A 77-year-old man underwent percutaneous transhepatic gallbladder drainage(PTGBD) for acute cholecystitis as a preoperative procedure;however,he suddenly suffered cardiopulmonary arrest 4 h after the PTGBD and died.Th...A 77-year-old man underwent percutaneous transhepatic gallbladder drainage(PTGBD) for acute cholecystitis as a preoperative procedure;however,he suddenly suffered cardiopulmonary arrest 4 h after the PTGBD and died.There were three centesis scars for the PTGBD,and only one pathway from the most dorsal centesis scar reached the gallbladder.Microscopically,the PTGBD pathway crossed and injured the intrahepatic arterial wall,and hepatic parenchymal bleeding extended along the PTGBD pathway to the inferior surface of the liver.Blood flowed to the peritoneal cavity through a small gap between the liver and gallbladder.Consequently,the PTGBD caused lethal bleeding.When the percutaneous transhepatic cholangio drainage/PTGBD pathway runs close to vessels near the liver surface,it might be necessary to deal with the possibility of rapid and lethal peritoneal bleeding.展开更多
When endoscopic retrograde cholangio-pancreatog-raphy fails to decompress the pancreatic or biliary system, alternative interventions are required. In this situation, endosonography guided cholangio-pancrea-tography(E...When endoscopic retrograde cholangio-pancreatog-raphy fails to decompress the pancreatic or biliary system, alternative interventions are required. In this situation, endosonography guided cholangio-pancrea-tography(ESCP), percutaneous radiological therapy or surgery can be considered. Small case series reporting the initial experience with ESCP have been superseded by comprehensive reports of large cohorts. Although these reports are predominantly retrospective, they demonstrate that endoscopic ultrasound(EUS) guided biliary and pancreatic interventions are associated with high levels of technical and clinical success. The proce-dural complication rates are lower than those seen with percutaneous therapy or surgery. This article describes and discusses data published in the last five years relat-ing to EUS-guided biliary and pancreatic intervention.展开更多
目的:评价延续性护理在经皮肝穿刺胆道引流术后带管出院病人中的应用效果。方法:通过计算机检索the Cochrane Library、PubMed、Web of Science、EMbase、中国知网、万方数据库、维普、中国生物医学文献数据库中关于延续性护理对经皮肝...目的:评价延续性护理在经皮肝穿刺胆道引流术后带管出院病人中的应用效果。方法:通过计算机检索the Cochrane Library、PubMed、Web of Science、EMbase、中国知网、万方数据库、维普、中国生物医学文献数据库中关于延续性护理对经皮肝穿刺胆道引流术后带管出院病人康复影响的随机对照试验,检索时间为各数据库建库至2020年2月。由2名研究者独立进行文献筛选、质量评价、资料提取,使用RevMan 5.3软件进行Meta分析。结果:共纳入20篇文献,涉及1813例病人。Meta分析结果显示,延续性护理可降低经皮肝穿刺胆道引流术带管出院病人的管道相关并发症发生率[RR=0.31,95%CI(0.27,0.36),P<0.00001],提高病人再次入院的满意度[OR=7.38,95%CI(3.61,15.08),P<0.00001]、生活质量[MD=8.23,95%CI(4.49,11.98),P<0.0001]、相关知识知晓情况[RR=1.33,95%CI(1.25,1.42),P<0.00001],改善肝功能。结论:现有证据表明,与常规护理相比,延续性护理能降低经皮肝穿刺胆道引流术后带管出院病人相关并发症的发生率,提高护理满意度,改善病人生活质量,并有利于肝功能的恢复。展开更多
文摘A 77-year-old man underwent percutaneous transhepatic gallbladder drainage(PTGBD) for acute cholecystitis as a preoperative procedure;however,he suddenly suffered cardiopulmonary arrest 4 h after the PTGBD and died.There were three centesis scars for the PTGBD,and only one pathway from the most dorsal centesis scar reached the gallbladder.Microscopically,the PTGBD pathway crossed and injured the intrahepatic arterial wall,and hepatic parenchymal bleeding extended along the PTGBD pathway to the inferior surface of the liver.Blood flowed to the peritoneal cavity through a small gap between the liver and gallbladder.Consequently,the PTGBD caused lethal bleeding.When the percutaneous transhepatic cholangio drainage/PTGBD pathway runs close to vessels near the liver surface,it might be necessary to deal with the possibility of rapid and lethal peritoneal bleeding.
文摘When endoscopic retrograde cholangio-pancreatog-raphy fails to decompress the pancreatic or biliary system, alternative interventions are required. In this situation, endosonography guided cholangio-pancrea-tography(ESCP), percutaneous radiological therapy or surgery can be considered. Small case series reporting the initial experience with ESCP have been superseded by comprehensive reports of large cohorts. Although these reports are predominantly retrospective, they demonstrate that endoscopic ultrasound(EUS) guided biliary and pancreatic interventions are associated with high levels of technical and clinical success. The proce-dural complication rates are lower than those seen with percutaneous therapy or surgery. This article describes and discusses data published in the last five years relat-ing to EUS-guided biliary and pancreatic intervention.
