目的:对比腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)与内镜下胆管下段Oddi括约肌切开术(endoscopic sphincterotomy,EST)联合LC治疗胆囊结石合并胆...目的:对比腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)与内镜下胆管下段Oddi括约肌切开术(endoscopic sphincterotomy,EST)联合LC治疗胆囊结石合并胆总管结石的效果及对患者炎症因子水平的影响。方法:选取2019年1月—2021年12月福建医科大学附属龙岩第一医院收治的176例胆囊结石合并胆总管结石患者作为研究对象,用随机数表法将其分为对照组和观察组,各88例。对照组接受EST+LC治疗,观察组接受LC+LCBDE治疗,比较两组疗效、围手术期指标、炎症因子、并发症等。结果:观察组一次性结石清除率为94.32%,低于对照组的95.45%,但差异无统计学意义(χ^(2)=0.1171,P>0.05)。观察组治疗费用少于对照组,住院时间短于对照组,手术时间长于对照组,差异均有统计学意义(t=4.9958、46.0574、24.1632,P<0.05);但两组首次下床活动时间、术中出血量比较,差异均无统计学意义(t=0.0000、0.0628,P>0.05)。两组术前肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、C反应蛋白(CRP)比较,差异无统计学意义(t=0.0061、0.0092、0.3235,P>0.05);观察组TNF-α、IL-8、CRP均低于对照组,差异均有统计学意义(t=6.4203、8.2981、39.5606,P<0.05)。观察组并发症发生率为2.27%,低于对照组的3.41%,但差异无统计学意义(χ^(2)=0.2058,P>0.05)。结论:LC+LCBDE与EST+LC治疗胆囊结石合并胆总管结石的效果相当,但前者炎症因子水平更低、住院时间更短,临床可根据患者实际状况综合确定治疗方式。展开更多
胆总管结石的治疗方式有传统开腹胆总管探查手术(common bile duct exploration,CBDE)、腹腔镜下胆总管探查术(laparoscopic common bile duct exploration,LCBDE)和逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ER...胆总管结石的治疗方式有传统开腹胆总管探查手术(common bile duct exploration,CBDE)、腹腔镜下胆总管探查术(laparoscopic common bile duct exploration,LCBDE)和逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)、经内镜Oddi括约肌切开术(endoscopic sphincterotomy,EST)或经内镜十二指肠乳头切开术[1,2],现将武警安徽总队医院1 268例胆总管结石的治疗体会加以总结和分析。展开更多
AIM： To determine the rates of success and complications of precut biliary sphincterotomy （PBS） based on prior experience and to compare the complication rates between PBS and standard endoscopic sphincterotomy （E...AIM： To determine the rates of success and complications of precut biliary sphincterotomy （PBS） based on prior experience and to compare the complication rates between PBS and standard endoscopic sphincterotomy （ES）. METHODS： A retrospective evaluation of prospectively collected non-randomized data at an academic tertiary referral center, The study included all patients in an eight-year period who underwent PBS and ES by a single endoscopist who had no formal training in PBS. The main outcorne measures of the study were success and complications of PBS with a comparison to complications of ES.RESULTS： A total of 2939 endoscopic retrograde chola ngiopancreatographies （ERCPs） were performed during the study period, including 818 （28%） ES and 150 （5%） PBS procedures. Selective biliary cannulation via PBS was successful at the first attempt in 75% of the patients. Cannulation was achieved in an additional 13% of the patients at a subsequent attempt （total 87%）. Complication rate from PBS was 45% higher than ES, but did not differ significantly [7% （10/50） vs 5% （38/818）, P = 0.29]. None of the complications from PBS was severe. A significant trend towards increasing success existed with regard to the endoscopist＇s first attempt at precut （P = 0.0393, Cochran-Armitage exact test for trend, Z = -1.7588）. CONCLUSION： Despite the lack of specific training in this technique, PBS was performed with a high success rate and a complication rate similar to or less than reports from other experienced centers. These results suggest that endoscopic experience and perhaps innate endoscopic skill may play an important role in the outcome of this procedure.展开更多
AIM： To retrospectively investigate the effect and safety of various new type precut sphincterotomy techniques （VNTPST） in endoscopic retrograde cholangiopancreatography （ERCP） due to difficult biliary duct cannu...AIM： To retrospectively investigate the effect and safety of various new type precut sphincterotomy techniques （VNTPST） in endoscopic retrograde cholangiopancreatography （ERCP） due to difficult biliary duct cannulation （DBC）. METHODS： A plough-like pull-type sphincterotome （PLPTS） or improved short nose sphincterotome or improved needle knife was applied. VNTPST was carried out in 30 of 280 patients, whose biliary tract could not be exposed well or deep cannulation was difficult to perform during ERCP with traditional methods. Patients were followed up for short-term complications and the therapeutic effect of VNTPS was observed and compared with that of traditional endoscopic sphincterotomy （EST）. RESULTS： A total 280 patients underwent ERCP, of which 3 failed in operation because of pathological features in stomch or duodenum, 247 successfully underwent traditional ERCP （89.1%, 247/277）, 30 failed （10.8%, 30/277）. VNTPS technique succeeded in 24 （80%, 24/30） of 30 cases. The successful rate of deep biliary duct cannulation increased 8.6% （24/277）, the total cannulation successful rate following precut was 97.7%. There was a significant difference between the two groups （97.7% vs 89.1%, x^2= 17.1, P 〈 0.01）. The incidence of complications was 9.3% （26/277） for traditional ERCP group and 13.3% （4/30） for VNTPS technique group. Guideline tip was broken in pancreatic duct （KPDGP） of one patient, and there was no pancreatitis, slight or moderate bleeding postoperatively occurred in 2 patients, 1 patient had bleeding during operation （PDWN）. There were no differences between VNTPS technique group and traditional ERCP（TRERCP）group （13.3% vs 9.3%, %2 = 0.478, P 〉 0.05）. CONCLUSION： VNTPS procedure and Deng＇s precut are highly effective methods to get biliary access during ERCP with DBC. With skillful techniques, it can increase the successful rate for deep cannulation of biliary duct and decrease complications. VNTPS technique, especially Deng＇s precut is as effective and safe as EST. This technique can be well performed in hospitals without particular equipments.展开更多
AIM： To evaluate whether an automatically controlled cut system （endocut mode） could reduce the complication rate of endoscopic sphincterotomy （EST） and serum hyperamylasemia after EST compared to the conventiona...AIM： To evaluate whether an automatically controlled cut system （endocut mode） could reduce the complication rate of endoscopic sphincterotomy （EST） and serum hyperamylasemia after EST compared to the conventional blended cut mode. METHODS： From January 2001 to October 2003, 134 patients with choledocholithiasis were assigned to either endocut mode group or conventional blended cut mode group at the time of sphincterotomy. The two groups were retrospectively compared for the complications after EST and serum amylase level before and 24 h after the procedure. RESULTS： Of the 134 patients treated, 79 were assigned to conventional blended cut mode group and 55 to endocut mode group. There was no significant difference in age, sex, and serum amylase level before EST between the two groups. Complications were found in 5 patients of the endocut mode group （9%）： hyperamylasemia （5 times higher than normal） in 4 and moderate pancreatitis in 1. Complications were found in 13 patients of the conventional blended cut mode group （16%）： hyperamylasemia in 12 and moderate pancreatitis in 1. Serum amylase levels were elevated in both groups 24 h after EST （P〈0.02）. The average serum amylase level 24 h after EST in the conventional blended cut mode group was significantly higher than that in the endocut mode group （P〈 0.05）. CONCLUSION： Endocut mode offers a safety advantage over conventional blended cut mode for pancreatitis after EST by reducing hyperamylasemia.展开更多
目的:探讨腹腔镜下胆囊切除术(laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)治疗胆囊结石合并胆总管结石的临床效果。方法:选择2018年5月-2020年2月在笔者所在医院收治的...目的:探讨腹腔镜下胆囊切除术(laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)治疗胆囊结石合并胆总管结石的临床效果。方法:选择2018年5月-2020年2月在笔者所在医院收治的152例胆囊结石合并胆总管结石患者作为观察对象,将其随机分为两组,每组76例。A组采用LC+LCBDE治疗,B组采用内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)/内镜下十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)+LC治疗,比较两组临床疗效。结果:A组手术时间、术后排气时间、住院费用分别为(131.63±13.37)min、(26.24±3.26)h、(2.02±0.15)万元,均优于B组的(154.35±18.21)min、(37.02±3.68)h、(3.07±0.16)万元,差异有统计学意义(P<0.001)。B组术中出血量少于A组,下床时间早于A组,差异有统计学意义(P<0.05)。但两组住院时间、完全取石率和中转开腹率比较差异均无统计学意义(P>0.05)。术后,两组TBIL、ALT、AST、AMS均较术前明显改善(P<0.05),但两组术后TBIL、ALT、AST、AMS比较差异均无统计学意义(P>0.05)。两组术后并发症发生率比较差异无统计学意义(P>0.05)。结论:在胆囊结石合并胆总管结石的手术治疗中,LC+LCBDE与ERCP/EST+LC两种术式均能获得理想疗效,且安全性良好,临床可根据医院的医疗条件与患者病情选择手术方式。展开更多
文摘目的:对比腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)与内镜下胆管下段Oddi括约肌切开术(endoscopic sphincterotomy,EST)联合LC治疗胆囊结石合并胆总管结石的效果及对患者炎症因子水平的影响。方法:选取2019年1月—2021年12月福建医科大学附属龙岩第一医院收治的176例胆囊结石合并胆总管结石患者作为研究对象,用随机数表法将其分为对照组和观察组,各88例。对照组接受EST+LC治疗,观察组接受LC+LCBDE治疗,比较两组疗效、围手术期指标、炎症因子、并发症等。结果:观察组一次性结石清除率为94.32%,低于对照组的95.45%,但差异无统计学意义(χ^(2)=0.1171,P>0.05)。观察组治疗费用少于对照组,住院时间短于对照组,手术时间长于对照组,差异均有统计学意义(t=4.9958、46.0574、24.1632,P<0.05);但两组首次下床活动时间、术中出血量比较,差异均无统计学意义(t=0.0000、0.0628,P>0.05)。两组术前肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、C反应蛋白(CRP)比较,差异无统计学意义(t=0.0061、0.0092、0.3235,P>0.05);观察组TNF-α、IL-8、CRP均低于对照组,差异均有统计学意义(t=6.4203、8.2981、39.5606,P<0.05)。观察组并发症发生率为2.27%,低于对照组的3.41%,但差异无统计学意义(χ^(2)=0.2058,P>0.05)。结论:LC+LCBDE与EST+LC治疗胆囊结石合并胆总管结石的效果相当,但前者炎症因子水平更低、住院时间更短,临床可根据患者实际状况综合确定治疗方式。
文摘胆总管结石的治疗方式有传统开腹胆总管探查手术(common bile duct exploration,CBDE)、腹腔镜下胆总管探查术(laparoscopic common bile duct exploration,LCBDE)和逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)、经内镜Oddi括约肌切开术(endoscopic sphincterotomy,EST)或经内镜十二指肠乳头切开术[1,2],现将武警安徽总队医院1 268例胆总管结石的治疗体会加以总结和分析。
文摘AIM： To determine the rates of success and complications of precut biliary sphincterotomy （PBS） based on prior experience and to compare the complication rates between PBS and standard endoscopic sphincterotomy （ES）. METHODS： A retrospective evaluation of prospectively collected non-randomized data at an academic tertiary referral center, The study included all patients in an eight-year period who underwent PBS and ES by a single endoscopist who had no formal training in PBS. The main outcorne measures of the study were success and complications of PBS with a comparison to complications of ES.RESULTS： A total of 2939 endoscopic retrograde chola ngiopancreatographies （ERCPs） were performed during the study period, including 818 （28%） ES and 150 （5%） PBS procedures. Selective biliary cannulation via PBS was successful at the first attempt in 75% of the patients. Cannulation was achieved in an additional 13% of the patients at a subsequent attempt （total 87%）. Complication rate from PBS was 45% higher than ES, but did not differ significantly [7% （10/50） vs 5% （38/818）, P = 0.29]. None of the complications from PBS was severe. A significant trend towards increasing success existed with regard to the endoscopist＇s first attempt at precut （P = 0.0393, Cochran-Armitage exact test for trend, Z = -1.7588）. CONCLUSION： Despite the lack of specific training in this technique, PBS was performed with a high success rate and a complication rate similar to or less than reports from other experienced centers. These results suggest that endoscopic experience and perhaps innate endoscopic skill may play an important role in the outcome of this procedure.
文摘AIM： To retrospectively investigate the effect and safety of various new type precut sphincterotomy techniques （VNTPST） in endoscopic retrograde cholangiopancreatography （ERCP） due to difficult biliary duct cannulation （DBC）. METHODS： A plough-like pull-type sphincterotome （PLPTS） or improved short nose sphincterotome or improved needle knife was applied. VNTPST was carried out in 30 of 280 patients, whose biliary tract could not be exposed well or deep cannulation was difficult to perform during ERCP with traditional methods. Patients were followed up for short-term complications and the therapeutic effect of VNTPS was observed and compared with that of traditional endoscopic sphincterotomy （EST）. RESULTS： A total 280 patients underwent ERCP, of which 3 failed in operation because of pathological features in stomch or duodenum, 247 successfully underwent traditional ERCP （89.1%, 247/277）, 30 failed （10.8%, 30/277）. VNTPS technique succeeded in 24 （80%, 24/30） of 30 cases. The successful rate of deep biliary duct cannulation increased 8.6% （24/277）, the total cannulation successful rate following precut was 97.7%. There was a significant difference between the two groups （97.7% vs 89.1%, x^2= 17.1, P 〈 0.01）. The incidence of complications was 9.3% （26/277） for traditional ERCP group and 13.3% （4/30） for VNTPS technique group. Guideline tip was broken in pancreatic duct （KPDGP） of one patient, and there was no pancreatitis, slight or moderate bleeding postoperatively occurred in 2 patients, 1 patient had bleeding during operation （PDWN）. There were no differences between VNTPS technique group and traditional ERCP（TRERCP）group （13.3% vs 9.3%, %2 = 0.478, P 〉 0.05）. CONCLUSION： VNTPS procedure and Deng＇s precut are highly effective methods to get biliary access during ERCP with DBC. With skillful techniques, it can increase the successful rate for deep cannulation of biliary duct and decrease complications. VNTPS technique, especially Deng＇s precut is as effective and safe as EST. This technique can be well performed in hospitals without particular equipments.
文摘AIM： To evaluate whether an automatically controlled cut system （endocut mode） could reduce the complication rate of endoscopic sphincterotomy （EST） and serum hyperamylasemia after EST compared to the conventional blended cut mode. METHODS： From January 2001 to October 2003, 134 patients with choledocholithiasis were assigned to either endocut mode group or conventional blended cut mode group at the time of sphincterotomy. The two groups were retrospectively compared for the complications after EST and serum amylase level before and 24 h after the procedure. RESULTS： Of the 134 patients treated, 79 were assigned to conventional blended cut mode group and 55 to endocut mode group. There was no significant difference in age, sex, and serum amylase level before EST between the two groups. Complications were found in 5 patients of the endocut mode group （9%）： hyperamylasemia （5 times higher than normal） in 4 and moderate pancreatitis in 1. Complications were found in 13 patients of the conventional blended cut mode group （16%）： hyperamylasemia in 12 and moderate pancreatitis in 1. Serum amylase levels were elevated in both groups 24 h after EST （P〈0.02）. The average serum amylase level 24 h after EST in the conventional blended cut mode group was significantly higher than that in the endocut mode group （P〈 0.05）. CONCLUSION： Endocut mode offers a safety advantage over conventional blended cut mode for pancreatitis after EST by reducing hyperamylasemia.
文摘目的:探讨腹腔镜下胆囊切除术(laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)治疗胆囊结石合并胆总管结石的临床效果。方法:选择2018年5月-2020年2月在笔者所在医院收治的152例胆囊结石合并胆总管结石患者作为观察对象,将其随机分为两组,每组76例。A组采用LC+LCBDE治疗,B组采用内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)/内镜下十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)+LC治疗,比较两组临床疗效。结果:A组手术时间、术后排气时间、住院费用分别为(131.63±13.37)min、(26.24±3.26)h、(2.02±0.15)万元,均优于B组的(154.35±18.21)min、(37.02±3.68)h、(3.07±0.16)万元,差异有统计学意义(P<0.001)。B组术中出血量少于A组,下床时间早于A组,差异有统计学意义(P<0.05)。但两组住院时间、完全取石率和中转开腹率比较差异均无统计学意义(P>0.05)。术后,两组TBIL、ALT、AST、AMS均较术前明显改善(P<0.05),但两组术后TBIL、ALT、AST、AMS比较差异均无统计学意义(P>0.05)。两组术后并发症发生率比较差异无统计学意义(P>0.05)。结论:在胆囊结石合并胆总管结石的手术治疗中,LC+LCBDE与ERCP/EST+LC两种术式均能获得理想疗效,且安全性良好,临床可根据医院的医疗条件与患者病情选择手术方式。
