laparoscopic cholecystectomy and 2 （11.8%） open cholecystectomy. All recurrent CBD stones were successfully removed endoscopically. The mean time elapse to acute cholecystitis was 10.2 mo （1-37 mo） and that to recurrent CBD stone was 18.4 mo. Of the 17 patients who received cholecystectomy, 2 （11.8%） developed recurrent CBD stones after cholecystectomy. By multivariate analysis, a serum total bUirubin level of 〈1.3 mg/dL and a CBD diameter of 〈11 mm at the time of stone removal were found to predict the development of acute cholecystitis. CONCLUSION： After CBD stone removal, there is no need for routine prophylactic cholecystectomy. However, patients without a dilated bile duct （〈11 mm） and jaundice （〈1.3 mg/dL） at the time of CBD stone removal have a higher risk of acute cholecystitis and are possible candidates for prophylactic cholecystectomy.

Factors associated with time to laparoscopic cholecystectomy for acute cholecystitis

AIM: To determine patient and process of care factors associated with performance of timely laparoscopic cholecystectomy for acute cholecystitis. METHODS: A retrospective medical record review of 88 consecutive patients with acute cholecystitis was conducted. Data collected included demographic data, co-morbidities, symptoms and physical findings at presentation, laboratory and radiological investigations, length of stay, complications, and admission service (medical or surgical). Patients not undergoing cholecystectomy during this hospitalization were excluded from analysis. Hierarchical generalized linear models were constructed to assess the association of pre-operative diagnostic procedures, presenting signs, and admitting service with time to surgery.RESULTS: Seventy cases met inclusion and exclusion criteria, among which 12 were admitted to the medical service and 58 to the surgical service. Mean ± SD time to surgery was 39.3 ± 43 h, with 87% of operations performed within 72 h of hospital arrival. In the adjusted models, longer time to surgery was associated with number of diagnostic studies and endoscopic retrograde cholangio-pancreatography (ERCP, P = 0.01) as well with admission to medical service without adjustment for ERCP (P < 0.05). Patients undergoing both magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT) scans experienced the longest waits for surgery. Patients admitted to the surgical versus medical service underwent surgery earlier (30.4 ± 34.9 vs 82.7 ± 55.1 h, P < 0.01), had less post-operative complications (12% vs 58%, P < 0.01), and shorter length of stay (4.3 ± 3.4 vs 8.1 ± 5.2 d, P < 0.01).CONCLUSION: Admission to the medical service and performance of numerous diagnostic procedures, ERCP, or MRCP combined with CT scan were associated with longer time to surgery. Expeditious performance of ERCP and MRCP and admission of medically stable patients with suspected cholecystitis to the surgical service to speed up time to surgery should be considered.

Timing of laparoscopic cholecystectomy for acute cholecystitis: A prospective non randomized study

AIM： To study the timing of laparoscopic cholecystectomy for patients with acute cholecystitis. METHODS： Between January 2002 and December 2005, all American Society of Anesthesiologists classification （ASA） Ⅰ ,Ⅱ and Ⅲ patients with acute cholecystitis were treated laparoscopically during the urgent （index） admission. The patients were divided into three groups according to the timing of surgery： （1） within the first 3 d, （2） between 4 and 7 d and （3） beyond 7 d from the onset of symptoms. The impact of timing on the conversion rate, morbidity and postoperative hospital stay was studied. RESULTS： One hundred and twenty-nine patients underwent laparoscopic cholecystectomy for acute cholecystitis during the index admission. Thirty six were assigned to group 1, 58 to group 2, and 35 to group 3. The conversion rate and morbidity for the whole cohort of patients were 4.6% and 10.8%, respectively. There was no significant difference in the conversion rate, morbidity and postoperative hospital stay between the three groups.CONCLUSION： Laparoscopic cholecystectomy for acute cholecystitis during the index admission is safe, regardless of the time elapsed from the onset of symptoms. This policy can result in an overall shorter hospitalization.

H pylori are associated with chronic cholecystitis

AIM： To study whether H pylon are associated with chronic cholecystitis. METHODS： The subjects were divided into three groups： H pylori-infected cholecystitis group, H pylorinegative cholecystitis group and control group. Pathologic changes of the gallbladder were observed by optic and electronic microscopes and the levels of interleukin-1, 6 and 8 （IL-1, 6 and 8） were detected by radioimmunoassay. RESULTS： Histological evidence of chronic cholecystitis including degeneration, necrosis, inflammatory cell infiltration, were found in the region where H pylori colonized. Levels of IL-1, 6 and 8 in gallbladder mucosa homogenates were significantly higher in H py/oriinfected cholecystitis group than those in Hpylorinegative cholecystitis group and control group. CONCLUSION： H pylon infection may be related to cholecystitis.

Metastatic melanoma of the gallbladder: An unusual clinical presentation of acute cholecystitis

Metastatic disease from cutaneous melanoma can af-fect all organs of the body, and varies in its biological behavior and clinical presentation. We present the case of a 58-year-old man who arrived at our clinic with acute abdominal pain, which, after investigation, was diagnosed as acute cholecystitis. The patient under-went laparotomy and cholecystectomy. Two years ago, he underwent surgical removal of a primary cutaneous melanoma on his right upper back. Pathological exami-nation revealed the presence of malignant melanoma with a metastatic lesion of the gallbladder.

Original single-incision laparoscopic cholecystectomy for acute inflammation of the gallbladder

AIM： To investigate the safety and feasibility of our original single-incision laparoscopic cholecystectomy （SII_C） for acute inflamed gallbladder （AIG）.

Sclerosing cholecystitis associated with autoimmune pancreatitis

AIM： TO evaluate the histopathological and radiological findings of the gallbladder in patients with autoimmune pancreatitis （AIP）. METHODS： The radiological findings of the gallbladder of 19 AIP patients were retrospectively reviewed. Resected gallbladders of 8 AIP patients were examined histologically and were immunostained with anti- IgG4 antibody. Controls consisted of gallbladders resected for symptomatic gallstones （n = 10） and those removed during pancreatoduodenectomy for pancreatic carcinoma （n = 10）, as well as extrahepatic bile ducts and pancreases removed by pancreatoduodenectomy for pancreatic carcinoma （n = 10）. RESULTS： Thickening of the gallbladder wall was detected by ultrasound and/or computed tomography in 10 patients with AIP （3 severe and 7 moderate）; in these patients severe stenosis of the extrahepatic bile duct was also noted. Histologically, thickening of the gallbladder was detected in 6 of 8 （75%） patients with AIP; 4 cases had transmural lymphoplasmacytic infiltration with fibrosis, and 2 cases had mucosal-based lymphoplasmacytic infiltration. Considerable transmural thickening of the extrahepatic bile duct wall with dense fibrosis and diffuse ly,mphoplasmacytic infiltration was detected in 7 patients. Immunohistochemically, severeor moderate infiltration of IgG4-positive plasma cells was detected in the gallbladder, bile duct, and pancreas of all 8 patients, but was not detected in controls. CONCLUSION： Gallbladder wall thickening with fibrosis and abundant infiltration of IgG4-positive plasma cells is frequently detected in patients with AIP. We propose the use of a new term, sclerosing cholecystitis, for these cases that are induced by the same mechanism as sclerosing pancreatitis or sclerosing cholangitis in AIP.

Tc-99m ciprofloxacin imaging in acute cholecystitis

AIM: To evaluate the eff icacy of a new nuclear imaging Infecton (Tc-99m ciprofloxacin) for the diagnosis of acute cholecystitis. METHODS: Sixteen patients thought to have acute cholecystitis were included in this study. The diagnosis of acute cholecystitis was made based on clinical symptoms and ultrasonographic and pathologic f indings. RESULTS: The 16 patients were composed of 12 acute and 4 chronic cholecystitis patients. Twelve patients with acute cholecystitis were image-positive, including one false-positive. Four patients with chronic cholecystitis were image-negative, of whom three were true-negative. This nuclear imaging had a sensitivity of 91.7%, a specificity of 75%, a positive-predictive value of 91.7%, and a negative-predictive value of 75%. CONCLUSION: Tc-99m ciprofloxacin imaging is easy to perform and applicable for the diagnosis of acute cholecystitis.

Acute transient hepatocellular injury in cholelithiasis and cholecystitis without evidence of choledocholithiasis

AIM： To investigate acute transient hepatocellular injury in patients with cholelithiasis and cholecystitis but no evidence of choledocholithiasis.METHODS： The medical records of patients with cholelithiasis who underwent cholecystectomy between July 2003 and June 2007 were retrospectively reviewed. Imaging studies to detect common bile duct （CBD） stones were performed in 186 patients, who constituted the study population. Biochemical liver tests before and after surgery, and with the presence or absence of CBD stones were analyzed.RESULTS： In 96 patients with cholelithiasis and cholecystitis without evidence of CBD stones, 49 （51.0%） had an alanine aminotransferase level elevated to 2-3 times the upper limit of normal, and 40 （41.2%） had an elevated aspartate aminotransferase level. Similar manifestations of hepatocellular injury were, as would be expected, even more obvious in the 90 patients with CBD stones. These markers of hepatocellular injury resolved almost completely within 2 wk to 1 mo after cholecystectomy. Compared to 59 patients with histologically less severe cholecystitisin the group undergoing urgent surgery （total 74 patients）, the 15 patients with a gangrenous gallbladder had a higher mean level of total bilirubin （2.14 ± 1.27 mg/dL vs 2.66 ± 2.97 mg/dL, P 〈 0.001） and white cell count （9480 ± 4681/μL vs 12840 ± 5273/μL, P = 0.018）.CONCLUSION： Acute hepatocellular injury in cholelithiasis and cholecystitis without choledocholithiasis is mild and transient. Hyperbilirubinemia and leukocytosis may predict severe inflammatory changes in the gallbladder.

Percutaneous liver biopsy complicated by hemobilia-associated acute cholecystitis

Liver biopsy is generally considered a safe and highly useful procedure. It is frequently performed in an outpatient setting for diagnosis and follow-up in numerous liver disorders. Since its introduction at the end of the 19th century, broad experience, new imaging techniques and special needles have significantly reduced the rate of complications associated with liver biopsy. Known complications of percutaneous biopsy of the liver include hemoperitoneum, subcapsular hematoma, hypotension, pneumothorax and sepsis. Other intra-abdominal complications are less common. Hemobilia due to arterio-biliary duct fistula has been described, which has only rarely been clinically expressed as cholecystitis or pancreatitis. We report a case of a fifteen year-old boy who developed severe acute cholecystitis twelve days after a percutaneous liver biopsy performed in an outpatient setting. The etiology was clearly demonstrated to be hemobilia-associated, and the clinical course required the performance of a laparoscopic cholecystectomy. The post operative course was uneventful and the patient was discharged home. Percutaneous liver biopsy is a safe and commonly performed procedure. However, severe complications can occasionally occur. Both medical and surgical options should be evaluated while dealing with these rare incidents.