Background: Diagnosing primary sclerosing cholangitis (PSC) is problematic and requires meeting a burden of proof through clinical, biochemical, radiologic, and histological features. Endoscopic ultrasound yields deta...Background: Diagnosing primary sclerosing cholangitis (PSC) is problematic and requires meeting a burden of proof through clinical, biochemical, radiologic, and histological features. Endoscopic ultrasound yields detailed images of the extrahepatic biliary tree, but its value in contributing to the diagnosis of this condition is unknown. Objectives: To determine the potential for transduodenal EUS to detect common bile duct wall thickening in PSC.Design: A prospective, controlled study with retrospective, blinded data analysis. Setting: Single tertiary referral center for inflammatory bowel disease and EUS. Patients: Four groups of patients were assessed with radial endosonography: PSC (n = 9); inflammatory bowel disease (IBD) with abnormal liver blood tests (n = 21); choledocholithiasis (n = 15); and normal controls (n = 50). Measurements were made of the common bile duct diameter and wall thickness. Interventions: Transduodenal radial EUS of the biliary tree. Main Outcome Measurements: Common bile duct diameter and wall thickness. Results: The mean diameter (SD) of the common bile duct for the PSC, IBD, choledocholithiasis, and normal control groups measured 8.9 mm (2.8), 5.4 mm (1.7), 7.2 mm (2.2), and 5.0 mm (1.9), respectively (PSC and chole-docholithiasis groups compared to the IBD group, P < .05 for a single test of hypothesis, but correction for the multiple testing of data removed this significance; normal control group P < .005). Mean ductal wall thickness (SD) was 2.5 mm (0.8) for the PSC group, 0.7 mm (0.4) for the IBD group, 0.8 mm (0.4) for the choledocholithiasis group, and 0.8 mm (0.4) for the normal control group, respectively (PSC group compared to the other 3 groups, P < .005). Limitations: Assessment of intrahepatic PSC is problematic. Conclusion: Thickening ( >1.5 mm) of the common bile duct wall is seen in patients with PSC but not in those with aPPArently uncomplicated IBD or choledocholithiasis. The results of this study suggest that standard endosonography contributes to the imaging and potentially to the diagnosis of PSC.展开更多
文摘目的探讨胆总管侧壁 T 管引流术在腹腔镜胆囊切除术( laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查术( laparoscopic common bile duct exploration,LCBDE)应用的临床疗效。方法 2016 年 7 月~ 2018 年 9 月在我院行 LC+LCBDE 的 175 例胆囊合并胆总管结石患者,按随机数字表法分为两组,采用不同位置引出 T 管:胆总管前壁 T 管引流(前壁组) 88 例,胆总管侧壁 T 管引流(侧壁组) 87 例。比较两组术中出血量、T 管放置时间、缝合胆总管时间、术后肛门排气时间、腹腔引流时间、胆汁引流量、术后至 T 管完全夹闭时间、住院时间、住院费用、患者耐受 T 管的主观感受及术后并发症等。结果两组患者术中出血量、术中安放 T 管时间、术后肛门排气时间、腹腔引流时间、日均胆汁引流量、术后至完全夹闭 T 管时间、术后住院时间、住院费用及患者耐受 T 管的 VRS 评分比较均无统计学差异( P>0.05),但侧壁组术中缝合胆总管时间较前壁组少,差异有统计学意义( P<0.05)。所有患者均获随访,时间 2 ~ 36 月。随访期内均未出现术后出血、腹腔感染、黄疸、急性胆管炎和急性胰腺炎等并发症,经 T 管胆道造影未见胆管狭窄,肝功能均恢复正常。术后前壁组发生胆漏 7 例,结石残留 1 例, T 管拔除困难 2 例,侧壁组胆漏 1 例,结石残留 1 例;组间并发症率比较,差异有统计学意义( 11.36%vs. 2.30%,P<0.05)。结论 LC+LCBDE 胆总管侧壁 T 管引流较前壁 T 管引流更简单、易操作、更安全,值得推广。
文摘Background: Diagnosing primary sclerosing cholangitis (PSC) is problematic and requires meeting a burden of proof through clinical, biochemical, radiologic, and histological features. Endoscopic ultrasound yields detailed images of the extrahepatic biliary tree, but its value in contributing to the diagnosis of this condition is unknown. Objectives: To determine the potential for transduodenal EUS to detect common bile duct wall thickening in PSC.Design: A prospective, controlled study with retrospective, blinded data analysis. Setting: Single tertiary referral center for inflammatory bowel disease and EUS. Patients: Four groups of patients were assessed with radial endosonography: PSC (n = 9); inflammatory bowel disease (IBD) with abnormal liver blood tests (n = 21); choledocholithiasis (n = 15); and normal controls (n = 50). Measurements were made of the common bile duct diameter and wall thickness. Interventions: Transduodenal radial EUS of the biliary tree. Main Outcome Measurements: Common bile duct diameter and wall thickness. Results: The mean diameter (SD) of the common bile duct for the PSC, IBD, choledocholithiasis, and normal control groups measured 8.9 mm (2.8), 5.4 mm (1.7), 7.2 mm (2.2), and 5.0 mm (1.9), respectively (PSC and chole-docholithiasis groups compared to the IBD group, P < .05 for a single test of hypothesis, but correction for the multiple testing of data removed this significance; normal control group P < .005). Mean ductal wall thickness (SD) was 2.5 mm (0.8) for the PSC group, 0.7 mm (0.4) for the IBD group, 0.8 mm (0.4) for the choledocholithiasis group, and 0.8 mm (0.4) for the normal control group, respectively (PSC group compared to the other 3 groups, P < .005). Limitations: Assessment of intrahepatic PSC is problematic. Conclusion: Thickening ( >1.5 mm) of the common bile duct wall is seen in patients with PSC but not in those with aPPArently uncomplicated IBD or choledocholithiasis. The results of this study suggest that standard endosonography contributes to the imaging and potentially to the diagnosis of PSC.
