临床研究(Clinical Research)

胆囊腺肌症的诊治:附205 例报告

Published at: 2015年第24卷第8期

高鹏骥 1 , 张龙辉 1 , 王东 1 , 陈雷 1 , 王福顺 1 , 冷希圣 1 , 朱继业 1
1 北京大学人民医院 肝胆外科,北京 100044
通讯作者 继业 朱 Email: gandanwk@vip.sina.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.08.020
基金:

摘要

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。


Ultrasound-guided percutaneous transhepatic catheterization and bidirectional drainage for liver abscess after Roux-en-Y hepaticojejunostomy

Abstract

Objective: To discuss the diagnosis and treatment of adenomyomatosis of the gallbladder. Methods: The data of patients undergoing gallbladder surgery from January 2003 to December 2013 were retrieved from the medical record database in Peking University People’s Hospital to pick up the pathologically confirmed cases of gallbladder adenomyomatosis, and then, the correct diagnostic rate of different imaging examinations, surgical procedures and results were retrospectively analyzed. Results: Among 6 336 patients undergoing gallbladder surgery, 205 cases (3.2%) were pathologically diagnosed as adenomyomatosis of the gallbladder, of whom 195 cases (95.1%) were accompanied with cholecystitis and 150 cases (73.2%) were complicated with gallbladder stones. The correct diagnostic rate of ultrasonography, CT and MRI was 16.2%, 26.5% and 43.8%, respectively. Of the lesions, the localized type accounted for the majority, which was found in 164 cases (80.0%), and the diffuse and segmental types were relatively infrequent, which was seen 16 (7.8%) and 25 cases (12.2%), respectively. Of the patients, 178 cases underwent laparoscopic cholecystectomy and 24 cases were subjected to open cholecystectomy, and no complications such as bile duct injury occurred; 3 cases received partial cholecystectomy. At follow-up one year after operation, no residual lesion or recurrence was noted. Conclusion: Gallbladder adenomyomatosis is often combined with cholecystitis and gallbladder stones, and is likely to be undiagnosed. For cases with localized lesion in the base of the gallbladder, laparoscopic partial cholecystectomy can be considered as a treatment option.


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引用

引用本文: 鹏骥 高, 龙辉 张, 东 王, 雷 陈, 福顺 王, 希圣 冷, 继业 朱. 胆囊腺肌症的诊治:附205 例报告[J]. 中国普通外科杂志, 2015, 24(8): 1155-1158.
Cite this article as: GAO Pengji, ZHANG Longhui, WANG Dong, CHEN Lei, WANG Fushun, LENG Xisheng, ZHU Jiye . Ultrasound-guided percutaneous transhepatic catheterization and bidirectional drainage for liver abscess after Roux-en-Y hepaticojejunostomy[J]. Chin J Gen Surg, 2015, 24(8): 1155-1158.