Полип (конкремент?) жёлчного пузыря.
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#3
03.02.2008, 12:10
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ПХ синдром? Что это такое?. Не существует ПХЭС! Существует недостаточная предоперационная диагностика заболеваний панкреатобилиарной зоны и ,следовательно, все проблемы после ХЭ связаны с недиагносцированными до операции заболеваниями. В последние годы об этом очень много говорится.
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#4
03.02.2008, 12:35
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Цитата:
Почитать о ПХЭС можно [Ссылки доступны только зарегистрированным пользователям ].
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#5
03.02.2008, 12:36
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Цитата:
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#6
03.02.2008, 20:31
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Цитата:
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#7
03.02.2008, 20:37
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Цитата:
1. Если это полип - Полип ж.п. диаметром 1см. надо удалять вместе с ж.п. 2. Если это конкремент ж.п.(а это скорее всего он  ) - "удалять к чёртовой матери, не дожидаясь никаких о.холециститов, водянок ж.п. и т.п."Я извиняюсь за резкость высказываний, но это ИМХО!
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#9
04.02.2008, 17:46
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Да, уважаемый Галлен! Конкремент желчного пузыря - показание для холецистэктомии, если Вы не знаете! Почитайте литературу 21века и удосужтесь съездить хотя бы на один хирургический съезд в Россию, Вам там быстро объяснят, кто в каком веке живет! И вообще, оставьте свой высокомерный тон для кого-нибудь другого. Имейте хотя-бы каплю уважения к коллегам и их мнению!
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#10
04.02.2008, 17:54
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Конкремент желчного пузыря не является показанием к холицистектомии. Вы перепутали что-то.
Зря вы сердитесь. Мнение уважаемых коллег, считаюших иначе, - ошибочно.
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#11
04.02.2008, 18:01
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Эх, коллега, жаль, патроны для Вас закончились. Вы в очередной раз изволили сказать глупость. Кажется, в том году специально для Вас на форуме была опубликована, напр., [Ссылки доступны только зарегистрированным пользователям ] ссылка, в которой Вы могли бы посмотреть, как принято поступать с холелитиазом во всем цивилизованном медицинском мире, а также почему именно так а не иначе. Понимаете, уважаемый Ш.С., воинствующее невежество раздражает. Сорри, ничего личного...
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#12
04.02.2008, 18:28
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Цитата:
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#13
04.02.2008, 18:50
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"Почитайте литературу 21века" (c)
Current Surgical Diagnosis and Treatment, 12th Edition Gerard M. Doherty and Lawrence W. Way Asymptomatic Gallstones ...Each year, about 2% of patients with asymptomatic gallstones develop symptoms, usually biliary colic rather than one of the complications of gallstone disease. Patients with chronic colic tend to have symptoms of the same level of severity and frequency. The present practice of operating only on symptomatic patients, leaving the millions without symptoms alone, seems appropriate. A question is often raised about what to advise the asymptomatic patient found to have gallstones during the course of unrelated studies. The presence of either of the following portends a more serious course and should probably serve as a reason for prophylactic cholecystectomy: (1) large stones (> 2 cm in diameter), because they produce acute cholecystitis more often than small stones; and (2) a calcified gallbladder, because it so often is associated with carcinoma. However, most asymptomatic patients have no special features. If coexistent cardiopulmonary or other problems increase the risk of surgery, operation should not be considered. For the average asymptomatic patient, it is not reasonable to make a strong recommendation for cholecystectomy. The tendency, however, is to operate on younger patients and temporize in the elderly... Gallstones & Chronic Cholecystitis (Biliary Colic) Essentials of Diagnosis Episodic abdominal pain. Dyspepsia. Gallstones on cholecystography or ultrasound scan. General Considerations Chronic cholecystitis is the most common form of symptomatic gallbladder disease and is associated with gallstones in nearly every case. In general, the term cholecystitis is applied whenever gallstones are present regardless of the histologic appearance of the gallbladder. Repeated minor episodes of obstruction of the cystic duct cause intermittent biliary colic and contribute to inflammation and subsequent scar formation. Gallbladders from symptomatic patients with gallstones who have never had an attack of acute cholecystitis are of two types: (1) In some, the mucosa may be slightly flattened, but the wall is thin and unscarred and, except for the stones, appears normal. (2) Others exhibit obvious signs of chronic inflammation, with thickening, cellular infiltration, loss of elasticity, and fibrosis. The clinical history in these two groups cannot always be distinguished, and inflammatory changes may also be found in patients with asymptomatic gallstones. Clinical Findings Symptoms and Signs Biliary colic, the most characteristic symptom, is caused by transient gallstone obstruction of the cystic duct. The pain usually begins abruptly and subsides gradually, lasting for a few minutes to several hours. The pain of biliary colic is usually steady—not intermittent, like that of intestinal colic. In some patients, attacks occur postprandially; in others, there is no relationship to meals. The frequency of attacks is quite variable, ranging from nearly continuous trouble to episodes many years apart. Nausea and vomiting may accompany the pain. Biliary colic is usually felt in the right upper quadrant, but epigastric and left abdominal pain are common, and some patients experience precordial pain. The pain may radiate around the costal margin into the back or may be referred to the region of the scapula. Pain on top of the shoulder is unusual and suggests direct diaphragmatic irritation. In a severe attack, the patient usually curls up in bed, changing position frequently in order to be more comfortable. During an attack, there may be tenderness in the right upper quadrant, and, rarely, the gallbladder is palpable. Fatty food intolerance, dyspepsia, indigestion, heartburn, flatulence, nausea, and eructations are other symptoms associated with gallstone disease. Because they are also frequent in the general population, their presence in any given patient may only be incidental to the gallstones. Laboratory Findings An ultrasound scan of the gallbladder should usually be the first test. Gallstones can be demonstrated in about 95% of cases, and a positive reading for gallstones is almost never in error. An oral cholecystogram should be obtained if the ultrasound study is equivocal, if the patient is a candidate for lithotripsy or ursodiol therapy, or if symptoms are highly suggestive and an ultrasound study has been read as normal. About 2% of patients with gallstone disease have normal ultrasound studies and oral cholecystograms. Therefore, if the clinical suspicion of gallbladder disease is high and these two tests are negative, the patient should be studied by ERCP (to opacify the gallbladder in the search for stones) or duodenal intubation and examination of duodenal bile for cholesterol crystals or bilirubinate granules. Differential Diagnosis Gallbladder colic may be strongly suggested by the history, but the clinical impression should always be verified by an ultrasound study. Biliary colic may simulate the pain of duodenal ulcer, hiatal hernia, pancreatitis, and myocardial infarction. An ECG and a chest x-ray should be obtained to investigate cardiopulmonary disease. It has been suggested that biliary colic may sometimes aggravate cardiac disease, but angina pectoris or an abnormal ECG should rarely be indications for cholecystectomy. Right-sided radicular pain in the T6–T10 dermatomes may be confused with biliary colic. Osteoarthritic spurs, vertebral lesions, or tumors may be shown on x-rays of the spine or may be suggested by hyperesthesia of the abdominal skin. An upper gastrointestinal series may be indicated to search for esophageal spasm, hiatal hernia, peptic ulcer, or gastric tumors. In some patients, the irritable colon syndrome may be mistaken for gallbladder discomfort. Carcinoma of the cecum or ascending colon may be overlooked on the assumption that postprandial pain in these conditions is due to gallstones. Complications Chronic cholecystitis predisposes to acute cholecystitis, common duct stones, and adenocarcinoma of the gallbladder. The longer the stones have been present, the higher the incidence of all of these complications. Complications are infrequent, however, and the presence of gallstones is not reason enough for prophylactic cholecystectomy in a person with asymptomatic or mildly symptomatic disease. Treatment Medical Treatment Avoidance of offending foods may be helpful. Dissolution Cholesterol gallstones in the gallbladder can be dissolved in some cases by chronic treatment with ursodiol, which reduces the cholesterol saturation of bile by inhibiting cholesterol secretion. The resulting undersaturated bile slowly dissolves the solid cholesterol in the gallstones. Unfortunately, bile salt therapy has marginal efficacy. The gallstones must be small (eg, < 5 mm) and devoid of calcium (ie, nonopaque on CT scans), and the gallbladder must opacify on oral cholecystography (an indication of unobstructed flow of bile between bile duct and gallbladder). About 15% of patients with gallstones are candidates for treatment. Dissolution is achieved within 2 years in about 50% of highly selected patients. Stones recur, however, in 50% of cases within 5 years. In general, dissolution therapy—alone or in conjunction with lithotripsy—is used only rarely. Lithotripsy and Dissolution Extracorporeal shock wave lithotripsy (ESWL) involves focusing shock waves, which pass through tissue and fluids, upon the gallstones. The stones are fragmented by explosion of small air bubbles within interstices of the solid material. Lithotripsy is of little therapeutic value because the fragments remain in the gallbladder unless they can be dissolved. Consequently, candidates for lithotripsy must also use ursodiol therapy. Complete elimination of gallbladder stones is attained within 9 months in about 25% of appropriately selected patients. Because of the many drawbacks of this form of treatment, it has not been approved by the FDA in the United States. Surgical Treatment Cholecystectomy is indicated in most patients with symptoms. The procedure can be scheduled at the patient's convenience, within weeks or months after diagnosis. Active concurrent disease that increases the risk of surgery should be treated before operation. In some chronically ill patients, surgery should be deferred indefinitely. Cholecystectomy is most often performed laparoscopically, but when the laparoscopic approach is contraindicated (eg, too many adhesions) or unsuccessful, it may be performed through a laparotomy. The difference consists of 4 fewer days in the hospital and several fewer weeks off work when done laparoscopically. Regardless of how it is done, operative cholangiography is usually included to look for common duct stones. If stones are found, common duct exploration is performed (see under choledocholithiasis). Prognosis Serious complications and deaths related to the operation itself are rare. The operative death rate is about 0.1% in patients under age 50 and about 0.5% in patients over age 50. Most deaths occur in patients recognized preoperatively to have increased risks. The operation relieves symptoms in 95% of cases...
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#14
04.02.2008, 19:23
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Цитата:
Боюсь,что таковой не найдется,а потому это заблуждение,и полное отсутствие ориентации действительно в современной литературе. Ссылка Вам дана [Ссылки доступны только зарегистрированным пользователям ] Изучите,и больше не настаивайте на глупости.
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#15
04.02.2008, 19:32
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Benign Tumors & Pseudotumors of the Gallbladder
Various unrelated lesions appear on the cholecystogram as projections from the gallbladder wall. The differentiation from gallstones is based upon observing whether a shift in position of the projections follows changes in posture of the patient, since stones are not fixed. Cancer should be suspected in any polypoid lesion that exceeds 1 cm in diameter. Polyps Most of these are not true neoplasms but cholesterol polyps, a local form of cholesterosis. Histologically, they consist of a cluster of lipid-filled macrophages in the submucosa. They easily become detached from the wall when the gallbladder is handled at surgery. It is not known whether cholesterol polyps are important in the genesis of gallstones. Some patients experience gallbladder pain, but whether this is related to the presence of the polyps per se or is a manifestation of functional gallbladder disease has not been established. Inflammatory polyps have also been reported, but they are quite rare. Adenomyomatosis On cholecystography, this entity presents as a slight intraluminal convexity that is often marked by central umbilication. It is usually found in the fundus but may occur elsewhere. It is unclear whether adenomyomatosis is an acquired degenerative lesion or a developmental abnormality (ie, hamartoma). The following synonyms for this lesion appear in the literature: adenomatous hyperplasia, cholecystitis glandularis proliferans, and diverticulosis of the gallbladder. Although the condition is probably asymptomatic in many cases, adenomyomatosis can cause abdominal pain. Cholecystectomy should be performed in such patients. Adenomas These appear as pedunculated adenomatous polyps, true neoplasms that may be papillary or nonpapillary histologically. In a few cases they have been found in association with carcinoma in situ of the gallbladder. Current Surgical Diagnosis and Treatment, 12th Edition Gerard M. Doherty and Lawrence W. Way
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