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Removal of intrahepatic bile duct stone could reduce the risk of cholangiocarcinoma: A single-center retrospective study in South Korea 被引量:1
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作者 Tae In Kim Sung Yong Han +1 位作者 Jonghyun Lee Dong Uk Kim 《World Journal of Clinical Cases》 SCIE 2024年第5期913-921,共9页
BACKGROUND Intrahepatic duct(IHD)stones are among the most important risk factors for cholangiocarcinoma(CCC).Approximately 10%of patients with IHD stones develop CCC;however,there are limited studies regarding the ef... BACKGROUND Intrahepatic duct(IHD)stones are among the most important risk factors for cholangiocarcinoma(CCC).Approximately 10%of patients with IHD stones develop CCC;however,there are limited studies regarding the effect of IHD stone removal on CCC development.AIM To investigate the association between IHD stone removal and CCC development.METHODS We retrospectively analyzed 397 patients with IHD stones at a tertiary referral center between January 2011 and December 2020.RESULTS CCC occurred in 36 of the 397 enrolled patients.In univariate analysis,chronic hepatitis B infection(11.1%vs 3.0%,P=0.03),carbohydrate antigen 19-9(CA19-9,176.00 vs 11.96 II/mL,P=0.010),stone located in left or both lobes(86.1%vs 70.1%,P=0.042),focal atrophy(52.8%vs 26.9%,P=0.001),duct stricture(47.2%vs 24.9%,P=0.004),and removal status of IHD stone(33.3%vs 63.2%,P<0.001)were significantly different between IHD stone patients with and without CCC.In the multivariate analysis,CA19-9>upper normal limit,carcinoembryonic antigen>upper normal limit,stones located in the left or both lobes,focal atrophy,and complete removal of IHD stones without recurrence were independent factors influencing CCC development.However,the type of removal method was not associated with CCC risk.CONCLUSION Complete removal of IHD stones without recurrence could reduce CCC risk. 展开更多
关键词 intrahepatic bile duct stone CHOLANGIOCARCINOMA Percutaneous transhepatic cholangioscopy Endoscopic retrograde cholangiopancreatography Carbohydrate antigen 19-9
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Congenital left intrahepatic bile duct draining into gastric wall mimicking biliary reflux gastritis 被引量:7
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作者 Jian Guan Ling Zhang +2 位作者 Jian-Ping Chu Shao-Chun Lin Zi-Ping Li 《World Journal of Gastroenterology》 SCIE CAS 2015年第11期3425-3428,共4页
Abnormalities and variations of the biliary ducts are not rare.Most aberrant bile ducts eventually drain into the descending part of duodenum through the papilla of vater.However,drainage of the left hepatic bile duct... Abnormalities and variations of the biliary ducts are not rare.Most aberrant bile ducts eventually drain into the descending part of duodenum through the papilla of vater.However,drainage of the left hepatic bile duct into the stomach is extremely rare.A 29-year old man was admitted to the hospital with the diagnosis of biliary reflux gastritis.Comprehensive imaging modalities were performed including electronic endoscopy,endoscopic ultrasonography,endoscopic retrograde cholangiopancreatography and magnetic resonance cholangio-pancreatography.Finally,congenital ectopic left intrahepatic bile duct draining into the stomach was found,which caused biliary reflux gastritis.The patient did not receive any surgery.Good recovery was achieved by medical treatment. 展开更多
关键词 ECTOPIC LEFT intrahepatic bile duct Endo-scopic ul
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A case of very large intrahepatic bile duct adenoma followed for 7 years 被引量:4
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作者 Futa Koga Hiroto Tanaka +8 位作者 Seigo Takamatsu Shinnichi Baba Hiroshi Takihara Akioko Hasegawa Eri Yanagihara Taro Inoue Toshihiro Nakano Chie Ueda Wataru Ono 《World Journal of Clinical Oncology》 CAS 2012年第4期63-66,共4页
A 70-year-old man was referred to our hospital due to abnormal liver function. A tumor of 92 mm × 61 mm was detected on ultrasound screening of the left liver lobe. Although the tumor was suspected to be intrahep... A 70-year-old man was referred to our hospital due to abnormal liver function. A tumor of 92 mm × 61 mm was detected on ultrasound screening of the left liver lobe. Although the tumor was suspected to be intrahepatic bile duct carcinoma, he had chronic heart disease and was unable to undergo surgery. Therefore, he was followed without further testing. No increase in tumor serum markers or tumor size was observed for the subsequent 7 years. We continued to suspect intrahepatic bile duct carcinoma, and we decided to perform a tumor biopsy. Tumor biopsy findings indicated intrahepatic bile duct adenoma(BDA), which is a rare benign epithelial liver tumor typically ranging from 1 mm to20 mm. We herein report a case of very large BDA followed for 7 years. 展开更多
关键词 intrahepatic bile duct ADENOMA LARGE TUMOR Differential diagnosis BENIGN liver TUMOR
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Modified rendezvous intrahepatic bile duct cannulation technique to pass a PTBD catheter in ERCP 被引量:3
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作者 Tae Hoon Lee Sang-Heum Park +5 位作者 Sae Hwan Lee Chang-Kyun Lee Suck-Ho Lee Il-Kwun Chung Hong Soo Kim Sun-Joo Kim 《World Journal of Gastroenterology》 SCIE CAS CSCD 2010年第42期5388-5390,共3页
The rendezvous procedure combines an endoscopic technique with percutaneous transhepatic biliary drainage(PTBD).When a selective common bile duct cannulation fails,PTBD allows successful drainage and retrograde access... The rendezvous procedure combines an endoscopic technique with percutaneous transhepatic biliary drainage(PTBD).When a selective common bile duct cannulation fails,PTBD allows successful drainage and retrograde access for subsequent rendezvous techniques.Traditionally,rendezvous procedures such as the PTBDassisted over-the-wire cannulation method,or the parallel cannulation technique,may be available when a bile duct cannot be selectively cannulated.When selective intrahepatic bile duct(IHD) cannulation fails,this modified rendezvous technique may be a feasible alternative.We report the case of a modified rendezvous technique,in which the guidewire was retrogradely passed into the IHD through the C2 catheter after end-to-end contact between the tips of the sphincterotome and the C2 catheter at the ampulla's orifice,in a 39-year-old man who had been diagnosed with gallbladder carcinoma with a metastatic right IHD obstruction.Clinically this procedure may be a feasible and timesaving technique. 展开更多
关键词 Endoscopic retrograde cholangiopancreatography intrahepatic bile duct Rendezvous technique
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Clinical Studies on Ultrasound Lithotripsy in Intrahepatic Bile-duct via Abdomen
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作者 郭奉云 《Journal of Huazhong University of Science and Technology(Medical Sciences)》 SCIE CAS 1995年第2期108-111,共4页
patients with left/right intrahepatic bile-duct calculi received ultrasonic lithotresis via abdomen by using the percutaneous cholecystoscopeand ultrasonic lithotresis apparatus. The results indicated that all the sur... patients with left/right intrahepatic bile-duct calculi received ultrasonic lithotresis via abdomen by using the percutaneous cholecystoscopeand ultrasonic lithotresis apparatus. The results indicated that all the surgical manipulations were successful with a residual rate of 6. 7 %, compared with a residual rate of 78. 2 % in 23 cases of left/right intrahepatic bile-duct lithiasis treated simultaneously by lithotomy apparatus. The differences between them were statistically significant (μ= 4. 29, P<0. 01). Among 12 cases undergoing follow-up observation , no side effect due to ultrasonic lithotresis and no residual calculus after 2- 4 check-ups with B-mode ultrasound diagnostic set were found and all of their symptoms disappeared except for 1 case. 展开更多
关键词 intrahepatic bile-duct ultrasound lithotripsy
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The abnormal expression of E-cadherin in intrahepatic bile duct epithelia cells in biliary atresia and its relationship with apoptosis
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作者 黄磊 《外科研究与新技术》 2005年第3期167-167,共1页
To explore the relationship between the expression of E-cadherin and the apoptosis in intrahepatic bile duct epithelial cells in biliary atresia (BA).Methods The E-cadherin expression was demonstrated by immunohistoch... To explore the relationship between the expression of E-cadherin and the apoptosis in intrahepatic bile duct epithelial cells in biliary atresia (BA).Methods The E-cadherin expression was demonstrated by immunohistochemical staining for the liver specimens from 38 children with BA and 16 normal children.The apoptotic intrahepatic bile duct epithelial cells in these specimens were visualized by TdT-mediated dUTP-digoxigenin nick end labeling (TUNEL) assay,and the apoptotic index (AI) was calculated from the percentage of apoptotic cells in total cells.Results The intensity of E-cadherin expression in bile duct epithelial cells in BA group was lower than that in the normal control group (0.33±0.12 vs 0.62±0.20,P<0.01).On the other hand,the AI in BA group was significant higher than that in control group (51.74±19.93 vs 12.34±19.32,P<0.01).An inverse correlation was detected between the intensity of E-cadherin and the AI in the liver from children with BA.Conclusion The abnormal decrease of E-cadherin may lead to an increase of the apoptosis of intrahepatic bile epithelial cells in BA,resulting in developmental disorder of intrahepatic bile duct and ductal plate malformation in the liver.12 refs,4 figs,1 tab. 展开更多
关键词 The abnormal expression of E-cadherin in intrahepatic bile duct epithelia cells in biliary atresia and its relationship with apoptosis
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Pathological classification of intrahepatic cholangiocarcinoma based on a new concept 被引量:39
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作者 Yasuni Nakanuma Yasunori Sato +2 位作者 Kenichi Harada Mokoto Sasaski Hiroko Ikeda 《World Journal of Hepatology》 CAS 2010年第12期419-427,共9页
Intrahepatic cholangiocarcinoma (ICC) arises from the lining epithelium and peribiliary glands of the intrahepatic biliary tree and shows variable cholangiocytic dif-f-e-re-ntiation. To date-,ICC was large-ly classifi... Intrahepatic cholangiocarcinoma (ICC) arises from the lining epithelium and peribiliary glands of the intrahepatic biliary tree and shows variable cholangiocytic dif-f-e-re-ntiation. To date-,ICC was large-ly classifie-d into adenocarcinoma and rare variants. Herein,we propose to subclassify the former,based on recent progress in the-study of-ICC including the-gross classification and hepatic progenitor/stem cells and on the pathological similarities between biliary and pancreatic neoplasms. That is,ICC is classifiable into the conventional (bile duct) type,the bile ductular type,the intraductal neoplasm type and rare variants. The conventional type is further divided into the small duct type (peripheral type) and large bile duct type (perihilar type). The former is a tubular or micropapillary adenocarcinoma while the latter involves the intrahepatic large bile duct. Bile ductular type resembles proliferated bile ductules and shows a replacing growth of the hepatic parenchyma.Hepatic progenitor cell or stem cell phenotypes such as neural cell adhesion molecule expression are frequently expressed in the bile ductular type. Intraductal type includes papillary and tubular neoplasms of the bile duct (IPNBs and ITNBs) and a superficial spreading type. IPNB and ITNB show a spectrum from a preneoplastic borderline lesion to carcinoma and may have pancreatic counterparts. At invasive sites,IPNB is associated with the conventional bile duct ICC and mucinous carcinoma. Biliary mucinous cystic neoplasm with ovarian-like stroma in its wall is different from IPNB,particularly IPNB showing cystic dilatation of the affected ducts. Rare variants of ICC include squamous/adenosquamous cell carcinoma,mucinous/signet ring cell carcinoma,clear cell type,undifferentiated type,neuroendocrine carcinoma and so on. This classification of-ICC may ope-n up a ne-w fie-ld of-re-se-arch of-ICC and contribute-to the-clini cal approach to ICC. 展开更多
关键词 intrahepatic CHOLANGIOCARCINOMA ADENOCARCINOMA bile duct bile ductule INTRADUCTAL NEOPLASM
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Apoptosis and proliferation of intrahepatic bil educt after ischemia-reperfusion injury 被引量:13
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作者 Wen-Hui Xu, Qi-Fa Ye and Sui-Sheng Xia Institute of Organ Transplantation, Tongji Hospital,Tongji Medical College, Huazhong University of Science and Technology,Wuhan 430030, China 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2004年第3期428-432,共5页
BACKGROUND: In orthotopic liver transplantation, ische-mic-reperfusion is one of the most important factors thatcause the incidence of biliary complicance. The aim of thisstudy was to investigate the effects of ischem... BACKGROUND: In orthotopic liver transplantation, ische-mic-reperfusion is one of the most important factors thatcause the incidence of biliary complicance. The aim of thisstudy was to investigate the effects of ischemia reperfusionon epithelial cells apoptosis and proliferation of intrahepaticbile duct (IBD) (>20 μm).METHODS: 30-minute warm ischemia was applied to ratlivers respectively, and experiment was performed on days2,7, 14, 28 after reperfusion. Apoptosis was determined insitu by morphology and TUNEL, and cholangiocyte proli-feration was evaluated in situ by morphometry of liver sec-tions stained for cytokeratin-19 ( CK-19) and by prolifera-ting cellular nuclear antigen staining in liver sections.RESULTS: Two days after ischemia reperfusion, apoptosisof cells was observed in large intrahepatic bile ducts (>20μm) (5.6%±1.2%) , but the number of large intrahepaticbile ducts reduced (0.32 ±0.06). Seven days after ischemiareperfusion, the apoptosis index of cholangiocytes de-creased to 1.2%±0.3%, and the number of intrahepatic bileducts began to proliferate and returned to nearly normal onday 28.CONCLUSION: Ischemia reperfusion causes a decrease inthe number of intrahepatic bile ducts (>20 μm) as a resultof a higher rate of apoptosis and absence of initial prolifera-tion. 展开更多
关键词 APOPTOSIS PROLIFERATION intrahepatic bile duct epithelial cells
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Clinical and biological significance of precursor lesions of intrahepatic cholangiocarcinoma 被引量:3
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作者 Mark Ettel Ogechukwu Eze Ruliang Xu 《World Journal of Hepatology》 CAS 2015年第25期2563-2570,共8页
Cholangiocarcinoma(CC) is primarily a malignant tumor of older adults most prevalent in Southeast Asia,where liver fluke infestation is high.However the etiology in western countries is unknown.Although the incidence ... Cholangiocarcinoma(CC) is primarily a malignant tumor of older adults most prevalent in Southeast Asia,where liver fluke infestation is high.However the etiology in western countries is unknown.Although the incidence of extrahepatic cholangiocarcinoma has remained constant,incidence of intrahepatic CC(ICC) which differs inmorphology,pathogenesis,risk factors,treatment and prognosis is increasing.While this increase is associated with hepatitis C virus infection,chronic nonalcoholic liver disease,obesity,and smoking,the pathogenesis of ICC and molecular alterations underlying the carcinogenesis are not completely elucidated.Benign biliary lesions such as biliary intraepithelial neoplasia,intraductal papillary neoplasm of the bile duct,von Meyenburg complex or bile duct hamartoma,and bile duct adenoma have been associated with ICC.For each of these entities,evidence suggests or supports a role as premalignant lesions.This article summarized the important biological significance of the precursor lesions of ICC and the molecular mechanisms that may be involved in intrahepatic cholangiocarcinogenesis. 展开更多
关键词 Intraepithelial NEOPLASIA Von Meyenburgcomplex or bile DUCT HAMARTOMA bile DUCT adenoma intrahepatic cholangiocarcinoma INTRADUCTAL papillaryneoplasm of the bile DUCT
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Preventive effects of autologous bone marrow mononuclear cell implantation on intrahepatic ischemic-type biliary lesion in rabbits 被引量:4
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作者 Qu, Zhao-Wei Chen, Da-Zhi +3 位作者 Sheng, Qin-Song Lang, Ren He, Qiang Wang, Ming-Feng 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2010年第6期593-599,共7页
BACKGROUND: The ischemic-type biliary lesion (ITBL) is one of the most serious biliary complications of liver transplantation. This study aimed to investigate the effects of autologous bone marrow mononuclear cell (BM... BACKGROUND: The ischemic-type biliary lesion (ITBL) is one of the most serious biliary complications of liver transplantation. This study aimed to investigate the effects of autologous bone marrow mononuclear cell (BM-MNC) implantation on neovascularization and the prevention of intrahepatic ITBL in a rabbit model. METHODS: The rabbits were divided into control, experimental model, and cell implantation groups, with 10 in each group. The model of intrahepatic ITBL was established by clamping the hepatic artery and common bile duct. Autologous BM-MNCs were isolated from the tibial plateau by density gradient centrifugation and were implanted through the common hepatic artery. Changes in such biochemical markers as aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyltranspeptidase, total bilirubin and direct bilirubin were measured. Four weeks after operation, cholangiography, histopathological manifestations, differentiation of BM-MNCs, microvessel density and the expression of vascular endothelial growth factor were assessed. RESULTS: Compared with the experimental model group, the BM-MNC implantation group showed superiority in the time to recover normal biochemistry. The microvessel density and vascular endothelial growth factor expression of the implantation group were significantly higher than those of the control and experimental model groups. The ITBL in the experimental model group was more severe than that in the implantation group and fewer new capillary blood vessels occurred around it. CONCLUSIONS: Implanted autologous BM-MNCs can differentiate into vascular endothelial cells, promote neovascularization and improve the blood supply to the ischemic bile duct, and this provides a new way to diminish or prevent intrahepatic ITBL after liver transplantation. (Hepatobiliary Pancreat Dis Int 2010; 9:593-599) 展开更多
关键词 bone marrow mononuclear cell intrahepatic ischemic-type biliary lesion liver transplantation bile duct ANGIOGENESIS
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Clinical characteristics of intrahepatic biliary papilloma:A case report 被引量:2
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作者 Dan Yi Li-Jing Zhao +2 位作者 Xiao-Bo Ding Tai-Wei Wang Song-Yang Liu 《World Journal of Clinical Cases》 SCIE 2021年第13期3185-3193,共9页
BACKGROUND Intrahepatic bile duct papilloma(IPNB)is a rare benign tumour from the bile duct epithelium and has a high malignant transformation rate.Early radical resection can obviously improve the prognosis of patien... BACKGROUND Intrahepatic bile duct papilloma(IPNB)is a rare benign tumour from the bile duct epithelium and has a high malignant transformation rate.Early radical resection can obviously improve the prognosis of patients,but it is difficult to be sure of the diagnosis of IPNB before operating.CASE SUMMARY This study included 28 patients with intraductal papilloma admitted to the First Hospital of Jilin University from January 2010 to November 2020 and recorded their clinical manifestations,imaging features,complications and prognosis.There were 12 males and 16 females with an average age of 61.36±8.03 years.Most patients had symptoms of biliary obstruction.Biliary dilatation and cystic mass could be seen on imaging.After surgery,IPNB was diagnosed by pathology.CONCLUSION IPNB is a rare benign tumour in the bile duct.Early diagnosis and timely R0 resection can improve the prognosis of IPNB. 展开更多
关键词 intrahepatic bile duct Papillary tumour Biliary obstruction Mural nodules Case report
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Cystic Degeneration of Peripheral Intrahepatic Cholangiocarcinoma: An Atypical Presentation
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作者 Leandro Trstã o Abi-Ramia de Moraes +3 位作者 José Vitor Rassi Garcia Anderson da costa Lino Costa Marcos Duarte Guimarã es 《Case Reports in Clinical Medicine》 2019年第3期43-48,共6页
Cholangiocarcinomas are primary malignant tumors of the liver that arises from the epithelium lining the small intra and extrahepatic bile ducts, and has numerous histologic types and growth patterns. At computed tomo... Cholangiocarcinomas are primary malignant tumors of the liver that arises from the epithelium lining the small intra and extrahepatic bile ducts, and has numerous histologic types and growth patterns. At computed tomography (CT) and magnetic ressonance (MR), it has various appearences which motivated the present study;we present a case within an atypical presentation. The objective is to show the variety of differential diagnoses before an atypical aspect and the importance of the imaging methods for the diagnosis. Cholangiocarcinoma is still an uncommon neoplasm, and CT and MR are crucial for accurate diagnosis and for differentiation from other hepatic tumorous and nontumorous lesions. 展开更多
关键词 CHOLANGIOCARCINOMA PERIPHERAL CHOLANGIOCARCINOMA intrahepatic Cholangiocarinoma Liver NEOPLASMS bile ducts NEOPLASMS CYSTIC Lesion
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Servqual模型评价肝内外胆管结石微创手术护理质量的研究
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作者 胡星 桂艳 +2 位作者 熊丹 江娟 杜建君 《当代医学》 2024年第8期166-170,共5页
目的探究Servqual模型在评价肝内外胆管结石微创手术护理质量中的应用效果。方法选取2021年1月至2022年6月于九江市第一人民医院肝胆外科行肝内外胆管结石微创手术的200例住院患者作为研究对象,采用随机数字表法分为对照组与观察组,每组... 目的探究Servqual模型在评价肝内外胆管结石微创手术护理质量中的应用效果。方法选取2021年1月至2022年6月于九江市第一人民医院肝胆外科行肝内外胆管结石微创手术的200例住院患者作为研究对象,采用随机数字表法分为对照组与观察组,每组100例。对照组给予常规护理,观察组给予改进护理干预。两组均采用Servqual量表评估护理质量。比较两组护理质量评分,采用单因素分析和多元线性回归分析护理质量的影响因素。结果观察组移情性、保证性、反应性、可靠性、有形性及总分服务期望(E)、服务感知(P)、感知服务质量(SQ)值均高于对照组,差异有统计学意义(P<0.05);单因素分析结果显示,不同学历、家庭人均月收入、医疗支付方式、不良情绪、自理能力、病房环境、护理人员态度的患者SQ值比较差异有统计学意义(P<0.05)。多元线性回归分析结果显示,家庭人均月收入、医疗支付方式是护理质量的影响因素(P<0.05)。结论Servqual模型评价肝内外胆管结石微创手术的护理质量具有可靠性,可有效评估护理干预中存在的问题,并提出相应改进对策,提升护理质量。 展开更多
关键词 SERVQUAL模型 肝内外胆管结石 微创手术 护理质量 影响因素 改进对策
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全身麻醉联合前锯肌平面阻滞和腹直肌后鞘阻滞处置外科手术治疗的肝内胆管结石患者镇痛效果研究
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作者 韩洋 张莉莉 +1 位作者 王雨峰 贾倩倩 《实用肝脏病杂志》 CAS 2024年第6期943-946,共4页
目的探讨采用全身麻醉联合前锯肌平面阻滞和腹直肌后鞘阻滞处理外科手术治疗的肝内胆管结石(IHS)患者术后镇痛效果。方法2020年4月~2024年1月我院收治的60例IHS患者,均接受外科手术切除含有结石的肝组织。在麻醉镇痛时,将患者分成两组,... 目的探讨采用全身麻醉联合前锯肌平面阻滞和腹直肌后鞘阻滞处理外科手术治疗的肝内胆管结石(IHS)患者术后镇痛效果。方法2020年4月~2024年1月我院收治的60例IHS患者,均接受外科手术切除含有结石的肝组织。在麻醉镇痛时,将患者分成两组,其中在28例对照组采用胸椎旁神经阻滞,在32例观察组采用前锯肌平面阻滞和腹直肌后鞘阻滞,比较两组包括麻醉恢复室(PACU)停留时间等手术指标,采用Ramsay镇静评分及静息和活动时视觉模拟评分(VAS),采用术后恢复质量量表(QoR-40)评估恢复质量。结果观察组PACU停留时间为(35.1±2.0)min,显著短于对照组【(40.3±2.1)min,P<0.05】;在术后2 h和24 h时,观察组静息VAS评分分别为(2.9±1.4)分和(2.5±1.1)分,显著低于对照组【分别为(3.7±1.7)分和(3.3±1.4)分,P<0.05】,活动VAS评分分别为(3.7±1.6)分和(2.9±1.5)分,显著低于对照组【分别为(4.4±1.5)分和(3.6±1.4)分,P<0.05】;观察组疼痛感受、身体舒适度和QoR-40总分分别为(35.3±1.2)分、(52.8±2.3)分和(175.0±8.0)分,均显著高于对照组【分别为(28.4±1.5)分、(45.8±2.8)分和(165.1±9.7)分,P<0.05】。结论在行外科手术切除HIS患者肝内结石时,采用全身麻醉联合前锯肌平面阻滞和腹直肌后鞘阻滞的镇痛效果比较好,可以提高患者舒适度。 展开更多
关键词 肝内胆管结石 前锯肌平面阻滞 腹直肌后鞘阻滞 全身麻醉 镇痛
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腹腔镜联合胆道镜治疗左肝内胆管结石合并胆总管结石的安全性及有效性分析
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作者 叶国华 姜继豪 杨阳 《中国医学创新》 CAS 2024年第6期18-22,共5页
目的:研究腹腔镜联合胆道镜治疗左肝内胆管结石同时合并胆总管结石的效果,同时探讨安全性及有效性。方法:选取萍乡市人民医院肝胆胰外科2018年1月—2022年12月收治的左肝内胆管结石合并胆总管结石患者180例作为研究对象,按照随机数字表... 目的:研究腹腔镜联合胆道镜治疗左肝内胆管结石同时合并胆总管结石的效果,同时探讨安全性及有效性。方法:选取萍乡市人民医院肝胆胰外科2018年1月—2022年12月收治的左肝内胆管结石合并胆总管结石患者180例作为研究对象,按照随机数字表法分为观察组(90例)和对照组(90例)。观察组的患者使用腹腔镜左肝切除及胆道镜取石,对照组的患者采取常规开腹左肝切除及胆道镜取石,比较两组患者相关手术时间、术中出血量、术后患者结石残留率、并发症发生率,比较两组患者术后下地时间、胃肠道功能恢复时间、术后住院时间及肝功能变化等指标。结果:观察组的手术时间长于对照组,其术中出血量少于对照组,术后下地时间、术后胃肠道功能恢复时间、术后住院时间均明显短于对照组(P<0.05)。观察组术后丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)和总胆红素(TBIL)的水平均明显低于对照组(P<0.05)。观察组围手术期切口感染、胆漏、胆道出血及肺部感染的发生率为6.67%(6/90),显著低于对照组的16.67%(15/90)(P<0.05)。术后随访显示,观察组结石残留率为3.33%(3/90),对照组为2.22%(2/90),两组间结石残留率差异无统计学意义(P>0.05)。结论:腹腔镜肝切除联合胆道镜取石治疗左肝内胆管结石合并胆总管结石可减少手术创伤,加快患者康复,改善肝功能,减少术后并发症,取石效果好,安全可靠。 展开更多
关键词 腹腔镜 胆道镜 肝内胆管结石 胆总管结石
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腹腔镜下联合胆道镜、术中超声及液电碎石仪治疗复杂肝内胆管结石的效果
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作者 叶国华 姜继豪 王小方 《中国当代医药》 CAS 2024年第31期20-23,共4页
目的探讨腹腔镜下联合胆道镜、术中超声及液电碎石仪治疗复杂肝内胆管结石的应用价值。方法选取2023年1月至2024年3月就诊于萍乡市人民医院的60例复杂肝内胆管结石(可同时合并有肝外结石)患者为研究对象,按照随机数字表法分为对照组(n=... 目的探讨腹腔镜下联合胆道镜、术中超声及液电碎石仪治疗复杂肝内胆管结石的应用价值。方法选取2023年1月至2024年3月就诊于萍乡市人民医院的60例复杂肝内胆管结石(可同时合并有肝外结石)患者为研究对象,按照随机数字表法分为对照组(n=30)和试验组(n=30)。试验组行腹腔镜下联合胆道镜、术中超声及液电碎石仪手术治疗,对照组行腹腔镜下联合胆道镜手术治疗。比较两组患者的围手术期指标(术中出血量、手术时间、胃肠功能恢复时间、术后住院时间、拔管时间)、肝功能[天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)]、并发症发生率和残石率。结果试验组的残石率低于对照组,差异有统计学意义(P<0.05)。试验组的术中出血量少于对照组,手术时间、胃肠功能恢复时间、术后住院时间、拔管时间短于对照组,差异有统计学意义(P<0.05)。术前两组患者的AST和ALT水平比较,差异无统计学意义(P>0.05),试验组术后的AST和ALT水平低于对照组,差异有统计学意义(P<0.05)。试验组的并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论腹腔镜下联合胆道镜、术中超声及液电碎石仪治疗复杂肝内胆管结石可减少手术并发症,降低胆管残石率,缩短患者术后住院时间,安全性较高,值得临床推广。 展开更多
关键词 复杂肝内胆管结石 术中超声 胆道镜 液电碎石仪 腹腔镜
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Laennec膜入路的肝切除在左肝内胆管结石中的应用
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作者 叶国华 姜继豪 王小方 《中国当代医药》 CAS 2024年第27期67-70,共4页
目的探索Laennec膜入路为主的肝切除在左肝内胆管结石中的安全性、可行性和应用价值。方法选取2021年1月至2023年7月萍乡市人民医院收治因左肝内胆管结石(可同时合并肝外胆道系统结石)的60例患者作为研究对象,采用随机数字表法分为观察... 目的探索Laennec膜入路为主的肝切除在左肝内胆管结石中的安全性、可行性和应用价值。方法选取2021年1月至2023年7月萍乡市人民医院收治因左肝内胆管结石(可同时合并肝外胆道系统结石)的60例患者作为研究对象,采用随机数字表法分为观察组与对照组,每组30例。所有患者均行腹腔镜左肝(含左半肝和左外叶)切除术,观察组采用Laennec膜入路为主,对照组采用Glisson鞘或肝静脉入路为主。比较两组围手术期指标、肝功能指标、残石率及并发症发生率。结果观察组围手术期各指标水平均优于对照组,差异有统计学意义(P<0.05);两组手术前肝功能各指标水平比较,差异无统计学意义(P>0.05),观察组手术后丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、直接胆红素(DBil)水平均低于对照组,差异有统计学意义(P<0.05);观察组残石率、并发症总发生率均低于对照组,差异有统计学意义(P<0.05)。结论Laennec膜入路为主的解剖性肝切除在左肝内胆管结石患者治疗中获得显著效果,残石率较低,并发症较少,临床应用安全可靠,值得推广。 展开更多
关键词 左肝内胆管结石 肝切除 Laennec膜入路
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腹腔镜解剖性肝Ⅲ段切除治疗左肝区域性肝内胆管结石临床效果 被引量:3
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作者 聂云贵 成武 王文儿 《肝胆胰外科杂志》 2024年第1期26-30,35,共6页
目的 探讨腹腔镜解剖性肝Ⅲ段切除治疗左肝区域性肝内胆管结石的手术要点、适应证及可行性。方法 采用回顾性描述性研究方法,收集2021年8月至2022年10月湘雅常德医院(3例)和湘西土家族苗族自治州人民医院(1例)收治的4例局限于肝Ⅲ段的... 目的 探讨腹腔镜解剖性肝Ⅲ段切除治疗左肝区域性肝内胆管结石的手术要点、适应证及可行性。方法 采用回顾性描述性研究方法,收集2021年8月至2022年10月湘雅常德医院(3例)和湘西土家族苗族自治州人民医院(1例)收治的4例局限于肝Ⅲ段的肝内胆管结石患者临床资料,其中男1例,女3例,中位年龄61.5(45.0~69.0)岁。4例患者中,2例为单纯性肝Ⅲ段肝内胆管结石,1例为肝Ⅲ段肝内胆管结石合并胆囊结石、胆总管结石,1例为肝Ⅲ段肝内胆管结石合并胆囊结石。4例患者均接受腹腔镜解剖性肝Ⅲ段切除术式治疗局限于肝Ⅲ段的肝内胆管结石。结果 4例患者均顺利完成腹腔镜解剖性肝Ⅲ段切除术,其中1例实施联合肝左静脉重建的解剖性肝Ⅲ段切除术。无中转开腹病例及切肝范围的变更。手术时间分别为280 min、440 min、220 min及110 min;第一肝门阻断时间分别为60 min、60 min、75 min和25 min。术中均无输血。4例患者术后住院时间分别为12 d、10 d、9 d和6 d。1例发生肝断面积液,经保守治疗吸收治愈;其余3例均无并发症发生。4例患者均获随访,中位随访时间19.5(10.0~24.0)个月,均无结石复发或胆道相关症状。结论 对于符合特定解剖条件的局限于肝Ⅲ段的肝内胆管结石,腹腔镜解剖性肝Ⅲ段切除术安全可行,疗效满意。 展开更多
关键词 解剖性肝切除 肝Ⅲ段切除 肝内胆管结石 脐裂静脉
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鞘管保护下硬质胆道镜经腹腔镜胆总管入路治疗肝内外胆管结石的临床价值
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作者 陆涛 黄荣德 +4 位作者 张洪昌 孙兴 裴恒照 苏泽 方兆山 《微创医学》 2024年第2期128-133,共6页
目的探讨鞘管保护下硬质胆道镜(硬镜)经腹腔镜胆总管入路治疗肝内胆管结石和胆总管结石的临床价值。方法选取115例肝内外胆管结石患者作为研究对象。根据手术方法将患者分为硬镜组58例、软镜组57例,硬镜组采用鞘管保护下硬质胆道镜经腹... 目的探讨鞘管保护下硬质胆道镜(硬镜)经腹腔镜胆总管入路治疗肝内胆管结石和胆总管结石的临床价值。方法选取115例肝内外胆管结石患者作为研究对象。根据手术方法将患者分为硬镜组58例、软镜组57例,硬镜组采用鞘管保护下硬质胆道镜经腹腔镜胆总管入路取石治疗,软镜组采用纤维胆道镜经腹腔镜胆总管入路取石治疗。比较两组患者的手术时间、术中出血量、术后住院时间、结石清除率,以及术后第1天肝功能(空腹静脉血总胆红素、直接胆红素、碱性磷酸酶、γ-谷氨酰转移酶水平)、术后并发症发生情况等。结果硬镜组患者的手术时间短于软镜组,结石清除率高于软镜组,差异均有统计学意义(均P<0.05);两组患者的术中出血量、术后住院时间、术后并发症发生率,以及术后第1天总胆红素、直接胆红素、碱性磷酸酶、γ-谷氨酰转移酶水平比较,差异均无统计学意义(均P>0.05)。结论鞘管保护下硬质胆道镜经腹腔镜胆总管入路治疗肝内胆管结石和胆总管结石的手术时间短、结石清除率高,是一种安全、高效的手术策略,具有一定的潜在应用价值。 展开更多
关键词 肝内胆管结石 胆总管结石 硬质胆道镜 纤维胆道镜 腹腔镜胆总管探查术
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ERAS理念在腹腔镜肝切除术治疗肝内胆管结石中的应用
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作者 董瑞鹏 沈娜 +1 位作者 刘彩云 史光军 《腹部外科》 2024年第3期185-189,共5页
目的探讨加速术后康复(enhanced recovery after surgery,ERAS)理念应用于微创肝切除术治疗肝内胆管结石肝萎缩病人围手术期的临床价值。方法回顾性队列研究分析青岛市市立医院肝胆外科2016年12月至2023年3月通过腹腔镜下肝切除术治疗... 目的探讨加速术后康复(enhanced recovery after surgery,ERAS)理念应用于微创肝切除术治疗肝内胆管结石肝萎缩病人围手术期的临床价值。方法回顾性队列研究分析青岛市市立医院肝胆外科2016年12月至2023年3月通过腹腔镜下肝切除术治疗的63例肝内胆管结石肝萎缩病人的临床资料,根据围手术期处理方法不同将其分为ERAS组(32例)和对照组(常规组,31例)。比较分析ERAS理念对病人术中情况(手术时间及术中出血量)、住院费用、术后肝功能、康复时间及并发症等指标的影响。呈偏态分布的计量资料以M(Q1,Q3)表示,采用秩和检验。结果ERAS组与对照组比较,病人术后康复时间明显缩短[6.0(5.0,7.0)d比8.0(5.0,9.0)d,P<0.01],住院费用更少[46531(38676,51311)元比55553(47638,65529)元,P<0.01],并发症发生率更低[31.3%(10/32)比93.5%(29/31),P<0.01],术后留置T管率更低[28.1%(9/32)比58.1%(18/31),P<0.01];两组病人在手术时间、出血量以及术后1 d、3 d的血谷丙转氨酶、谷草转氨酶、C反应蛋白及预后营养指数方面差异均无统计学意义(均P>0.05)。结论ERAS理念应用于肝切除治疗肝胆管结石肝萎缩的围手术期管理是安全有效的,有助于病人的快速安全康复,值得在肝内胆管结石肝切除术中推广。 展开更多
关键词 加速术后康复 肝内胆管结石 肝切除术
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