Background and Study Aims: Portal hypertension often coexists with pancreatic pseudocysts and is potentially dangerous if a collateral vessel is in the vicini ty of the needle puncture pathway. Hitherto, there have be...Background and Study Aims: Portal hypertension often coexists with pancreatic pseudocysts and is potentially dangerous if a collateral vessel is in the vicini ty of the needle puncture pathway. Hitherto, there have been no reports of pseud ocyst drainage in this setting. Patients and Methods: Patients who underwent end oscopic ultrasound (EUS)-guided pancreatic pseudocyst drainage complicated by i ntervening vessels were assessed for success and outcomes. An Olympus mechanical linear-array video echo endoscope GF-UM 140D was used for the drainage proced ure in all patients. Either a “hot"diathermy technique was employed or a “cold " technique using direct aspiration with a 19-G needle, followed by deployment of a nasocystic catheter. Results: Eight patients with a symptomatic pseudocyst and intervening vessels underwent drainage that was guided (n = 6) or assisted ( n = 2) by EUS. All were found to have successful resolution of the cyst at follo w-up 6 weeks later, while segmental portal hypertension had disappeared in one patient. There were no major complications.One patient had transient hemorrhagic drainage that resolved by itself. Conclusions: Pseudocysts complicated by porta l hypertension or by intervening vessels can be safely drained under EUS guidanc e, even in the absence of color Doppler imaging.展开更多
目的 评估内镜鼻胆囊引流(ENGD)治疗胆总管结石合并急性化脓性胆囊炎的安全性和有效性。方法 回顾性纳入2023年1—12月大连医科大学附属第一医院及同济大学附属东方医院收治的46例胆总管结石合并急性化脓性胆囊炎患者,其中21例行内镜逆...目的 评估内镜鼻胆囊引流(ENGD)治疗胆总管结石合并急性化脓性胆囊炎的安全性和有效性。方法 回顾性纳入2023年1—12月大连医科大学附属第一医院及同济大学附属东方医院收治的46例胆总管结石合并急性化脓性胆囊炎患者,其中21例行内镜逆行胰胆管造影(ERCP)取石+ENGD治疗(ENGD组),另外25例行ERCP取石+经皮肝穿刺胆管引流(PTGD)(PTGD组),比较两组操作成功率、手术时间、并发症发生率、不良事件发生率、住院时间、治疗费用、患者满意度,以及二期腹腔镜胆囊切除(LC)手术时间、并发症发生率、腹腔引流管留置率及住院时间。结果 两组患者操作成功率均为100%。ENGD组和PTGD组在手术时间[(46.4±4.8)min vs (55.0±6.0)min]、治疗费用[(3.2±0.3)万元vs (3.5±0.3)万元]、患者满意度[5(5,5)分vs 4(4,5)分]方面的比较,差异具有统计学意义(P<0.05);ENGD组二期LC手术时间[(45.4±7.0)min vs (58.4±9.2)min]、并发症发生率[1(4.8%) vs 7(28.0%)]、腹腔引流管留置率[10(47.6%) vs 23(92.0%)]及住院时间[(3.6±0.7)d vs (4.7±0.6)d]均低于PTGD组,差异具有统计学意义(P<0.05)。结论 ENGD治疗胆总管结石合并急性化脓性胆囊炎安全、有效,患者满意度高,并能降低LC风险。展开更多
目的 探讨饮食干预对内镜胆管内引流(ERBD)术后单猪尾胆管支架脱落的影响。方法 前瞻性选择2022年1月至2023年12月同济大学附属东方医院胆石病中心因胆总管结石行内镜逆行胰胆管造影(ERCP)取石及ERBD置入7 Fr 5cm单猪尾胆管支架治疗的...目的 探讨饮食干预对内镜胆管内引流(ERBD)术后单猪尾胆管支架脱落的影响。方法 前瞻性选择2022年1月至2023年12月同济大学附属东方医院胆石病中心因胆总管结石行内镜逆行胰胆管造影(ERCP)取石及ERBD置入7 Fr 5cm单猪尾胆管支架治疗的患者作为研究对象,术后对病区A的患者进行饮食干预(试验组,n=209),病区B的患者采取常规饮食干预(对照组,n=106),比较两组患者餐后腹痛发生率、不同时间段支架脱落率、并发症发生率、残石率。结果 试验组餐后腹痛发生率低于对照组[6.22%(13/209) vs 25.47%(27/106)],差异有统计学意义(P<0.001)。试验组术后单猪尾胆管支架总脱落率高于对照组[86.60%(181/209) vs 85.85%(91/106),P=0.854],其中试验组术后1~2 d支架脱落率低于对照组[4.78%(10/209) vs 12.26%(13/106),P=0.016],术后3~7 d支架脱落率低于对照组[27.14%(54/199) vs38.71%(36/93),P=0.046],但术后8~30 d支架脱落率高于对照组[80.69%(117/145) vs 73.68%(42/57),P=0.274]。试验组术后早期并发症发生率低于对照组[4.69%(3/64) vs 18.37%(9/49),P=0.022],术后晚期并发症发生率也低于对照组[4.83%(7/145) vs 5.26%(3/57),P=0.898]。试验组术后残石率低于对照组[0.96%(2/209) vs 7.55%(8/106),P=0.002]。结论 特定的饮食干预能显著降低内镜胆管内引流术后单猪尾胆管支架早期脱落率、近远期并发症发生率及残石率,符合快速康复护理理念。展开更多
文摘Background and Study Aims: Portal hypertension often coexists with pancreatic pseudocysts and is potentially dangerous if a collateral vessel is in the vicini ty of the needle puncture pathway. Hitherto, there have been no reports of pseud ocyst drainage in this setting. Patients and Methods: Patients who underwent end oscopic ultrasound (EUS)-guided pancreatic pseudocyst drainage complicated by i ntervening vessels were assessed for success and outcomes. An Olympus mechanical linear-array video echo endoscope GF-UM 140D was used for the drainage proced ure in all patients. Either a “hot"diathermy technique was employed or a “cold " technique using direct aspiration with a 19-G needle, followed by deployment of a nasocystic catheter. Results: Eight patients with a symptomatic pseudocyst and intervening vessels underwent drainage that was guided (n = 6) or assisted ( n = 2) by EUS. All were found to have successful resolution of the cyst at follo w-up 6 weeks later, while segmental portal hypertension had disappeared in one patient. There were no major complications.One patient had transient hemorrhagic drainage that resolved by itself. Conclusions: Pseudocysts complicated by porta l hypertension or by intervening vessels can be safely drained under EUS guidanc e, even in the absence of color Doppler imaging.
文摘目的 评估内镜鼻胆囊引流(ENGD)治疗胆总管结石合并急性化脓性胆囊炎的安全性和有效性。方法 回顾性纳入2023年1—12月大连医科大学附属第一医院及同济大学附属东方医院收治的46例胆总管结石合并急性化脓性胆囊炎患者,其中21例行内镜逆行胰胆管造影(ERCP)取石+ENGD治疗(ENGD组),另外25例行ERCP取石+经皮肝穿刺胆管引流(PTGD)(PTGD组),比较两组操作成功率、手术时间、并发症发生率、不良事件发生率、住院时间、治疗费用、患者满意度,以及二期腹腔镜胆囊切除(LC)手术时间、并发症发生率、腹腔引流管留置率及住院时间。结果 两组患者操作成功率均为100%。ENGD组和PTGD组在手术时间[(46.4±4.8)min vs (55.0±6.0)min]、治疗费用[(3.2±0.3)万元vs (3.5±0.3)万元]、患者满意度[5(5,5)分vs 4(4,5)分]方面的比较,差异具有统计学意义(P<0.05);ENGD组二期LC手术时间[(45.4±7.0)min vs (58.4±9.2)min]、并发症发生率[1(4.8%) vs 7(28.0%)]、腹腔引流管留置率[10(47.6%) vs 23(92.0%)]及住院时间[(3.6±0.7)d vs (4.7±0.6)d]均低于PTGD组,差异具有统计学意义(P<0.05)。结论 ENGD治疗胆总管结石合并急性化脓性胆囊炎安全、有效,患者满意度高,并能降低LC风险。
文摘目的 探讨饮食干预对内镜胆管内引流(ERBD)术后单猪尾胆管支架脱落的影响。方法 前瞻性选择2022年1月至2023年12月同济大学附属东方医院胆石病中心因胆总管结石行内镜逆行胰胆管造影(ERCP)取石及ERBD置入7 Fr 5cm单猪尾胆管支架治疗的患者作为研究对象,术后对病区A的患者进行饮食干预(试验组,n=209),病区B的患者采取常规饮食干预(对照组,n=106),比较两组患者餐后腹痛发生率、不同时间段支架脱落率、并发症发生率、残石率。结果 试验组餐后腹痛发生率低于对照组[6.22%(13/209) vs 25.47%(27/106)],差异有统计学意义(P<0.001)。试验组术后单猪尾胆管支架总脱落率高于对照组[86.60%(181/209) vs 85.85%(91/106),P=0.854],其中试验组术后1~2 d支架脱落率低于对照组[4.78%(10/209) vs 12.26%(13/106),P=0.016],术后3~7 d支架脱落率低于对照组[27.14%(54/199) vs38.71%(36/93),P=0.046],但术后8~30 d支架脱落率高于对照组[80.69%(117/145) vs 73.68%(42/57),P=0.274]。试验组术后早期并发症发生率低于对照组[4.69%(3/64) vs 18.37%(9/49),P=0.022],术后晚期并发症发生率也低于对照组[4.83%(7/145) vs 5.26%(3/57),P=0.898]。试验组术后残石率低于对照组[0.96%(2/209) vs 7.55%(8/106),P=0.002]。结论 特定的饮食干预能显著降低内镜胆管内引流术后单猪尾胆管支架早期脱落率、近远期并发症发生率及残石率,符合快速康复护理理念。
