胆囊

Objective:To evaluate the spiral CT cholecystography with three-dimentional reconstruction for diagnosis of gallbladder lesions.Methods:Combining oral and intravenous cholecystgraphic CT,43 patients underwent single breath-hold upper abdominal spiral CT volume scanning.

43例胆囊疾病者中胆囊结石27例，胆囊癌9例，胆囊息肉7例；利用口服胆囊造影CT和静脉输入胆道对比剂Biliscopin相结合，行上腹部螺旋CT容积扫描，在工作站利用软件将图像处理后得到胆囊及胆管系统立体图像。

Methods 8cases severe adherence acute cholecystitis,10cases repeatedly broken out,the gallbladder recrease fibross,2cases of Mirizzi sydrome the chololith occlude the neck of the cyst,the total chole-cystectomy is difficult,partly retain the gallbladder back wall of cyst,the mucosa is damaged by electrotore,partly anat-omize the cyst duct,close the duct in the proper postion.

8例粘连严重处于炎症急性期，10例反复发作胆囊壁纤维增厚，2例Mirizzi综合征结石嵌顿在胆囊颈部，强行完整切除胆囊困难，采取保留部分胆囊后壁，残留黏膜予以破坏，部分游离胆囊管，在适当位置关闭胆囊管。

Stone recurred in 8 cases including atrophic gallbladder,a preoperative history of suppurative cholecystitis, Hour-glass gallbladder,and tortuous gall duct in one each.

共有8例复发胆囊结石，葫芦状胆囊、化脓性胆囊炎、萎缩性胆囊炎和胆囊管过长各1例，9例胆囊胆固醇沉积症复发4例。8例胆囊收缩功能30%～50%者5例复发结石。

~in august, 1997 the good gallbladder majority of excisions 45 examples clinical material carried on the analysis to june, 1986.result:in 45 examples because the gallbladder itself pathological change good gallbladder majority of excises 41 examples, after the technique the non-gallbladder fistula, the hemorrhage, illness complication and so on icterus, abdominal cavity abscess.

48例腹腔镜胆囊切除术治疗胆囊良性疾。。。目的：探讨胆囊大部分切除在胆道外科中的应用价值。方法：对1986年6月～1997年8月行胆囊大部分切除的45例临床资料进行分析。结果：45例中因胆囊本身病变行胆囊大部分切除41例，术后无胆瘘、出血、黄疸、腹腔脓肿等并发症。

ABSTRACT Objective To discuss the importance of the study of conformation and variation of extrahepatic bile duct before gallbladder operationMethods The images of 100 cases having normal structure of gallbladder and extrahepatic bile duct were studied;the conformations and confluence sites were analyzedResults Among the 100 cases,97 cases had clear images of extrahepatic bile duct (97%),3 cases with large amount of air bulbs in bile duct because of the laxation of the lower common bile duct still had clear images of the general conformation of extrahepatic bile duct,87 cases had clear images of gallbladder and cystic duct (87%),13 cases (13%) had partial images of gallbladder or cystic ductConclusions ERCP can clearly show out the conformation and variation of extrahepatic bile duct and cystic duct and it is of important value before gallbladder operation

目的 通过对100例胆囊及肝外胆管正常结构尚存在的患者ERCP图像资料进行归纳和分析，探讨胆囊手术术前了解肝外胆道系统形态及变异的重要性。方法选出100例胆囊及肝外胆管正常结构尚存在的患者图像，对其形态、汇合位置进行分析。结果 100例患者图像中肝外胆管显示清晰者97例(97%)，3例因胆总管下端开口松弛导致大量气泡进入胆道，但肝外胆管大体形态显示尚清晰，胆囊及胆囊管显示清晰者87例(87%)，13例(13%)仅部分显示胆囊或胆囊管。结论 ERCP可以清晰显示肝外胆管及胆囊管的形态及变异情况，对于胆囊手术术前了解肝外胆道系统形态及变异有重要价值。 ERCP；胆囊管；肝外胆管

Objective To explore the relationship between abnormal position gallbladder plica and gallbladder diseases. Methods There were 5 000 cases of gallbladder with plica during recent 11 years who were divided into 2 groups and whose data were analyzed retrospectively.

目的探讨胆囊皱襞异常与胆囊疾病的关系方法我科1995年1月至2006年10月共发现5 000例皱襞胆囊，根据其位置分胆囊皱襞位置正常组（2 500例）和胆囊皱襞位置异常组（2 500例），对其超声资料进行回顾性分析。

Results Preoperative diagnostic rate was53.6%,and operative resection rate was71.4%,simple cholecystectomy in6cases,cholecystectomy and exploration of the biliary passage in4cases,gallbladder and regional lymphadonectomy in2cases,gallbladder and liver wedge resection and regional lymphadonectomy in6cases,gallblad-der and liver wedge resection and regional lymphadonectomy and right hemicolectomy in1case,and gallbladder and liver wedge resection and regional lymphadonectomy and subtotal gastrectomy and right hemicolectomy in1case.Unre-sectable rate were28.6%,gastro-jejunostomy in2cases,cholecystostomy in1case.Laparotomy exploration only in5cases.

结果 术前确诊率仅为53.6%（15/28），手术切除率为71.4%（20/28），单纯胆囊切除术6例（占21.4%），胆囊切除+总胆管探查4例（占14.3%），胆囊切除+区域淋巴结清扫2例（占7.1%），胆囊+肝楔状切除+区域淋巴结清扫6例（占21.4%），胆囊+肝楔状切除+区域淋巴结清扫+右半结肠切除1例（占3.6%），胆囊+肝楔状切除+区域淋巴结清扫+胃大部切除+右半结肠切除1例（占3.6%），未切除率为28.6%，胃-空肠吻合术2例（占7.1%），胆囊造瘘1例（占3.6%），仅做剖腹探查术5例（占17.9%）。

Results: Among 80 cases of ACST, 76 cases were successfully implemented LC, gallbladder puncture and decompression choledocholithotomy T-tube drainage were performed in 11 cases, choledocholithotomy T-tube drainage in 15 cases, common bile duct gall bladder fistula Toishi T-tube drainage in 14 cases, gallbladder removal choledocholithotomy T-tube drainage in 36 cases, operative time 15-120 min, bleeding 10-80 ml; 4 cases transitted laparotomy, 1 case of gallbladder and surrounding tissue adhesion serious, ampulla signs disappear, and the hepatoduodenal ligament ill-defined, 2 cases of gallbladder contraction deep within the liver, gallbladder triangle scar adhesions, and 1 case of duct stone impaction and severe adhesions; postoperative hospital stay was 8-11 d, all were well recovered; pathological diagnosis, acute cholecystitis in 41 cases （51.2％）, acute suppurative cholecystitis in 24 cases （30.0％）, acute gangrenous cholecystitis in 15 cases （18.8％）.

结果：重症急性胆囊炎80例，76例成功实施LC，其中，胆囊穿刺减压胆总管切开取石T管引流11例，胆总管切开取石T管引流15例，胆囊造瘘胆总管切开取石T管引流14例，胆囊切除胆总管切开取石T管引流36例，手术时间15～120 min，术中出血10～85 ml；4例中转开腹，其中，1例胆囊与周围组织粘连严重，壶腹部标志消失，与肝十二指肠韧带界限不清，2例胆囊萎缩深陷肝脏内，胆囊三角区瘢痕粘连，1例胆囊管结石嵌顿且严重粘连，术后住院时间8～11 d，术后恢复均良好，治愈出院；80例术后病理诊断，急性单纯性胆囊炎41例（51.2％），急性化脓性胆囊炎24例（30.0％），急性坏疽性胆囊炎15例（18.8％）。

The anatomy relationship of venae hepaticae intermediae and its branches on gallbladder bed were analysed,which could be the reference during the LC.Results:For 112 patients suffered from inatrophic cholecystitis and cholecystolithiasis,whose gallbladders were decoherence directdly from ectoptygma muscular coat close to the gallbladder wall.

结果：对于术前经彩色多普勒超声波检查明确的肝中静脉直接和胆囊床相贴的非萎缩性胆囊炎胆囊结石的102例患者，采用紧靠胆囊壁的浆肌层直接进行剥离；而慢性萎缩性胆囊炎胆囊结石的24例患者，采用胆囊粘膜切除，或者直接开腹手术切除，未发生因损伤胆囊床肝中静脉而大出血。

Methods 8cases severe adherence acute cholecystitis,10cases repeatedly broken out,the gallbladder recrease fibross,2cases of Mirizzi sydrome the chololith occlude the neck of the cyst,the total chole-cystectomy is difficult,partly retain the gallbladder back wall of cyst,the mucosa is damaged by electrotore,partly anat-omize the cyst duct,close the duct in the proper postion.

目的 总结20例腹腔镜胆囊次全切除术的临床应用经验方法 8例粘连严重处于炎症急性期，10例反复发作胆囊壁纤维增厚，2例Mirizzi综合征结石嵌顿在胆囊颈部，强行完整切除胆囊困难，采取保留部分胆囊后壁，残留黏膜予以破坏，部分游离胆囊管，在适当位置关闭胆囊管。

Neither the killing of Mr Zarqawi nor any breakthrough on the political front will stop the insurgency and the fratricidal murders in their tracks.

在对危险的南部地区访问时，他斥责什叶派民兵领导人对中央集权的挑衅行为。

In fact,I've got him on the satellite mobile right now.

实际上 我们已接通卫星可视电话了