BACKGROUND Endoscopic sphincterotomy(EST) is widely regarded as the first choice in the management of common bile duct(CBD) stones. However, for some patients, this treatment is not possible. The percutaneous transhep...BACKGROUND Endoscopic sphincterotomy(EST) is widely regarded as the first choice in the management of common bile duct(CBD) stones. However, for some patients, this treatment is not possible. The percutaneous transhepatic balloon dilation(PTBD)technique has been suggested as an alternative but has yet to gain wide acceptance.AIM To review cases of PTBD for removing CBD stones and explore the safety and efficacy of this treatment.METHODS We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched EMBASE,PubMed, and Web of Science for cases of PTBD that underwent CBD stone removal from 1981 to January 2019. We analyzed all relevant articles available in full text. We extracted data on patient's age, gender, overall technique success rate, reasons for technique failure, and the presence and type of major and minor complications. We analyzed the data and reported the results in a table and text.Altogether, we retrieved 12 case series and 6 case reports, for a total of 1347 patients. Thirty cases were excluded due to a lack of patient data.RESULTS The overall technique success rate for removing a CBD stone was 98.5%(1327/1347) and 98.1%(109/111) for removing concurrent CBD and gallbladder stones. Based on available data(n = 1312), mean age of all patients(687 males and625 females) was 68.9 years. The total number of procedures in the remaining 1317 patients(after exclusion) was 3237(average 2.4 procedures per patient). The total number of failures for eliminating a CBD stone was 20, and the reasons for failure included: Stone impaction(n = 10), intrahepatic bile duct stricture(n = 5),large stone(n = 2), severe CBD dilation(n = 1), multiple stones(n = 1), and duodenal perforation(n = 1). Various major complications related to the procedure were reported, but the incidence rate was low(1.4%). No pancreatitis or procedure related mortality was reported. Minor complications including transient hyperamylasemia, nausea, vomiting, abdominal pain, fever, and mild hemobilia were reported. For 218 patients(88 patients with unsuccessful endoscopic removal due to anatomical change and large or impacted stone and130 cases who refused endoscopic procedure due to poor general condition or other additional disease), the CBD stones were successfully pushed into the duodenum by performing the PTBD procedure.CONCLUSION PTBD is a safe and effective approach in the nonoperative management of CBD stones. PTBD provides an alternative treatment when endoscopic procedures fail or are unsuitable for the patient.展开更多
目的探讨保留左肝管主干的前入路左半肝切除术在治疗左肝内胆管结石预防胆漏中的应用价值。方法回顾性分析泰州市人民医院2008年1月至2016年9月行左半肝切除术治疗的左肝内胆管结石患者75例,其中行保留左肝管主干的前入路左半肝切除术37...目的探讨保留左肝管主干的前入路左半肝切除术在治疗左肝内胆管结石预防胆漏中的应用价值。方法回顾性分析泰州市人民医院2008年1月至2016年9月行左半肝切除术治疗的左肝内胆管结石患者75例,其中行保留左肝管主干的前入路左半肝切除术37例(前入路组),传统入路左半肝切除术38例(传统组),比较两组手术时间、术中失血量、住院天数及术后胆漏并发症的差异。结果所有病例均顺利完成手术。两组的性别、年龄、肝功能Child-Pugh分级的比较无统计学差异,前入路组较传统组手术时间短[(153.27±19.55)min vs(184.26±22.41)min,t=-6.38,P<0.01],术中出血量少[(109.78±18.41)m L vs(317.71±28.14)m L,t=-37.76,P<0.01],住院时间短[(10.16±0.65)d vs(15.39±1.03)d,t=-26.32,P<0.01],术后胆漏并发症例数少(1 vs 13,χ~2=12.26,P<0.01)。结论保留左肝管主干的前入路左半肝切除术可减少手术时间、术中失血量和住院时间,并显著减少术后胆漏发生率,在左半肝切除治疗左肝内胆管结石中值得推广。展开更多
目的探讨腹腔镜中路纵剖法取石术治疗复杂性肝胆结石的效果。方法选取我院2016年1月~2017年9月收治的复杂性肝内胆管结石患者80例,按随机数字表分为观察组和对照组,每组各40例。观察组采用中路纵剖法行腹腔镜取石术,对照组采用传统的腹...目的探讨腹腔镜中路纵剖法取石术治疗复杂性肝胆结石的效果。方法选取我院2016年1月~2017年9月收治的复杂性肝内胆管结石患者80例,按随机数字表分为观察组和对照组,每组各40例。观察组采用中路纵剖法行腹腔镜取石术,对照组采用传统的腹腔镜取石术,比较两组患者手术相关指标以及并发症发生情况。结果观察组中转开腹率(2.50%)明显低于对照组(12.50%),差异有统计学意义(χ^2=13.206,P<0.05)。两组手术时间、术中出血量和术后排气时间比较,差异均无统计学意义(P>0.05);观察组住院时间明显短于对照组,差异有统计学意义(P<0.05)。观察组患者术后仅1例肝门区积液,对照组出现胆管出血3例,伤口感染、肝门区积液、胆漏及黄疸各1例。两组并发症率比较,观察组低于对照组,差异有统计学意义(2.56% vs. 20%,P<0.05)。结论采用中路纵剖法行腹腔镜取石术治疗复杂性肝胆结石较传统手术在分离和暴露Calot三角中具有更高的安全性,且可缩短住院时间,值得临床进一步推广应用。展开更多
基金Supported by the Natural Science Foundation of Shandong Province,Nos.2014ZRE27479,ZR2018PH032,and ZR2018PH033the National Natural Science Foundation of China,No.6167276
文摘BACKGROUND Endoscopic sphincterotomy(EST) is widely regarded as the first choice in the management of common bile duct(CBD) stones. However, for some patients, this treatment is not possible. The percutaneous transhepatic balloon dilation(PTBD)technique has been suggested as an alternative but has yet to gain wide acceptance.AIM To review cases of PTBD for removing CBD stones and explore the safety and efficacy of this treatment.METHODS We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched EMBASE,PubMed, and Web of Science for cases of PTBD that underwent CBD stone removal from 1981 to January 2019. We analyzed all relevant articles available in full text. We extracted data on patient's age, gender, overall technique success rate, reasons for technique failure, and the presence and type of major and minor complications. We analyzed the data and reported the results in a table and text.Altogether, we retrieved 12 case series and 6 case reports, for a total of 1347 patients. Thirty cases were excluded due to a lack of patient data.RESULTS The overall technique success rate for removing a CBD stone was 98.5%(1327/1347) and 98.1%(109/111) for removing concurrent CBD and gallbladder stones. Based on available data(n = 1312), mean age of all patients(687 males and625 females) was 68.9 years. The total number of procedures in the remaining 1317 patients(after exclusion) was 3237(average 2.4 procedures per patient). The total number of failures for eliminating a CBD stone was 20, and the reasons for failure included: Stone impaction(n = 10), intrahepatic bile duct stricture(n = 5),large stone(n = 2), severe CBD dilation(n = 1), multiple stones(n = 1), and duodenal perforation(n = 1). Various major complications related to the procedure were reported, but the incidence rate was low(1.4%). No pancreatitis or procedure related mortality was reported. Minor complications including transient hyperamylasemia, nausea, vomiting, abdominal pain, fever, and mild hemobilia were reported. For 218 patients(88 patients with unsuccessful endoscopic removal due to anatomical change and large or impacted stone and130 cases who refused endoscopic procedure due to poor general condition or other additional disease), the CBD stones were successfully pushed into the duodenum by performing the PTBD procedure.CONCLUSION PTBD is a safe and effective approach in the nonoperative management of CBD stones. PTBD provides an alternative treatment when endoscopic procedures fail or are unsuitable for the patient.
文摘目的探讨保留左肝管主干的前入路左半肝切除术在治疗左肝内胆管结石预防胆漏中的应用价值。方法回顾性分析泰州市人民医院2008年1月至2016年9月行左半肝切除术治疗的左肝内胆管结石患者75例,其中行保留左肝管主干的前入路左半肝切除术37例(前入路组),传统入路左半肝切除术38例(传统组),比较两组手术时间、术中失血量、住院天数及术后胆漏并发症的差异。结果所有病例均顺利完成手术。两组的性别、年龄、肝功能Child-Pugh分级的比较无统计学差异,前入路组较传统组手术时间短[(153.27±19.55)min vs(184.26±22.41)min,t=-6.38,P<0.01],术中出血量少[(109.78±18.41)m L vs(317.71±28.14)m L,t=-37.76,P<0.01],住院时间短[(10.16±0.65)d vs(15.39±1.03)d,t=-26.32,P<0.01],术后胆漏并发症例数少(1 vs 13,χ~2=12.26,P<0.01)。结论保留左肝管主干的前入路左半肝切除术可减少手术时间、术中失血量和住院时间,并显著减少术后胆漏发生率,在左半肝切除治疗左肝内胆管结石中值得推广。
文摘目的探讨腹腔镜中路纵剖法取石术治疗复杂性肝胆结石的效果。方法选取我院2016年1月~2017年9月收治的复杂性肝内胆管结石患者80例,按随机数字表分为观察组和对照组,每组各40例。观察组采用中路纵剖法行腹腔镜取石术,对照组采用传统的腹腔镜取石术,比较两组患者手术相关指标以及并发症发生情况。结果观察组中转开腹率(2.50%)明显低于对照组(12.50%),差异有统计学意义(χ^2=13.206,P<0.05)。两组手术时间、术中出血量和术后排气时间比较,差异均无统计学意义(P>0.05);观察组住院时间明显短于对照组,差异有统计学意义(P<0.05)。观察组患者术后仅1例肝门区积液,对照组出现胆管出血3例,伤口感染、肝门区积液、胆漏及黄疸各1例。两组并发症率比较,观察组低于对照组,差异有统计学意义(2.56% vs. 20%,P<0.05)。结论采用中路纵剖法行腹腔镜取石术治疗复杂性肝胆结石较传统手术在分离和暴露Calot三角中具有更高的安全性,且可缩短住院时间,值得临床进一步推广应用。
