肝硬化患者胆囊继发性改变与肝功能的关系

采用B超对226例肝硬化和210例正常人胆囊形态改变进行检查,同时应用单光子发射型计算机断层显像方法对其中29例患者的胆囊排空功能进行了检查。结果:①肝硬化组胆囊壁毛糙、增厚、是双影、胆囊结石和胆囊排空迟缓的发病率分别为95.6％、90.3％、43.9％、13.3％和51.8％,均明显高于正常组(P<0.05)。②胆囊壁毛粗、增厚,呈双影的发生率和胆囊壁的厚度与肝功损伤程度呈明显的正相关(P<0.01)。说明肝功损伤越重,胆囊慢性病变发病率越高。

Use of color Doppler ultrasonography in the diagnosis of anomalous connection in pancreatobiliary disease

AIM: To estimate the detectability of anomalous connection in pancreatobiliary disease (ACPBD) cases, measuring gallbladder wall blood flow (GWBF).METHODS: In the retrospective study, we enrolled 42subjects with gallbladder wall thickening. GWBF velocity was determined as an average value of the peak velocity of color signals on the gallbladder wall, three times in each case. Based on the findings on endoscopic ultrasonography (EUS) or endoscopic retrograde cholangiopancreatography (ERCP), the 42 subjects were divided into 11 cases with ACPBD and 31 cases without ACPBD. In the prospective study, the subjects were 92 cases with gallbladder wall thickening. Using the cut-off level of the flow velocity obtained in the retrospective study, the usefulness of measuring GWBF velocity in diagnosing ACPBD was evaluated.RESULTS: In the retrospective study, imaging of GWBF was obtained in 40 of the 42 subjects. The mean GWBF velocity of the ACPBD cases was 29.4±3.9 cm/s(mean±SD), which was significantly different (P＜0.0001;95% CI 5.48-13.2) from that of the without ACPBD cases(20.1±5.9 cm/s). Based on this result, we prepared a receiver operating characteristic curve, and the cut-off level appropriate for diagnosing ACPBD was estimated to be 25 cm/s. In the prospective study, GWBF was detected in 86 of the 92 subjects. Based on the EUS or ERCP findings, the 92 subjects were divided into 15 cases with ACPBD and 77 cases without ACPBD. When a cut-off level of 25 cm/s was employed, ACPBD could be diagnosed with a sensitivity of 87.0% (13/15) and a specificity of87.3% (62/71).CONCLUSION: Measurement of GWBF velocity, which is less invasive and provides objective values, is very useful for diagnosing ACPBD prior to the development of malignant tumors in cases with gallbladder wall thickening.

Prenatal diagnosis of choledochal cyst using magnetic resonance imaging: A case report

Choledochal cysts are congenital anomalies of the biliary ducts, characterized by cystic dilatation of the ducts.Prenatal diagnosis of this anomaly using ultrasonography (US) has been well documented. Magnetic resonance imaging (MRI) has recently become an important complement to US in prenatal diagnosis of fetal anomalies. We herein report a patient in whom at 24 wk' gestation US suggested a right upper quadrant abdominal cyst and in whom at 26 wk' gestation MRI more clearly delineated the cyst and its surrounding structures and suggested a choledochal cyst, which was confirmed at postnatal surgery and histopathology.

Analysis of the histologic features in the differential diagnosis of intrahepatic neonatal cholestasis

AIM:To compare the histologic features of the liver in intrahepatic neonatal cholestasis(IHNC)with infectious,genetic-endocrine-metabolic,and idiopathic etiologies. METHODS:Liver biopsies from 86 infants with IHNC were evaluated.The inclusion criteria consisted of jaundice beginning at 3 mo of age and a hepatic biopsy during the 1st year of life.The following histologic features were evaluated:cholestasis,eosinophilia,giant cells,erythropoiesis,siderosis,portal fibrosis,and the presence of a septum. RESULTS:Based on the diagnosis,patients were classified into three groups:group 1(infectious;n=18),group 2(genetic-endocrine-metabolic;n=18),and group 3(idiopathic;n=50).There were no significant differences with respect to the following variables:cholestasis,eosinophilia,giant cells,siderosis,portalfibrosis,and presence of a septum.A significant difference was observed with respect to erythropoiesis,which was more severe in group 1(Fisher's exact test,P=0.016). CONCLUSION:A significant difference was observed in IHNC of infectious etiology,in which erythropoiesis was more severe than that in genetic-endocrine-metabolic and idiopathic etiologies,whereas there were no significant differences among cholestasis,eosinophilia,giant cells,siderosis,portal fibrosis,and the presence of a septum.

胆囊腺肌症的诊治:附205例报告

目的:探讨胆囊腺肌症的诊断和治疗方法。方法:从北京大学人民医院病案数据库中检索2003年1月1日-2013年12月31日接受胆囊手术的患者资料,选取病理证实存在胆囊腺肌症的病例,回顾性分析各种影像学检查方法对胆囊腺肌症的正确诊断率、手术方式及效果。结果:在6 336例胆囊手术患者中,病理证实存在205例(3.2%)胆囊腺肌症,其中195例(95.1%)合并慢性胆囊炎,150例(73.2%)合并胆囊结石。B超、CT、MRI的正确诊断率分别为16.2%、26.5%和43.8%。病变类型以局限型最多,为164例(80.0%),弥漫型和节段型相对较少,分别为16例(7.8%)和25例(12.2%)。178例(86.8%)接受了腹腔镜下胆囊切除手术,24例(11.7%)为传统开腹胆囊切除手术,未出现胆道损伤等并发症;3例接受了腹腔镜下胆囊部分切除手术。术后随访1年未发现胆囊腺肌症残留和复发病例。结论:胆囊腺肌症多合并胆囊结石和胆囊炎,容易漏诊,MRI检查正确诊断率较高。对于位于胆囊底部的局限型病例,可考虑选择腹腔镜下胆囊部分切除手术治疗。

胆囊息肉样变51例分析

目的:探讨胆囊息肉样变(PLG)的诊断及手术指征。方法:对B超和病理诊断的胆囊息肉样变51例进行回顾分析。结果:胆固醇性息肉以多发为主,本组为87.8%,平均直径3～7 mm。胆囊腺瘤以单发为主占76.9%(10/13)。腺瘤癌变4例,占30.7%,直径均>15 mm,伴轻中度不典型增生2例,重度不典型增生1例。结论:(1)B超是诊断PLG的首选方法;(2)单发,直径≥10 mm,基底宽,合并胆囊炎胆囊结石,有右上腹痛症状,息肉短期内增长较快者作为手术指征;(3)多发胆固醇性息肉可定期随访。

胆囊腺肌增生症28例临床分析

目的 总结胆囊腺肌增生症（GBA）患者的临床特点及诊治.方法 回顾分析28例GBA患者的临床资料.结果 胆囊腺肌增生症无特异性临床表现,术前诊断与术后诊断符合率7.14%（2/28）,患者术后恢复顺利,术后除横结肠癌者术后2年死亡外,余均无殊.结论 胆囊腺肌增生症临床无特异表现,容易误诊、漏诊,确诊需要依赖病理检查.行胆囊切除术（腹腔镜下单纯胆囊切除LC）是行之有效的治疗方法,愈后良好.

血清总胆汁酸在肝胆疾病中的临床应用

目的探讨血清总胆汁酸(total bile acids,TBA)测定在肝胆疾病中的临床应用价值。方法采用第五代循环酶法测定血清TBA与传统肝功能指标ALT、AST、ALP、GGT、CHE作比较,并对其在肝胆疾病中的应用作探讨。结果各类肝胆疾病的TBA均较对照组明显增高(P<0.01)。结论 TBA是一个良好的肝功能指标,能更好反映肝实质损伤的的一项重要指标。

胆囊残部综合征19例诊治体会

目的探讨胆囊残部综合征的病因、诊断和治疗,总结经验教训。方法回顾性分析19例胆囊残部综合征患者的临床资料。结果13例行胆囊残部切除术;4例同时探查胆总管;1例术中损伤胆总管而行胆管空肠Roux-en-Y吻合术;1例合并十二指肠胆总管内瘘,行胃部分切除,Roux-en-Y空肠胆管吻合术,均痊愈出院。19例随访6个月至5年,症状消失。结论再次手术切除胆囊残部,是治疗胆囊残部综合征的有效方法。