BACKGROUND Difficult bile duct intubation is a big challenge for endoscopists during endoscopic retrograde cholangiopancreatography(ERCP)procedure.We report a case of percutaneous transhepatic cholangial drainage(PTCD...BACKGROUND Difficult bile duct intubation is a big challenge for endoscopists during endoscopic retrograde cholangiopancreatography(ERCP)procedure.We report a case of percutaneous transhepatic cholangial drainage(PTCD)-guided methylene blue for fistulotomy using dual-knife for bile duct intubation.CASE SUMMARY A 50-year-old male patient had developed obstructive jaundice,and ERCP procedure need to be performed to treat the obstructive jaundice.But intubation cannot be performed if the duodenal papilla cannot be identified because of previous surgery for a perforated descending duodenal diverticulum.We used PTCD-guided methylene blue to identify the intramural common bile duct before dual-knife fistulotomy,and bile duct intubation was successfully completed.CONCLUSION The method that combing methylene blue and dual-knife fistulotomy to achieve bile duct intubation during difficult ERCP is safe and effective.展开更多
Background and aims:Biliary thermal injury caused by microwave ablation(MWA)for a hepatocellular carcinoma(HCC)close to the central bile ducts always results in severe complications and leads to mortality.Some studies...Background and aims:Biliary thermal injury caused by microwave ablation(MWA)for a hepatocellular carcinoma(HCC)close to the central bile ducts always results in severe complications and leads to mortality.Some studies have demonstrated that intraductal cooling of the biliary tract with chilled saline during thermal ablation can successfully prevent these complications.In this study,we present a novel bile duct cooling technique through a percutaneous transhepatic cholangial drainage(PTCD)tube for preventing biliary thermal injury caused by MWA,and compare the feasibility and safety of the intraductal cooling technique when performed with a PTCD tube and with an endoscopic nasobiliary drainage(ENBD)tube.Methods:Participants were randomly assigned to undergo MWA of HCC with intraductal chilled saline perfusion through a PTCD tube or an ENBD tube.The main study outcomes were bile duct complications related to MWA and local tumor recurrence,p value<0.05 was considered to indicate a statistically significant difference.Results:A total of 23 patients with an HCC(23 nodules)close to a central bile duct were enrolled in this study.Of these patients,12 had a PTCD tube and 11 had an ENBD tube placed into the hepatic duct close to the lesions.There were no PTCD-and ENBD-related mortality cases.There was no complication related to the PTCD procedure;however,3 patients(27.27%)developed acute pancreatitis and 1 patient(9.09%)had hemorrhage in the ENBD group(p=0.037).One patient(8.33%)in the PTCD group had bile leakage and 2 patients(18.18%)in the ENBD group developed a biloma.Within 5 years,1 patient in the PTCD group and 2 patients in the ENBD group had local recurrence.There was no significant difference in local recurrence,nonlocal hepatic recurrence,mortality rate,or median cumulative overall survival between the 2 groups.Conclusions:The intraductal cooling technique using a PTCD tube is a feasible and effective method for preventing bile duct thermal injury caused by MWA for an HCC close to the central bile ducts.It does not increase local recurrence and may be safer than intraductal cooling through an ENBD tube.展开更多
目的探讨血必净配合经皮肝胆道穿刺引流术(Percutaneous Transhepatic Cholangial Drainage,PTCD)治疗急性重症胆管炎(Acute Cholangitis of Severe Type,ACST)临床疗效。方法回顾性选取2019年1月-2020年12月湛江中心人民医院收治的103...目的探讨血必净配合经皮肝胆道穿刺引流术(Percutaneous Transhepatic Cholangial Drainage,PTCD)治疗急性重症胆管炎(Acute Cholangitis of Severe Type,ACST)临床疗效。方法回顾性选取2019年1月-2020年12月湛江中心人民医院收治的103例ACST患者的临床资料,按不同治疗方案分为4组:PTCD+抗菌素+血必净组31例、PTCD+抗菌素组25例、抗菌素+血必净组25例、单纯抗菌素组22例。观察各组患者治疗前后血清白细胞(White Blood Cells,WBC)、血小板(Platelets,PLT)、降钙素原(Procalcitonin,PCT)、C反应蛋白(Creactive Protein,CRP)、总胆红素(Total Bilirubin,TBIL)、住院时间等相关指标变化,并比较各组患者的疗效,从而进一步探讨血必净治疗ACST的临床意义。结果治疗前,4组ACST患者血清WBC、PLT、PCT、CRP及TBIL各项指标比较,差异无统计学意义(P均>0.05)。治疗后4组患者的TBIL、PCT、CRP比较,差异有统计学意义(P均<0.05),其中PTCD+抗菌素+血必净组患者的TBIL平均(23.3±12.9)μmol/L、PCT平均(3.4±1.8)ng/L和CRP平均(16.6±7.3)mg/L,较其余3组均显著降低,差异有统计学意义(P均<0.05)。治疗后4组患者的血清WBC、PLT比较,差异无统计学意义(P均>0.05)。单纯抗菌素组平均住院(7.1±2.0)d,较其余3组显著减少,差异有统计学意义(P<0.05)。4组疗效比较,差异有统计学意义(P<0.05),其中PTCD+抗菌素组及PTCD+抗菌素+血必净组的总有效率更高。结论血必净配合PTCD能明显缓解ACST患者的病情,血必净对促进病情恢复具有积极的临床意义。展开更多
文摘BACKGROUND Difficult bile duct intubation is a big challenge for endoscopists during endoscopic retrograde cholangiopancreatography(ERCP)procedure.We report a case of percutaneous transhepatic cholangial drainage(PTCD)-guided methylene blue for fistulotomy using dual-knife for bile duct intubation.CASE SUMMARY A 50-year-old male patient had developed obstructive jaundice,and ERCP procedure need to be performed to treat the obstructive jaundice.But intubation cannot be performed if the duodenal papilla cannot be identified because of previous surgery for a perforated descending duodenal diverticulum.We used PTCD-guided methylene blue to identify the intramural common bile duct before dual-knife fistulotomy,and bile duct intubation was successfully completed.CONCLUSION The method that combing methylene blue and dual-knife fistulotomy to achieve bile duct intubation during difficult ERCP is safe and effective.
基金Financial support from the Municipal Hospital Joint Research Project of Emerging Frontier Technology(Project SHDC12014112)Shanghai City,Shen Kang Group,and medical guided technology project of Shanghai Committee of Science and Technology,China(project 14411967500).
文摘Background and aims:Biliary thermal injury caused by microwave ablation(MWA)for a hepatocellular carcinoma(HCC)close to the central bile ducts always results in severe complications and leads to mortality.Some studies have demonstrated that intraductal cooling of the biliary tract with chilled saline during thermal ablation can successfully prevent these complications.In this study,we present a novel bile duct cooling technique through a percutaneous transhepatic cholangial drainage(PTCD)tube for preventing biliary thermal injury caused by MWA,and compare the feasibility and safety of the intraductal cooling technique when performed with a PTCD tube and with an endoscopic nasobiliary drainage(ENBD)tube.Methods:Participants were randomly assigned to undergo MWA of HCC with intraductal chilled saline perfusion through a PTCD tube or an ENBD tube.The main study outcomes were bile duct complications related to MWA and local tumor recurrence,p value<0.05 was considered to indicate a statistically significant difference.Results:A total of 23 patients with an HCC(23 nodules)close to a central bile duct were enrolled in this study.Of these patients,12 had a PTCD tube and 11 had an ENBD tube placed into the hepatic duct close to the lesions.There were no PTCD-and ENBD-related mortality cases.There was no complication related to the PTCD procedure;however,3 patients(27.27%)developed acute pancreatitis and 1 patient(9.09%)had hemorrhage in the ENBD group(p=0.037).One patient(8.33%)in the PTCD group had bile leakage and 2 patients(18.18%)in the ENBD group developed a biloma.Within 5 years,1 patient in the PTCD group and 2 patients in the ENBD group had local recurrence.There was no significant difference in local recurrence,nonlocal hepatic recurrence,mortality rate,or median cumulative overall survival between the 2 groups.Conclusions:The intraductal cooling technique using a PTCD tube is a feasible and effective method for preventing bile duct thermal injury caused by MWA for an HCC close to the central bile ducts.It does not increase local recurrence and may be safer than intraductal cooling through an ENBD tube.
