目的:探讨胆道开口小切开联合柱状气囊扩张术(EST+EPBD)治疗肝外胆管结石的有效性与安全性。方法:将64例肝外胆管结石并胆管直径≥0.8mm患者随机分成两组,EST组32例采用胆道开口单纯大切开后取石或碎石后取石,EST+EPBD组32例采用胆道开...目的:探讨胆道开口小切开联合柱状气囊扩张术(EST+EPBD)治疗肝外胆管结石的有效性与安全性。方法:将64例肝外胆管结石并胆管直径≥0.8mm患者随机分成两组,EST组32例采用胆道开口单纯大切开后取石或碎石后取石,EST+EPBD组32例采用胆道开口小切开,再行柱状气囊扩张后,进行取石或碎石后取石。结果:两组取石过程中出血、胆管引流情况及早期并发症等比较,差异均无统计学意义(P均>0.05)。两组取石次数(3.0±2.51 vs1.6±1.32)、机械碎石器使用率(37.5%vs 9.4%)、结石清除时间(29.32±12.84min vs 18.46±12.82min)比较,EST+EPBD组明显优于EST组,差异有统计学意义(P均<0.05)。结论:胆道开口小切开联合柱状气囊扩张治疗肝外胆管结石安全、有效,在手术时间、取石次数及机械碎石器使用率等方面优于传统的胆道开口切开后取石术。展开更多
AIM: To assess the effects of intramuscular analgesics(morphine, Ap-237, pethidine and tramadol) on humanOddi's sphincter motility with choledochoscope manometry.METHODS: A total of 70 patients having T tubes afte...AIM: To assess the effects of intramuscular analgesics(morphine, Ap-237, pethidine and tramadol) on humanOddi's sphincter motility with choledochoscope manometry.METHODS: A total of 70 patients having T tubes aftercholecystectomy and choledochotomy were assessed bycholedochoscope manometry. They were randomly dividedinto morphine group, Ap-237 group, pethidine group andtramadol group. Basal pressure of Oddi's sphincter (BPOS),amplitude of phasic contractions (SOCA), frequency ofphasic contractions (SOF), duration of phasic contractions(SOD), duodenal pressure (DP) and common bile ductpressure (CBDP) were scored and analyzed. All narcoticanalgesic drugs were administered intramuscularly.RESULTS: Levels of BPOS, SOCA and SOF were increasedafter injection of morphine and Ap-237 (P<0.05), level of CBDPwas increased from 4.97+3.87 mmHg to 8.62+7.43 mmHg(10 min later) and 7.32+5.95 mmHg (20 min later) afterinjection of morphine (P<0.01). No apparent changeoccurred after intramuscular injection of pethidine. Level ofBPOS was increased from 7.01+5.50 mmHg to 2.87+2.78 mmHg10 min after injection of tramadol and SOCA was decreasedfrom 63.34+35.29 mmHg to 45.90+27.86 mmHg (10 minlater, P<0.05) and 35.97+24.30 (20 min later, P<0.01) afteradministration of tramadol.CONCLUSION: All these findings indicate that Oddi'ssphincter manometry via choledochoscope is a practicaland new way to study the dynamics of Oddi' s sphincter.The regular dose of morphine and Ap-237 could increaseBPOS, SOF and SOCA. Morphine could increase the levelof CBDP, demonstrating an excitatory effect on the sphincterof Oddi. Pethidine had no effect on Oddi's sphincter motility.Tramadol shows an inhibitory effect on the motility of thesphincter of Oddi and decreases levels of BPOS and SOCA.展开更多
AIM： To investigate the endoscopic ampullectomy practices of expert biliary endoscopists. METHODS： An anonymous expert biliary endoscopists practices. survey was mailed to 79 to assess ampullectomy RESULTS： Forty s...AIM： To investigate the endoscopic ampullectomy practices of expert biliary endoscopists. METHODS： An anonymous expert biliary endoscopists practices. survey was mailed to 79 to assess ampullectomy RESULTS： Forty six （58%） biliary endoscopists returned the questionnaire. Of these, 63% were in academia and in practice for an average of 16.4 years （± 8.6）. Endoscopists performed an average of 1.1 （± 0.8） ampullectomies per month. Prior to ampullectomy, endoscopic ultrasound was ＂always＂ utilized by 67% of respondents vs ＂sometimes＂ in 31% of respondents. Empiric biliary sphincterotomy was not utilized uniformly, only 26% ＂always＂ and 37% ＂sometimes＂ performed it prior to resection. Fifty three percent reported ＂never＂ performing empiric pancreatic sphincterotomy prior to ampullectomy. Practitioners with high endoscopic retrograde cholangiopancreatography volumes were the most likely to perform a pancreatic sphincterotomy （OR = 10.9; P = 0.09）. Participants overwhelmingly favored ＂always＂ placing a prophylactic pancreatic stent, with 86% placing it after ampullectomy rather than prior to resection （23%）. Argon plasma coagulation was the favored adjunct modality （83%） for removal of residual adenomatous tissue. Practitioners uniformly （100%） preferred follow-up examination to be within 6 mo postmpullectomy.CONCLUSION： Among biliary experts, there is less variation in ampultectomy practices than is reflected in the literature.展开更多
Objective: To discuss the relationship between hypercholesterolemic disease and the functional and structural changes of Sphincter of Oddi (SO) by the study of effect of Cholesterol Liposome (CL) on structural and qua...Objective: To discuss the relationship between hypercholesterolemic disease and the functional and structural changes of Sphincter of Oddi (SO) by the study of effect of Cholesterol Liposome (CL) on structural and quantitative changes of SO cells. Methods: Rabbit SO was isolated for primary cell culture and subculture. After subcultured with different concentration of CL culture medium for 20 h, the structural and quantitative changes of SO cells were analyzed and detected by MTT-test, flow cytometer (FCM), electronic microscope and electrophoresis technique respectively. Results: CL contributed a prominent stimulus to SO cells proliferation at middle concentration (<0. 5 - 0. 8 mg/ml), which could be confirmed by FCM analysis which indicated the number of SO cells in S-phase increasing remarkably; however, high concentration of CL inhibited SO cells' proliferation (>1. 0 mg/ml) and induced apoptosis of SO cells. Swelled mitochondria and dilated endoplasmic reticulum as well as disjoined and diminished microfilaments were found in SO cells by electronic microscopy. The content of SO cells actin decreased with the increment of cholesterol concentration. There was a significant difference of actin content between CL groups and control group (P<0. 05). Conclusion: CL may change SO cell membrane's function, organelle's structure and especially the quantity and configuration of microfilaments, at the same time, CL at different concentration can induce changes of SO cells cycle and lead to different changes in the number of SO cells.展开更多
文摘目的:探讨胆道开口小切开联合柱状气囊扩张术(EST+EPBD)治疗肝外胆管结石的有效性与安全性。方法:将64例肝外胆管结石并胆管直径≥0.8mm患者随机分成两组,EST组32例采用胆道开口单纯大切开后取石或碎石后取石,EST+EPBD组32例采用胆道开口小切开,再行柱状气囊扩张后,进行取石或碎石后取石。结果:两组取石过程中出血、胆管引流情况及早期并发症等比较,差异均无统计学意义(P均>0.05)。两组取石次数(3.0±2.51 vs1.6±1.32)、机械碎石器使用率(37.5%vs 9.4%)、结石清除时间(29.32±12.84min vs 18.46±12.82min)比较,EST+EPBD组明显优于EST组,差异有统计学意义(P均<0.05)。结论:胆道开口小切开联合柱状气囊扩张治疗肝外胆管结石安全、有效,在手术时间、取石次数及机械碎石器使用率等方面优于传统的胆道开口切开后取石术。
文摘AIM: To assess the effects of intramuscular analgesics(morphine, Ap-237, pethidine and tramadol) on humanOddi's sphincter motility with choledochoscope manometry.METHODS: A total of 70 patients having T tubes aftercholecystectomy and choledochotomy were assessed bycholedochoscope manometry. They were randomly dividedinto morphine group, Ap-237 group, pethidine group andtramadol group. Basal pressure of Oddi's sphincter (BPOS),amplitude of phasic contractions (SOCA), frequency ofphasic contractions (SOF), duration of phasic contractions(SOD), duodenal pressure (DP) and common bile ductpressure (CBDP) were scored and analyzed. All narcoticanalgesic drugs were administered intramuscularly.RESULTS: Levels of BPOS, SOCA and SOF were increasedafter injection of morphine and Ap-237 (P<0.05), level of CBDPwas increased from 4.97+3.87 mmHg to 8.62+7.43 mmHg(10 min later) and 7.32+5.95 mmHg (20 min later) afterinjection of morphine (P<0.01). No apparent changeoccurred after intramuscular injection of pethidine. Level ofBPOS was increased from 7.01+5.50 mmHg to 2.87+2.78 mmHg10 min after injection of tramadol and SOCA was decreasedfrom 63.34+35.29 mmHg to 45.90+27.86 mmHg (10 minlater, P<0.05) and 35.97+24.30 (20 min later, P<0.01) afteradministration of tramadol.CONCLUSION: All these findings indicate that Oddi'ssphincter manometry via choledochoscope is a practicaland new way to study the dynamics of Oddi' s sphincter.The regular dose of morphine and Ap-237 could increaseBPOS, SOF and SOCA. Morphine could increase the levelof CBDP, demonstrating an excitatory effect on the sphincterof Oddi. Pethidine had no effect on Oddi's sphincter motility.Tramadol shows an inhibitory effect on the motility of thesphincter of Oddi and decreases levels of BPOS and SOCA.
文摘AIM： To investigate the endoscopic ampullectomy practices of expert biliary endoscopists. METHODS： An anonymous expert biliary endoscopists practices. survey was mailed to 79 to assess ampullectomy RESULTS： Forty six （58%） biliary endoscopists returned the questionnaire. Of these, 63% were in academia and in practice for an average of 16.4 years （± 8.6）. Endoscopists performed an average of 1.1 （± 0.8） ampullectomies per month. Prior to ampullectomy, endoscopic ultrasound was ＂always＂ utilized by 67% of respondents vs ＂sometimes＂ in 31% of respondents. Empiric biliary sphincterotomy was not utilized uniformly, only 26% ＂always＂ and 37% ＂sometimes＂ performed it prior to resection. Fifty three percent reported ＂never＂ performing empiric pancreatic sphincterotomy prior to ampullectomy. Practitioners with high endoscopic retrograde cholangiopancreatography volumes were the most likely to perform a pancreatic sphincterotomy （OR = 10.9; P = 0.09）. Participants overwhelmingly favored ＂always＂ placing a prophylactic pancreatic stent, with 86% placing it after ampullectomy rather than prior to resection （23%）. Argon plasma coagulation was the favored adjunct modality （83%） for removal of residual adenomatous tissue. Practitioners uniformly （100%） preferred follow-up examination to be within 6 mo postmpullectomy.CONCLUSION： Among biliary experts, there is less variation in ampultectomy practices than is reflected in the literature.
文摘Objective: To discuss the relationship between hypercholesterolemic disease and the functional and structural changes of Sphincter of Oddi (SO) by the study of effect of Cholesterol Liposome (CL) on structural and quantitative changes of SO cells. Methods: Rabbit SO was isolated for primary cell culture and subculture. After subcultured with different concentration of CL culture medium for 20 h, the structural and quantitative changes of SO cells were analyzed and detected by MTT-test, flow cytometer (FCM), electronic microscope and electrophoresis technique respectively. Results: CL contributed a prominent stimulus to SO cells proliferation at middle concentration (<0. 5 - 0. 8 mg/ml), which could be confirmed by FCM analysis which indicated the number of SO cells in S-phase increasing remarkably; however, high concentration of CL inhibited SO cells' proliferation (>1. 0 mg/ml) and induced apoptosis of SO cells. Swelled mitochondria and dilated endoplasmic reticulum as well as disjoined and diminished microfilaments were found in SO cells by electronic microscopy. The content of SO cells actin decreased with the increment of cholesterol concentration. There was a significant difference of actin content between CL groups and control group (P<0. 05). Conclusion: CL may change SO cell membrane's function, organelle's structure and especially the quantity and configuration of microfilaments, at the same time, CL at different concentration can induce changes of SO cells cycle and lead to different changes in the number of SO cells.
