AIM:To compare the outcomes of concomitant cholangiocarcinoma(C-CCA)and subsequent cholangiocar-cinoma(S-CCA)associated with hepatolithiasis. METHODS:From December 1987 to December 2007, 276 patients underwent hepatic...AIM:To compare the outcomes of concomitant cholangiocarcinoma(C-CCA)and subsequent cholangiocar-cinoma(S-CCA)associated with hepatolithiasis. METHODS:From December 1987 to December 2007, 276 patients underwent hepatic resection for hepa-tolithiasis in Changhua Christian Hospital.Sixty-five patients were excluded due to incomplete medical records and the remaining 211 patients constituted our study population base.Ten patients were diag-nosed with C-CCA based on the preoperative biopsy or postoperative pathology.During the follow-up period, 12 patients developed S-CCA.The diagnosis of S-CCA was made by image-guided biopsy or by pathology if surgical intervention was carried out.Patient charts were reviewed to collect clinical information.Parameters such as CCA incidence,interval from operation to CCA diagnosis,interval from CCA diagnosis to disease-related death,follow-up time,and mortality rate were calculated for both the C-CCA and S-CCA groups.The outcomes of the C-CCA and S-CCA groups were math-ematically compared and analysed. RESULTS:Our study demonstrates the clinical implications and the survival outcomes of C-CCA and S-CCA. Among the patients with unilateral hepatolithiasis,the incidence rates of C-CCA and S-CCA were fairly similar (4.8%vs 4.5%,respectively,P=0.906).However,for the patients with bilateral hepatolithiasis,the incidence rate of S-CCA(12.2%)was higher than that of C-CCA (4.7%),although the sample size was limited and the difference between two groups was not statistically sig-nificant(P=0.211).The average follow-up time was 56 mo for the C-CCA group and 71 mo for the S-CCA group.Regard to the average time intervals from operation to CCA diagnosis,S-CCA was diagnosed after 67 mo from the initial hepatectomy.The average time intervals from the diagnoses of CCA to disease-related death was 41 mo for the C-CCA group and 4 mo for the S-CCA group,this difference approached statistical sig-nificance(P=0.075).Regarding the rates of overall and disease-related mortality,the C-CCA group had signifi-cantly lower overall mortality(70%vs 100%,P=0.041) and disease-related mortality(60%vs 100%,P=0.015) than the S-CCA group.For the survival outcomes of two groups,the Kaplan-Meier curves corresponding to each group also demonstrated better survival outcomes for the C-CCA group(log rank P=0.005).In the C-CCA group,three patients were still alive at the time of data analysis,all of them had free surgical margins and did not have pathologically proven lymph node metastasis at the time of the initial hepatectomy.In the S-CCA group,only one patient had chance to undergo a second hepatectomy,and all 12 S-CCA patients had died at the time of data analysis. CONCLUSION:C-CCA has better outcomes than S-CCA.The first hepatectomy is crucial because most patients with recurrent CCA or S-CCA are not eligible for repeated surgical intervention.展开更多
AIM: To investigate the outcome of repeating endoscopic retrograde cholangiopancreaticography (ERCP) after initially failed precut sphincterotomy to achieve biliary cannulation.
AIM:To study the endoscopic and radiological characteristics of patients with hepaticojejunostomy(HJ)and propose a practical HJ stricture classif ication.METHODS:In a retrospective observational study,a balloon-assist...AIM:To study the endoscopic and radiological characteristics of patients with hepaticojejunostomy(HJ)and propose a practical HJ stricture classif ication.METHODS:In a retrospective observational study,a balloon-assisted enteroscopy(BAE)-endoscopic retrograde cholangiography was performed 44 times in 32 patients with surgically-altered gastrointestinal(GI)anatomy.BAE-endoscopic retrograde cholangio pancreatography(ERCP)was performed 23 times in 18 patients with HJ.The HJ was carefully studied with the endoscope and using cholangiography.RESULTS:The authors observed that the hepaticojejunostomies have characteristics that may allow these to be classif ied based on endoscopic and cholangiographic appearances:the HJ orif ice aspect may appear as small(type A)or large(type B)and the stricture may be short(type 1),long(type 2)and type 3,intrahepatic biliary strictures not associated with anastomotic stenosis.In total,7 patients had type A1,4 patients A2,one patient had B1,one patient had B(large orif ice without stenosis)and one patient had type B3.CONCLUSION:This practical classification allows for an accurate initial assessment of the HJ,thus potentially allowing for adequate therapeutic planning,as the shape,length and complexity of the HJ and biliary tree choice may mandate the type of diagnostic and thera-peutic accessories to be used.Of additional importance,a standardized classif ication may allow for better com-parison of studies of patients undergoing BAE-ERCP in the setting of altered upper GI anatomy.展开更多
The authors report their experience about 8 cases of intrabiliary rupture of hepatobiliary hydatid disease, and add an algorithm for treatment. To our opinion, the use of diagnostic and therapeutic endoscopic retrogra...The authors report their experience about 8 cases of intrabiliary rupture of hepatobiliary hydatid disease, and add an algorithm for treatment. To our opinion, the use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography （ERCP） in the management of hepatobiliary hydatid disease was not stated properly in their proposed algorithm. According to the algorithm, the use of ERCP and related modalities was only stated in the case of postoperative biliary fistulae. We think that postoperative persistant fistula is not a sole indication, there are many indications for ERCP and related techniques namely sphincterotomy, extraction, nasobiliary drainage and stenting, in the treatment algorithm before or after surgery.展开更多
AIM:To outline the appropriate diagnostic methods and therapeutic options for acquired bronchobiliary fistula(BBF).METHODS:Literature searches were performed in Medline,EMBASE,PHMC and LWW(January 1980August 2010)usin...AIM:To outline the appropriate diagnostic methods and therapeutic options for acquired bronchobiliary fistula(BBF).METHODS:Literature searches were performed in Medline,EMBASE,PHMC and LWW(January 1980August 2010)using the following keywords:biliobronchial fistula,bronchobiliary fistula,bronchobiliary fistula,biliarybronchial fistula,tracheobiliary fistula,hepatobronchial fistula,bronchopleural fistula,and biliptysis.Further articles were identified through crossreferencing.RESULTS:Sixtyeight cases were collected and reviewed.BBF secondary to tumors(32.3%,22/68),including primary tumors(19.1%,13/68)and hepatic metastases(13.2%,9/68),shared the largest proportion of all cases.Biliptysis was found in all patients,and other symptoms were respiratory symptoms,such as irritating cough,fever(36/68)and jaundice(20/68).Half of the patients were treated by lessinvasive methods such as endoscopic retrograde biliary drainage.Invasive approaches like surgery were used less frequently(41.7%,28/67).The outcome was good at the end of the followup period in 28 cases(range,2 wk to 72 mo),and the recovery rate was 87.7%(57/65).CONCLUSION:The clinical diagnosis of BBF can be established by sputum analysis.Careful assessment of this condition is needed before therapeutic procedure.Invasive approaches should be considered only when noninvasive methods failed.展开更多
文摘AIM:To compare the outcomes of concomitant cholangiocarcinoma(C-CCA)and subsequent cholangiocar-cinoma(S-CCA)associated with hepatolithiasis. METHODS:From December 1987 to December 2007, 276 patients underwent hepatic resection for hepa-tolithiasis in Changhua Christian Hospital.Sixty-five patients were excluded due to incomplete medical records and the remaining 211 patients constituted our study population base.Ten patients were diag-nosed with C-CCA based on the preoperative biopsy or postoperative pathology.During the follow-up period, 12 patients developed S-CCA.The diagnosis of S-CCA was made by image-guided biopsy or by pathology if surgical intervention was carried out.Patient charts were reviewed to collect clinical information.Parameters such as CCA incidence,interval from operation to CCA diagnosis,interval from CCA diagnosis to disease-related death,follow-up time,and mortality rate were calculated for both the C-CCA and S-CCA groups.The outcomes of the C-CCA and S-CCA groups were math-ematically compared and analysed. RESULTS:Our study demonstrates the clinical implications and the survival outcomes of C-CCA and S-CCA. Among the patients with unilateral hepatolithiasis,the incidence rates of C-CCA and S-CCA were fairly similar (4.8%vs 4.5%,respectively,P=0.906).However,for the patients with bilateral hepatolithiasis,the incidence rate of S-CCA(12.2%)was higher than that of C-CCA (4.7%),although the sample size was limited and the difference between two groups was not statistically sig-nificant(P=0.211).The average follow-up time was 56 mo for the C-CCA group and 71 mo for the S-CCA group.Regard to the average time intervals from operation to CCA diagnosis,S-CCA was diagnosed after 67 mo from the initial hepatectomy.The average time intervals from the diagnoses of CCA to disease-related death was 41 mo for the C-CCA group and 4 mo for the S-CCA group,this difference approached statistical sig-nificance(P=0.075).Regarding the rates of overall and disease-related mortality,the C-CCA group had signifi-cantly lower overall mortality(70%vs 100%,P=0.041) and disease-related mortality(60%vs 100%,P=0.015) than the S-CCA group.For the survival outcomes of two groups,the Kaplan-Meier curves corresponding to each group also demonstrated better survival outcomes for the C-CCA group(log rank P=0.005).In the C-CCA group,three patients were still alive at the time of data analysis,all of them had free surgical margins and did not have pathologically proven lymph node metastasis at the time of the initial hepatectomy.In the S-CCA group,only one patient had chance to undergo a second hepatectomy,and all 12 S-CCA patients had died at the time of data analysis. CONCLUSION:C-CCA has better outcomes than S-CCA.The first hepatectomy is crucial because most patients with recurrent CCA or S-CCA are not eligible for repeated surgical intervention.
文摘AIM: To investigate the outcome of repeating endoscopic retrograde cholangiopancreaticography (ERCP) after initially failed precut sphincterotomy to achieve biliary cannulation.
文摘AIM:To study the endoscopic and radiological characteristics of patients with hepaticojejunostomy(HJ)and propose a practical HJ stricture classif ication.METHODS:In a retrospective observational study,a balloon-assisted enteroscopy(BAE)-endoscopic retrograde cholangiography was performed 44 times in 32 patients with surgically-altered gastrointestinal(GI)anatomy.BAE-endoscopic retrograde cholangio pancreatography(ERCP)was performed 23 times in 18 patients with HJ.The HJ was carefully studied with the endoscope and using cholangiography.RESULTS:The authors observed that the hepaticojejunostomies have characteristics that may allow these to be classif ied based on endoscopic and cholangiographic appearances:the HJ orif ice aspect may appear as small(type A)or large(type B)and the stricture may be short(type 1),long(type 2)and type 3,intrahepatic biliary strictures not associated with anastomotic stenosis.In total,7 patients had type A1,4 patients A2,one patient had B1,one patient had B(large orif ice without stenosis)and one patient had type B3.CONCLUSION:This practical classification allows for an accurate initial assessment of the HJ,thus potentially allowing for adequate therapeutic planning,as the shape,length and complexity of the HJ and biliary tree choice may mandate the type of diagnostic and thera-peutic accessories to be used.Of additional importance,a standardized classif ication may allow for better com-parison of studies of patients undergoing BAE-ERCP in the setting of altered upper GI anatomy.
文摘The authors report their experience about 8 cases of intrabiliary rupture of hepatobiliary hydatid disease, and add an algorithm for treatment. To our opinion, the use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography （ERCP） in the management of hepatobiliary hydatid disease was not stated properly in their proposed algorithm. According to the algorithm, the use of ERCP and related modalities was only stated in the case of postoperative biliary fistulae. We think that postoperative persistant fistula is not a sole indication, there are many indications for ERCP and related techniques namely sphincterotomy, extraction, nasobiliary drainage and stenting, in the treatment algorithm before or after surgery.
文摘AIM:To outline the appropriate diagnostic methods and therapeutic options for acquired bronchobiliary fistula(BBF).METHODS:Literature searches were performed in Medline,EMBASE,PHMC and LWW(January 1980August 2010)using the following keywords:biliobronchial fistula,bronchobiliary fistula,bronchobiliary fistula,biliarybronchial fistula,tracheobiliary fistula,hepatobronchial fistula,bronchopleural fistula,and biliptysis.Further articles were identified through crossreferencing.RESULTS:Sixtyeight cases were collected and reviewed.BBF secondary to tumors(32.3%,22/68),including primary tumors(19.1%,13/68)and hepatic metastases(13.2%,9/68),shared the largest proportion of all cases.Biliptysis was found in all patients,and other symptoms were respiratory symptoms,such as irritating cough,fever(36/68)and jaundice(20/68).Half of the patients were treated by lessinvasive methods such as endoscopic retrograde biliary drainage.Invasive approaches like surgery were used less frequently(41.7%,28/67).The outcome was good at the end of the followup period in 28 cases(range,2 wk to 72 mo),and the recovery rate was 87.7%(57/65).CONCLUSION:The clinical diagnosis of BBF can be established by sputum analysis.Careful assessment of this condition is needed before therapeutic procedure.Invasive approaches should be considered only when noninvasive methods failed.
文摘目的:应用网状荟萃分析,比较不同插管方法在内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)困难胆管插管时的效果。方法:选取英文发表的随机对照研究文献,对ERCP困难胆管插管时所采用的不同插管方法(早期或晚期针刀切开法、胰腺导丝辅助法、胰腺支架辅助法、经胰腺括约肌切开法、持续常规插管法)的效果,进行比较分析。主要观察指标为胆管插管成功率以及ERCP术后胰腺炎(post-ERCP pancreatitis,PEP)发生率。对不同插管方法的效果进行成对和网状荟萃分析,并根据累积排名曲线下面积(surface under the cumulative ranking curve,SUCRA)进行排名。结果:18项研究符合要求,共2033例病人。经胰腺括约肌切开法的胆管插管成功率显著高于持续常规插管法(RR=1.34,95%CI:1.02~1.77)、胰腺导丝辅助法(RR=1.26,95%CI:1.00~1.60)。根据SUCRA评分排名,经胰腺括约肌切开法胆道插管成功率最高,其次为早期针刀切开法。与持续常规插管法相比,只有早期针刀切开法可显著降低PEP发生率(RR=0.53,95%CI:0.30~0.94)。与胰腺导丝辅助法相比,早期针刀切开法(RR=0.41,95%CI:0.17~0.99)、经胰腺括约肌切开法(RR=0.49,95%CI:0.25~0.96)的PEP发生率均显著降低。根据SUCRA评分排名,早期针刀切开法对降低PEP发生率效果最显著,其次为经胰腺括约肌切开法。结论:经胰腺括约肌切开法可提高ERCP困难胆管插管时的胆管插管成功率;早期针刀切开法、经胰腺括约肌切开法可降低PEP发生率,可作为ERCP困难胆道插管时的选择方法。
