Benign gallbladder diseases usually present with intraluminal lesions and localized or diffuse wall thickening.Intraluminal lesions of the gallbladder include gallstones,cholesterol polyps,adenomas,or sludge and polyp...Benign gallbladder diseases usually present with intraluminal lesions and localized or diffuse wall thickening.Intraluminal lesions of the gallbladder include gallstones,cholesterol polyps,adenomas,or sludge and polypoid type of gallbladder cancer must subsequently be excluded.Polyp size,stalk width,and enhancement intensity on contrast-enhanced ultrasound and degree of diffusion restriction may help differentiate cholesterol polyps and adenomas from gallbladder cancer.Localized gallbladder wall thickening is largely due to segmental or focal gallbladder adenomyomatosis,although infiltrative cancer may present similarly.Identification of Rokitansky-Aschoff sinuses is pivotal in diagnosing adenomyomatosis.The layered pattern,degree of enhancement,and integrity of the wall are imaging clues that help discriminate innocuous thickening from gallbladder cancer.High-resolution ultrasound is especially useful for analyzing the layering of gallbladder wall.A diffusely thickened wall is frequently seen in inflammatory processes of the gallbladder.Nevertheless,it is important to check for coexistent cancer in instances of acute cholecystitis.Ultrasound used alone is limited in evaluating complicated cholecystitis and often requires complementary computed tomography.In chronic cholecystitis,preservation of a two-layered wall and weak wall enhancement are diagnostic clues for excluding malignancy.Magnetic resonance imaging in conjunction with diffusion-weighted imaging helps to differentiate xathogranulomatous cholecystitis from gallbladder cancer by identifying the presence of fat and degree of diffusion restriction.Such distinctions require a familiarity with typical imaging features of various gallbladder diseases and an understanding of the roles that assorted imaging modalities play in gallbladder evaluations.展开更多
目的探讨内镜保胆取息肉术治疗胆囊息肉样病变(PLG)的疗效。方法回顾性分析2012年1月至2017年1月期间新疆军区总医院395例病理诊断为胆固醇性PLG患者的临床资料。其中行内镜取息肉术216例,行腹腔镜胆囊切除术(LC)179例。比较两组患者围...目的探讨内镜保胆取息肉术治疗胆囊息肉样病变(PLG)的疗效。方法回顾性分析2012年1月至2017年1月期间新疆军区总医院395例病理诊断为胆固醇性PLG患者的临床资料。其中行内镜取息肉术216例,行腹腔镜胆囊切除术(LC)179例。比较两组患者围术期指标、并发症发生率,观察两组远期疗效。结果两组术前资料具有可比性(P>0.05)。内镜取息肉术组手术时间[M(P25,P75),58(52,67)min vs 59(56,70)min]、术中出血量[(12.9±5.2)m L vs(16.6±4.7)m L]、术后排气时间[(17.3±5.3)h vs(21.0±3.8)h]、下床活动时间[M(P25,P75),8(6,15)h vs 12(8,19)h]、住院时间[(6.9±1.5)d vs(7.3±1.3)d]、腹痛和腹泻发生率(1.39%vs 6.15%)、总并发症发生率(3.24%vs 12.85%),均明显低于LC组(Z/χ2:-2.195,7.262,7.953,-6.410,2.330,4.749,10.988;均P<0.05)。随访截至2018年1月,随访时间12~72个月,中位随访41个月,失访率:内镜取息肉术组9.26%(20/216),LC组8.94%(16/179)。随访6年内,内镜取息肉术组复发率6.63%(13/196),LC组肝内外胆管结石发生率1.23%(2/163)。结论对于PLG可能为胆固醇性且有手术指征或处于指征边缘的患者,若无法坚持定期复查,内镜取息肉术不失为手术治疗方法中的优选。展开更多
文摘Benign gallbladder diseases usually present with intraluminal lesions and localized or diffuse wall thickening.Intraluminal lesions of the gallbladder include gallstones,cholesterol polyps,adenomas,or sludge and polypoid type of gallbladder cancer must subsequently be excluded.Polyp size,stalk width,and enhancement intensity on contrast-enhanced ultrasound and degree of diffusion restriction may help differentiate cholesterol polyps and adenomas from gallbladder cancer.Localized gallbladder wall thickening is largely due to segmental or focal gallbladder adenomyomatosis,although infiltrative cancer may present similarly.Identification of Rokitansky-Aschoff sinuses is pivotal in diagnosing adenomyomatosis.The layered pattern,degree of enhancement,and integrity of the wall are imaging clues that help discriminate innocuous thickening from gallbladder cancer.High-resolution ultrasound is especially useful for analyzing the layering of gallbladder wall.A diffusely thickened wall is frequently seen in inflammatory processes of the gallbladder.Nevertheless,it is important to check for coexistent cancer in instances of acute cholecystitis.Ultrasound used alone is limited in evaluating complicated cholecystitis and often requires complementary computed tomography.In chronic cholecystitis,preservation of a two-layered wall and weak wall enhancement are diagnostic clues for excluding malignancy.Magnetic resonance imaging in conjunction with diffusion-weighted imaging helps to differentiate xathogranulomatous cholecystitis from gallbladder cancer by identifying the presence of fat and degree of diffusion restriction.Such distinctions require a familiarity with typical imaging features of various gallbladder diseases and an understanding of the roles that assorted imaging modalities play in gallbladder evaluations.
文摘目的探讨内镜保胆取息肉术治疗胆囊息肉样病变(PLG)的疗效。方法回顾性分析2012年1月至2017年1月期间新疆军区总医院395例病理诊断为胆固醇性PLG患者的临床资料。其中行内镜取息肉术216例,行腹腔镜胆囊切除术(LC)179例。比较两组患者围术期指标、并发症发生率,观察两组远期疗效。结果两组术前资料具有可比性(P>0.05)。内镜取息肉术组手术时间[M(P25,P75),58(52,67)min vs 59(56,70)min]、术中出血量[(12.9±5.2)m L vs(16.6±4.7)m L]、术后排气时间[(17.3±5.3)h vs(21.0±3.8)h]、下床活动时间[M(P25,P75),8(6,15)h vs 12(8,19)h]、住院时间[(6.9±1.5)d vs(7.3±1.3)d]、腹痛和腹泻发生率(1.39%vs 6.15%)、总并发症发生率(3.24%vs 12.85%),均明显低于LC组(Z/χ2:-2.195,7.262,7.953,-6.410,2.330,4.749,10.988;均P<0.05)。随访截至2018年1月,随访时间12~72个月,中位随访41个月,失访率:内镜取息肉术组9.26%(20/216),LC组8.94%(16/179)。随访6年内,内镜取息肉术组复发率6.63%(13/196),LC组肝内外胆管结石发生率1.23%(2/163)。结论对于PLG可能为胆固醇性且有手术指征或处于指征边缘的患者,若无法坚持定期复查,内镜取息肉术不失为手术治疗方法中的优选。
