Repair of bile duct defect with degradable stent and autologous tissue in a porcine model

AIM:To introduce and evaluate a new method to repair bile duct defect with a degradable stent and autologous tissues. METHODS:Eight Baa mini-pigs were used in this study. Experimental models with common bile duct (CB ) defect (0.5-1.0 cm segment of CB resected) were established and then CB was reconstructed by duct to duct anastomosis with a novel degradable stent made of poly [sebacic acid-co-(1,3-propanediol)-co- (1,2-propanediol)]. In addition, a vascularized greater omentum was placed around the stent and both ends of CB . Cholangiography via gall bladder was per-formed for each pig at postoperative months 1 and 3 to rule out stent translocation and bile duct stricture. Complete blood count was examined pre-and post-operatively to estimate the inflammatory reaction. Liverenzymes and serum bilirubin were examined pre-and post-operatively to evaluate the liver function. Five pigs were sacrificed at month 3 to evaluate the healing of anastomosis. The other three pigs were raised for one year for long-term observation. RESULTS:All the animals underwent surgery successfully. There was no intraoperative mortality and no bile leakage during the observation period. The white blood cell counts were only slightly increased on day 14 and month 3 postoperatively compared with that before operation, the difference was not statistically significant (P = 0.652). The plasma level of alanine aminotrans-ferase on day 14 and month 3 postoperatively was also not significantly elevated compared with that before operation (P = 0.810). Nevertheless, the plasma level of γ-glutamyl transferase was increased after operation in both groups (P = 0.004), especially 2 wk after operation. The level of serum total bilirubin after operation was not significantly elevated compared with that before operation (P = 0.227), so did the serum direct bilirubin (P = 0.759). By cholangiography via gall bladder, we found that the stent maintained its integrity of shape and was still in situ at month 1, and it disap-peared completely at month 3. No severe CB dilation and stricture were observed at both months 1 and 3. No pig died during the 3-mo postoperative observation period. No sign of necrosis, bile duct stricture, bile leakage or abdominal abscess was found at reoperation at month 3 postoperatively. Pigs had neither fragments of stent nor stones formed in the CB . Collagen deposit was observed in the anastomosis by hematoxylin and eosin (HE) and asson's trichrome stains. No severe cholestasis was observed in liver parenchyma by HE staining. Intestinal obstruction was found in a pig 4 mo after operation, and no bile leakage, bile duct stricture or biliary obstruction were observed in laparotomy. No sign of bile duct stricture or bile leakage was observed in the other two pigs. CONCLUSION:The novel method for repairing bileduct defect yielded a good short-term effect without postoperative bile duct stricture. However, the longterm effect should be further studied.

Drug-eluting fully covered self-expanding metal stent for dissolution of bile duct stones in vitro

BACKGROUND The treatment of difficult common bile duct stones(CBDS)remains a big challenge around the world.Biliary stenting is a widely accepted rescue method in patients with failed stone extraction under endoscopic retrograde cholangiopancreatography.Fully covered self-expanding metal stent(FCSEMS)has gained increasing attention in the management of difficult CBDS.AIM To manufacture a drug-eluting FCSEMS,which can achieve controlled release of stone-dissolving agents and speed up the dissolution of CBDS.METHODS Customized covered nitinol stents were adopted.Sodium cholate(SC)and disodium ethylene diamine tetraacetic acid(EDTA disodium,EDTA for short)were used as stone-dissolving agents.Three different types of drug-eluting stents were manufactured by dip coating(Stent I),coaxial electrospinning(Stent II),and dip coating combined with electrospinning(Stent III),respectively.The drugrelease behavior and stone-dissolving efficacy of these stents were evaluated in vitro to sort out the best manufacturing method.And the selected stonedissolving stents were further put into porcine CBD to evaluate their biosecurity.RESULTS Stent I and Stent II had obvious burst release of drugs in the first 5 d while Stent III presented controlled and sustainable drug release for 30 d.In still buffer,the final stone mass-loss rate of each group was 5.19%±0.69%for naked FCSEMS,20.37%±2.13%for Stent I,24.57%±1.45%for Stent II,and 33.72%±0.67%for Stent III.In flowing bile,the final stone mass-loss rate of each group was 5.87%±0.25%for naked FCSEMS,6.36%±0.48%for Stent I,6.38%±0.37%for Stent II,and 8.15%±0.27%for Stent III.Stent III caused the most stone mass-loss no matter in still buffer or in flowing bile,which was significantly higher than those of other groups(P<0.05).In vivo,Stent III made no difference from naked FCSEMS in serological analysis(P>0.05)and histopathological examination(P>0.05).CONCLUSION The novel SC and EDTA-eluting FCSEMS is efficient in diminishing CBDS in vitro.When conventional endoscopic techniques fail to remove difficult CBDS,SC and EDTA-eluting FCSEMS implantation may be considered a promising alternative.

Effect of external beam radiotherapy on patency of uncovered metallic stents in patients with inoperable bile duct cancer

BACKGROUND： Although biliary decompression with metallic stenting is the preferred treatment for inoperable bile duct cancer（BDC）, maintenance of patency is still unsatisfactory.We tried to assess the effectiveness and safety of external beam radiotherapy（EBRT） for prolonging stent patency in patients having uncovered metallic stents.METHOD： We retrospectively reviewed 50 patients who received endoscopic stenting, of whom 18 received EBRT（RT group） and 32 did not（non-RT group）.RESULTS： No difference was found in baseline characteristics between the two groups. Although stent patency was longer in the RT group than that in the non-RT group（140.7±51.3 vs136.4±34.9 days, P=0.94）, the difference was not statistically significant. There were a lower rate of stent occlusion（27.8% vs50.0% of patients, P=0.12） and a longer overall survival（420.1 ±73.2 vs 269.1±41.7 days, P=0.11） in the RT group than in the non-RT group, and the difference again was not statistically significant. The development of adverse reactions did not differ（55.6% vs 53.1% of patients, P=0.91）. There was no serious adverse reaction in both groups（P=0.99）.CONCLUSIONS： EBRT did not significantly improve stent patency in patients with inoperable BDC having uncovered metallic stents. However, EBRT was safe. Future trials withrefined protocols for better efficacy are expected.

New tapered metallic stent for unresectable malignant hilar bile duct obstruction

AIM: To examine the usefulness of a new tapered metallic stent(MS) in patients with unresectable malignant hilar bile duct obstruction.METHODS: This new tapered MS was placed in 11 patients with Bismuth Ⅱ or severer unresectable malignant hilar bile duct obstruction, as a prospective study. The subjects were six patients with bile duct carcinoma, three with gallbladder cancer, and two with metastatic bile duct obstruction. Stenosis morphology was Bismuth Ⅱ: 7, Ⅲa: 3, and Ⅳ: 1. UMIN Clinical Trial Registry(UMIN000004758).RESULTS: MS placement was 100%(11/11) successful. There were no procedural accidents. The mean patency period was 208.401 d, the median survival period was 142.000 d, and the mean survival period was 193.273 d. Occlusion rate was 36.4%(4/11); the causes of occlusion were ingrowth and overgrowth in 2 patients each, 18.2%, respectively. Patients with occlusion underwent endoscopic treatment one more time and all were treatable. CONCLUSION: The tapered MS proved useful in patients with unresectable malignant hilar bile duct obstruction because it provided a long patency period, enabled re-treatment by re-intervention, and no procedural accidents occurred.

Mechanical lithotripsy and/or stenting in management of difficult common bile duct stones

BACKGROUND:Mechanical lithotripsy and/or stent insertion is the alternative therapeutic approach in difficult endoscopic retrograde cholangiopancreatography (ERCP)case.This study was designed to investigate the appropriate treatment for extraction of bile duct stones in difficult cases of ERCP. METHODS:Between 2000 and 2008,744 ERCP procedures were performed in 592 patients with choledocholithiasis in our endoscopy unit.The demographic features,and clinical and laboratory findings were collected from a prospectively held database.Bile duct calculi were extracted by basket and/or balloon catheter following ERCP and sphincterotomy.Patients with retained stones were regarded as difficult cases.These patients were treated with mechanical lithotripsy and those with incomplete clearance of stones underwent stent placement. RESULTS:Two hundred and forty-five patients(41%) were male and 347(59%)were female with a mean age of 58 years(range 19-95 years).Stones were impacted in 27 patients(5%).Stone extraction was performed by basket and/or balloon catheter in 610 ERCP procedures,and lithotripsy was performed in 70 ERCP procedures.Forty- four patients underwent stent insertion,and 20 underwent stent replacement.Morbidity occurred in 39 patients (5%),with no mortality associated with the procedure.Hemorrhage occurred in 9 patients and basket impaction in 4.Mild pancreatitis and cholangitis developed in 12 and 11 patients,respectively. CONCLUSION:Difficult cases of bile duct stones can be treated successfully with lithotripsy,and a stent should be applied when the common bile duct cannot be cleared completely.

Biliary drainage of the common bile duct with an enteral metal stent

In this case report we present an elderly patient who was referred to our hospital with recurrent episodes of cholangitis that persisted after placement of fi ve metal stents for a distal common bile duct(CBD) stenosis.All metal stents were endoscopically removed from the CBD by forceps after balloon dilatation of the papilla.A profoundly dilated CBD with sludge and concrements was seen.To ensure adequate bile drainage an enteral metal stent was inserted in the CBD.This case shows that proximally migrated uncovered metal stents in the CBD can be safely removed endoscopically under certain circumstances.We suggest that in the case of a CBD drainage problem due to an extremely dilated CBD,placement of an enteral metal stent in the CBD could be considered,especially in patients who are unfi t for surgery.

Failure of sequential biliary stenting for unsuccessful common bile duct stone removal

AIM: To determine the factors associated with the failure of stone removal by a biliary stenting strategy. METHODS: We retrospectively reviewed 645 patients with common bile duct (CBD) stones who underwent endoscopic retrograde cholangiography for stone removal in Siriraj GI Endoscopy center, Siriraj Hospital from June 2009 to June 2012. A total of 42 patients with unsuccessful initial removal of large CBD stones that underwent sequential biliary stenting were enrolled in the present study. The demographic data, laboratory results, stone characteristics, procedure details, and clinical outcomes were recorded and analyzed. In addition, the patients were classified into two groups based on outcome, successful or failed sequential biliary stenting, and the above factors were compared. RESULTS: Among the initial 42 patients with unsuccessful initial removal of large CBD stones, there were 37 successful biliary stenting cases and five failed cases. Complete CBD clearance was achieved in 88.0% of cases. The average number of sessions needed beforecomplete stone removal was achieved was 2.43 at an average of 25 wk after the first procedure. Complications during the follow-up period occurred in 19.1% of cases, comprising ascending cholangitis (14.3%) and pancreatitis (4.8%). The factors associated with failure of complete CBD stone clearance in the biliary stenting group were unchanged CBD stone size after the first biliary stenting attempt (10.2 wk) and a greater number of endoscopic retrograde cholangio-pancreatography sessions performed (4.2 sessions). CONCLUSION: The sequential biliary stenting is an effective management strategy for the failure of initial large CBD stone removal.

Successful stent-in-stent dilatation of the common bile duct through a duodenal prosthesis,a novel technique for malignant obstruction:A case report and review of literature

For patients suffering from both biliary and duodenal obstruction,endoscopic retrograde cholangiopancreatography(ERCP) with stent placement is the treatment of choice.ERCP through an already existing duodenal prosthesis is an uncommon procedure and furthermore no studies have reported installing a covered metal stent onto an already existing bare metal stent in the common bile duct(CBD).We describe a rare case of a stent-in-stent dilatation of the CBD through an already existing self-expanding metal stent in the second part of duodenum for the patient presenting with jaundice in setting of biliary and duodenal obstruction from pancreatic adenocarcinoma.The biliary obstruction was relieved with a decrease in bilirubin levels post-stenting.

Application of a new-type sutureless anastomosis stent to the primary reconstruction of the bilioenteric continuity after acute bile duct injury in dogs

Objective： To evaluate the effect of a new-type sutureless magnetic bilioenteric anastomosis stent that was used to reconstruct the bilioenteric continuity （primarily under the circumstances of severe inflammation after acute bile duct injury in dogs ）. Methods： Establishing an animal model of acute bile duct injury with severe inflammation and bile peritonitis in dogs. The newtype sutureless magnetic bilioenteric anastomosis stent was used to reconstruct the bilioenteric continuity primarily. Results： The experiment group anastomosis healed well with a mild local inflammation reaction, and the collagen lined up in order without the occurrence of observable bile leakage and infection. Conclusion： It was safe and feasible to use the new-type anastomosis stent to reconstruct the bilioenteric continuity primarily under the circumstances of severe inflammation after acute bile duct injury in dogs.

Prospective single-center feasible study of innovative autorelease bile duct supporter to delay adverse events after endoscopic papillectomy

BACKGROUND Conventional endoscopic papillectomy(EP)is safe and effective for the treatment of small papilla adenoma to even large laterally spreading tumors of duodenum lesions.As reported by some existing studies,temporarily placing a prophylactic stent in the pancreatic and bile duct can lower the risk of this perioperative complication.AIM To evaluate the usefulness,convenience,safety,and short-term results of a novel autorelease bile duct supporter after EP procedure,especially the effectiveness in preventing EP.METHODS A single-center comparison study was conducted to verify the feasibility of the novel method.After EP,a metallic endoclip and human fibrin sealant kit were applied for protection.The autorelease bile duct supporter fell into the duct segment and the intestinal segment.Specifically,the intestinal segment was extended by nearly 5 cm as a bent coil.The bile was isolated from the pancreatic juice using an autorelease bile duct supporter,which protected the wound surface.The autorelease bile duct supporter fell off naturally and arrived in colon nearly 10 d after the operation.RESULTS En bloc endoscopic resection was performed in 6/8 patients(75%),and piecemeal resection was performed in 2/8 of patients(25%).None of the above patients were positive for neoplastic lymph nodes or distant metastasis.No cases of mortality,hemorrhage,delayed perforation,pancreatitis,cholangitis or duct stenosis with the conventional medical treatment were reported.The autorelease bile duct supporter in 7 of 8 patients fell off naturally and arrived in colon 10 d after the operation.One autorelease bile duct supporter was successfully removed using forceps or snare under endoscopy.No recurrence was identified during the 8-mo(ranging from 6-9 mo)follow-up period.CONCLUSION In brief,it was found that the autorelease bile duct supporter could decrease the frequency of procedure-associated complications without second endoscopic retraction.Secure closure of the resection wound with clips and fibrin glue were indicated to be promising and important for the use of autorelease bile duct supporters.Well-designed larger-scale comparative studies are required to confirm the findings of this study.

Repair of a common bile duct defect with a decellularized ureteral graft

AIM To evaluate the feasibility of repairing a common bile duct defect with a decellularized ureteral graft in a porcine model.METHODS Eighteen pigs were randomly divided into three groups. An approximately 1 cm segment of the common bile duct was excised from all the pigs. The defect was repaired using a 2 cm long decellularized ureteral graft over a T-tube(T-tube group, n = 6) or a silicone stent(stent group, n = 6). Six pigs underwent bile duct reconstruction with a graft alone(stentless group). The surviving animals were euthanized at 3 mo. Specimens of the common bile ducts were obtained for histological analysis.RESULTS The animals in the T-tube and stent groups survived until sacrifice. The blood test results were normal in both groups. The histology results showed a biliary epithelial layer covering the neo-bile duct. In contrast, all the animals in the stentless group died due to biliary peritonitis and cholangitis within two months post-surgery. Neither biliary epithelial cells nor accessory glands were observed at the graft sites in the stentless group.CONCLUSION Repair of a common bile duct defect with a decellularized ureteral graft appears to be feasible. A T-tube or intraluminal stent was necessary to reduce postoperative complications.

Cholangiocarcinoma and malignant bile duct obstruction: A review of last decades advances in therapeutic endoscopy

In the last decades many advances have been achieved in endoscopy, in the diagnosis and therapy of cholangiocarcinoma, however blood test, magnetic resonance imaging, computed tomography scan may fail to detect neoplastic disease at early stage, thus the diagnosis of cholangiocarcinoma is achieved usually at unresectable stage. In the last decades the role of endoscopy has moved from a diagnostic role to an invaluable therapeutic tool for patients affected by malignant bile duct obstruction. One of the major issues for cholangiocarcinoma is bile ducts occlusion, leading to jaundice, cholangitis and hepatic failure. Currently, endoscopy has a key role in the work up of cholangiocarcinoma, both in patients amenable to surgical intervention as well as in those unfit for surgery or not amenable to immediate surgical curative resection owing to locally advanced or advanced disease, with palliative intention. Endoscopy allows successful biliary drainage and stenting in more than 90% of patients with malignant bile duct obstruction, and allows rapid reduction of jaundice decreasing the risk of biliary sepsis. When biliary drainage and stenting cannot be achieved with endoscopy alone, endoscopic ultrasound-guided biliary drainage represents an effective alternative method affording successful biliary drainage in more than 80% of cases. The purpose of this review is to focus on the currently available endoscopic management options in patients with cholangiocarcinoma.

How do we manage post-OLT redundant bile duct?

AIM: To address endoscopic outcomes of post-Orthotopic liver transplantation (OLT) patients diagnosed with a "redundant bile duct" (RBD). METHODS: Medical records of patients who underwent OLT at the Liver Transplant Center, University Texas Health Science Center at San Antonio Texas were retrospectively analyzed. Patients with suspected biliary tract complications (BTC) underwent endoscopic retrograde cholangiopancreatography (ERCP). All ERCP were performed by experienced biliary endoscopist. RBD was defined as a looped, sigmoid-shaped bile duct on cholangiogram with associated cholestatic liver biomarkers. Patients with biliary T-tube placement, biliary anastomotic strictures, bile leaks, bile-duct stonessludge and suspected sphincter of oddi dysfunction were excluded. Therapy included single or multiple biliary stents with or without sphincterotomy. The incidence of RBD, the number of ERCP corrective sessions, and the type of endoscopic interventions were recorded. Successful response to endoscopic therapy was defined as resolution of RBD with normalization of associated cholestasis. Laboratory data and pertinent radiographic imaging noted included the pre-ERCP period and a follow up period of 6-12 mo after the last ERCP intervention. RESULTS: One thousand two hundred and eighty-two patient records who received OLT from 1992 through 2011 were reviewed. Two hundred and twenty-four patients underwent ERCP for suspected BTC. RBD was reported in each of the initial cholangiograms. Twentyone out of 1282 (1.6%) were identified as having RBD. There were 12 men and 9 women, average age of 59.6 years. Primary indication for ERCP was cholestatic pattern of liver associated biomarkers. Nineteen out of 21 patients underwent endoscopic therapy and 2/21 required immediate surgical intervention. In the endoscopically managed group: 65 ERCP procedures were performed with an average of 3.4 per patient and 1.1 stent per session. Fifteen out of 19 (78.9%) patients were successfully managed with biliary stenting. All stents were plastic. Selection of stent size and length were based upon endoscopist preference. Stent size ranged from 7 to 11.5 Fr (average stent size 10 Fr); Stent length ranged from 6 to 15 cm (average length 9 cm). Concurrent biliary sphincterotomy was performed in 10/19 patients. Single ERCP session was sufficient in 6/15 (40.0%) patients, whereas 4/15 (26.7%) patients needed two ERCP sessions and 5/15 (33.3%) patients required more than two (average of 5.4 ERCP procedures). Single biliary stent was sufficient in 5 patients; the remaining patients required an average of 4.9 stents. Four out of 19 (21.1%) patients failed endotherapy (lack of resolution of RBD and recurrent cholestasis in the absence of biliary stent) and required either choledocojejunostomy (2/4) or percutaneous biliary drainage (2/4). Endoscopic complications included: 2/65 (3%) post-ERCP pancreatitis and 2/10 (20%)non-complicated post-sphincterotomy bleeding. No endoscopic related mortality was found. The medical records of the 15 successful endoscopically managed patients were reviewed for a period of one year after removal of all biliary stents. Eleven patients had continued resolution of cholestatic biomarkers (73%). One patient had recurrent hepatitis C, 2 patients suffered septic shock which was not associated with ERCP and 1 patient was transferred care to an outside provider and records were not available for our review. CONCLUSION: Although surgical biliary reconstruction techniques have improved, RBD represents a postOLT complication. This entity is rare however, endoscopic management of RBD represents a reasonable initial approach.

ERCP与经口胰胆管镜技术置入胆管支架在高位胆管癌中的疗效对比分析

目的探讨经ERCP与经口胰胆管镜技术行胆管支架置入在高位胆管癌中的疗效。方法回顾性分析2021年1月至2023年9月在南阳市中心医院行胆管支架置入的136例高位胆管癌患者临床资料。根据胆管支架置入方式分为ERCP组(86例)和经口胰胆管镜组(50例)。比较两组患者年龄、相关检验指标、住院天数、术后并发症、肝衰竭发生率、黄疸缓解率、支架材质及通畅率等情况。结果所有患者均成功完成手术。两组在术后肝衰竭发生率、黄疸缓解率、不同材质支架在术后并发症及短期通畅率方面对比,无明显统计学意义(P>0.05)。两组患者术后总的并发症比较,差异有统计学意义(t=12.02,P<0.05),其中术后胆道感染、术后出血相比较,ERCP组分别为26.7%、11.6%,明显高于经口胰胆管镜组的10.0%、2.0%(2=5.42,3.94;P<0.05);两组患者平均住院天数比较,经口胰胆管镜组(10.78±2.17)d<ERCP组(12.91±2.96)d,差异有统计学意义(P<0.05);两组患者手术前后肝功能明显改善,相关检验指标下降明显(P<0.05);塑料支架与金属支架在术后并发症及短期通畅率方面对比,无明显差异(P>0.05),在通畅时间>6个月的情况下,金属支架通畅率明显高于塑料支架(P<0.05)。结论经ERCP与经口胰胆管镜技术置入胆管支架对于缓解高位胆管癌临床症状有效,均可提高患者生存质量。其中经口胰胆管镜技术并发症发生率低、恢复快、优势更大,但花费较高;塑料支架对预期生存时间较短的患者有益,金属支架更适用于预期生存时间较长的患者。

恶性胆管梗阻病人经内镜逆行胰胆管造影术置入支架术后发生胆管炎的影响因素分析

目的 分析恶性胆管梗阻病人经内镜逆行胰胆管造影术(ERCP)置入支架术后胆管炎的危险因素。方法 收集2016年1月至2021年12月于承德市中心医院行ERCP支架置入的263例恶性胆管梗阻病人临床资料,纳入可能导致胆管炎发生的影响因素,应用logistic回归分析出相关危险因素,依据危险因素建立列线图预测模型。结果 263例病人有49例(18.63%)发生胆管炎。单因素分析显示,γ-谷氨酰转移酶(GGT)、白蛋白、困难插管、梗阻部位、吸烟与恶性胆管梗阻病人ERCP置入支架术后胆管炎发生相关(P<0.05);多因素分析显示GGT[OR=1.001,95%CI:(1.000,1.001)]、白蛋白[OR=6.199,95%CI:(1.625,23.641)]、困难插管[OR=19.734,95%CI:(2.900,134.267)]、梗阻部位[OR=6.865,95%CI:(2.911,16.190)]、吸烟[OR=3.877,95%CI:(1.722,8.727)]是胆管炎发生的独立危险因素。模型区分度用受试者操作特征曲线(ROC曲线)评价,ROC曲线下面积(AUC)为0.83[95%CI:(0.77,0.90),P<0.001],提示模型有较高的区分度。校准曲线中列线图模型预测恶性胆管梗阻病人ERCP置入支架术后胆管炎的概率与实际发生概率具有较高的一致性。结论 高GGT、低白蛋白、困难插管、高位胆管梗阻、吸烟是恶性胆管梗阻病人ERCP置入支架后胆管炎发生的独立危险因素,根据上述危险因素建立的列线图模型预测病人发生胆管炎能力较强,可根据预测病人发生胆管炎的概率采取个体化预防措施。

腹腔镜胆总管探查一期缝合与胆道内支架引流一期缝合疗效比较的Meta分析

目的:通过Meta分析比较腹腔镜胆总管探查一期缝合(PS)与胆道内支架引流(BDS)+PS的临床疗效,并探讨其临床应用价值。方法:检索国内外数据库中关于腹腔镜胆总管探查(LCBDE)+PS与LCBDE+BDS+PS疗效比较的临床研究。检索时间2010年1月1日至2023年8月1日。观察指标包括手术时间、住院时间、术后胆漏发生率及总并发症发生率,提取相关数据后应用RevMan 5.4软件进行Meta分析。结果:共纳入符合标准的回顾性队列研究5篇,文献累计样本量611例,其中PS组292例、BDS+PS组319例。Meta分析结果显示,两组手术时间(WMD=-1.66,95%CI=-15.78~12.46,P=0.82)、住院时间(WMD=-0.81,95%CI=-2.23~0.60,P=0.26)、残余结石率(OR=1.45,95%CI=0.24~8.83,P=0.69)、总并发症发生率(OR=1.15,95%CI=0.70~1.88,P=0.58)差异无统计学意义,PS组术后胆漏发生率(OR=3.63,95%CI=1.77~7.44,P=0.0004)高于BDS+PS组。结论:对于符合适应证的胆总管结石患者,LCBDE+BDS+PS可一定程度上降低术后胆漏发生率,是安全、有效的。

胆宁片在ERCP碎石术后留置胆管支架患者中的应用效果观察

目的评价胆宁片在ERCP碎石术后留置胆管支架患者中的应用效果。方法回顾性分析2022年9月至2023年8月同济大学附属东方医院247例实施ERCP碎石术后留置胆管支架患者的临床资料,按照术后是否服用胆宁片分为观察组(n=135)和对照组(n=112),其中观察组服用胆宁片,对照组不服用胆宁片。比较两组支架通畅率、肠胆返流率、结石残留率,以及总胆红素(TBIL)、结合胆红素(DBIL)、碱性磷酸酶(ALP)、γ-谷氨酰转移酶(GGT)的改善情况。结果与对照组比较,观察组胆管支架通畅率[89.63%(121/135)vs 57.14%(64/112),χ^(2)=34.36,P<0.001]较高,但肠胆反流发生率[8.89%(12/135)vs 33.21%(26/112),χ^(2)=23.77,P<0.001]和结石残留率均较低[13.33%(18/135)vs 23.21%(26/112),χ^(2)=8.133,P=0.004],差异有统计学意义(均P<0.05),而TBIL、DBIL、ALP和GGT均有降低,但仅有GGT的差异有统计学意义(P<0.05)。结论ERCP术后服用胆宁片可延长胆管支架的通畅时间,减少肠胆反流的发生及结石残留,并促进胆管酶谱的恢复。

胰管支架置入对急性胆源性胰腺炎患者预后及并发症的影响

目的分析急性胆源性胰腺炎(ABP)患者应用胰管支架置入治疗对预后及并发症的影响。方法选取2019年1月至2022年12月收治的300例ABP患者,按治疗方法不同分组,A组100例行鼻胆管引流治疗,B组100例行开腹胆总管探查联合T型管引流术治疗,C组100例行鼻胆管引流联合胰管支架置入治疗,对比3组肝功能、并发症、死亡率及恢复情况。结果B组术后总胆红素(TBIL)、天冬酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)水平低于A组(P<0.05);C组术后TBIL、AST、ALT水平低于A组和B组(P<0.05);B组恢复进食时间、体温恢复时间、住院时间较A组更短(P<0.05);C组恢复进食时间、腹痛消失时间、体温恢复时间及住院时间短于A组和B组(P<0.05);C组并发症发生率4.00%低于A组的12.00%(P<0.05);C组1.00%死亡率低于A组8.00%(P<0.05)。结论ABP患者应用胰管支架置入治疗,可有缩短患者恢复时间,有利于改善肝功能,死亡率低,且并发症少。

高危老年胆总管大结石患者塑料胆管支架置入后支架堵塞的影响因素分析

目的探讨合并慢性病的高危老年胆总管大结石患者,经塑料胆管支架置入治疗后影响支架堵塞的危险因素。方法回顾性分析2016年1月至2024年3月因胆总管大结石在解放军总医院第一医学中心行ERCP下塑料胆管支架置入治疗的高危老年患者资料,所有患者均随访3个月并在3个月内行第二次ERCP治疗。根据患者是否出现支架堵塞将患者分为堵塞组和通畅组。比较两组间的一般资料、化验结果、结石大小、是否存在壶腹周围憩室、支架种类和直径等指标,采用多因素logistics回归分析评估影响塑料胆管支架堵塞的危险因素。结果共入组111例患者,其中堵塞组28例,通畅组83例,支架堵塞率为25.23%。单因素分析示术前白细胞计数、丙氨酸氨基转移酶、壶腹周围憩室、支架直径在两组之间比较,差异有统计学意义(P值均<0.05)。多因素logistics回归分析显示,WBC[OR(95%CI):1.209(1.074~1.361)]、支架直径[OR(95%CI):0.279(0.088~0.887)]、壶腹周围憩室[OR(95%CI):3.396(1.077~10.710)]是术后支架堵塞的独立危险因素(P值均<0.05)。结论术前白细胞计数升高及存在壶腹周围憩室的患者术后发生支架堵塞的风险高,直径更大的胆管支架可有效降低术后支架堵塞的风险。

多镜联合胆管塑料支架置入胆管Ⅰ期缝合在肝外胆管结石中的应用

目的探讨腹腔镜、胆道镜、胃镜联合下胆管塑料支架置入胆管Ⅰ期缝合治疗肝外胆管结石的效果。方法收集2020年1月至2022年12月本院60例肝外胆管结石患者的临床资料。根据不同胆管引流方式将患者分为2组,各30例。观察组应用多镜联合下胆管塑料支架置入胆管Ⅰ期缝合;对照组应用腹腔镜胆总管探查+T管引流。比较两组手术时间、术中失血量、住院时间、治疗周期、住院费用。结果两组均成功完成手术,无中转剖腹。观察组术后住院时间、医疗费用少于对照组(P<0.05);手术时间、术中出血量、术后排气时间、结石清除率比较,差异无统计学意义(P>0.05)。观察组术后并发症总发生率3.33%,对照组16.67%,差异无统计学意义(P>0.05)。结论多镜联合胆管塑料支架置入胆管Ⅰ期缝合治疗肝外胆管结石可缩短住院时间、降低费用,手术安全性高,适宜在基层医院推广。