BACKGROUND Percutaneous hepatobiliary drainage(PTCD)is an effective method for the treatment of biliary obstruction and other diseases,but postoperative complications are still one of the important problems faced by p...BACKGROUND Percutaneous hepatobiliary drainage(PTCD)is an effective method for the treatment of biliary obstruction and other diseases,but postoperative complications are still one of the important problems faced by patients.Continuous nursing is a comprehensive nursing model that plays an important role in postoperative recovery.The purpose of this study was to investigate the effect of continuous nursing on the incidence of complications in patients after PTCD surgery through meta-analysis and to evaluate its efficacy and safety.AIM To evaluate the effect of extended nursing on the incidence of complications in discharged patients after percutaneous transhepatic biliary drainage(PTBD).METHODS Randomized controlled studies on PTBD postdischarge extended care were identified in the CNKI,Wanfang,VIP,CBM,PubMed,Cochrane Library,Embase,Web of Science,and other databases.The quality of the included studies was evaluated using the Joanna Briggs Institute of Australia literature quality evaluation tool,and a meta-analysis of the included studies was performed with RevMan 5.4 software.RESULTS Finally,9 studies were included,with a total sample size of 854 patients(425 patients in the control group and 429 patients in the intervention group).Meta-analysis revealed that extended care effectively reduced biliary tract infection(RR:0.42,95%CI:0.30-0.57),puncture wound infection(RR:0.19,95%CI:0.06-0.65),catheter protrusion or displacement in discharged patients after PTBD(RR:0.31,95%CI:0.18-0.54),catheter blockage(RR:0.23,95%CI:0.13-0.42),skin infection around the drainage tube(RR:0.30,95%CI:0.12-0.77),and catheter-related readmissions(RR:0.34,95%CI:0.18-0.65)(P<0.05).CONCLUSION Compared with conventional discharge care,extended care can effectively reduce the occurrence of complications such as biliary tract infection,puncture wound infection,catheter prolapse or displacement,catheter blockage,skin infection around the drainage tube,and catheter-related readmission in discharged patients after PTBD.展开更多
BACKGROUND Malignant obstructive jaundice(MOJ)is a condition characterized by varying degrees of bile duct stenosis and obstruction,accompanied by the progressive development of malignant tumors,leading to high morbid...BACKGROUND Malignant obstructive jaundice(MOJ)is a condition characterized by varying degrees of bile duct stenosis and obstruction,accompanied by the progressive development of malignant tumors,leading to high morbidity and mortality rates.Currently,the two most commonly employed methods for its management are percutaneous transhepatic bile duct drainage(PTBD)and endoscopic ultrasound-guided biliary drainage(EUS-BD).While both methods have demonstrated favorable outcomes,additional research needs to be performed to determine their relative efficacy.To compare the therapeutic effectiveness of EUS-BD and PTBD in treating MOJ.METHODS This retrospective analysis,conducted between September 2015 and April 2023 at The Third Affiliated Hospital of Soochow University(The First People’s Hospital of Changzhou),involved 68 patients with MOJ.The patients were divided into two groups on the basis of surgical procedure received:EUS-BD subgroup(n=33)and PTBD subgroup(n=35).Variables such as general data,preoperative and postoperative indices,blood routine,liver function indices,myocardial function indices,operative success rate,clinical effectiveness,and complication rate were analyzed and compared between the subgroups.RESULTS In the EUS-BD subgroup,hospital stay duration,bile drainage volume,effective catheter time,and clinical effect-iveness rate were superior to those in the PTBD subgroup,although the differences were not statistically significant(P>0.05).The puncture time for the EUS-BD subgroup was shorter than that for the PTBD subgroup(P<0.05).Postoperative blood routine,liver function index,and myocardial function index in the EUS-BD subgroup were significantly lower than those in the PTBD subgroup(P<0.05).Additionally,the complication rate in the EUS-BD subgroup was lower than in the PTBD subgroup(P<0.05).CONCLUSION EUS-BD may reduce the number of punctures,improve liver and myocardial functions,alleviate traumatic stress,and decrease complication rates in MOJ treatment.展开更多
Biliary complications are common after living donor liver transplant(LDLT) although with advancements in surgical understanding and techniques, the incidence is decreasing. Biliary strictures are more common than leak...Biliary complications are common after living donor liver transplant(LDLT) although with advancements in surgical understanding and techniques, the incidence is decreasing. Biliary strictures are more common than leaks. Endoscopic retrograde cholangiopancreatography(ERCP) is the first line modality of treatment of post LDLT biliary strictures with a technical success rate of 75%-80%. Most of ERCP failures are successfully treated by percutaneous transhepatic biliary drainage(PTBD) and rendezvous technique. A minority of patients may require surgical correction. ERCP for these strictures is technically more challenging than routine as well post deceased donor strictures. Biliary strictures may increase the morbidity of a liver transplant recipient, but the mortality is similar to those with or without strictures. Post transplant strictures are short segment and soft, requiring only a few session of ERCP before complete dilatation. Long-term outcome of patients with biliary stricture is similar to those without stricture. With the introduction of new generation cholangioscopes, ERCP success rate may increase, obviating the need for PTBD and surgery in these patients.展开更多
AIM： To investigate the usefulness of a new rendezvous technique for placing stents using the Kumpe （KMP） catheter in angulated or twisted biliary strictures. METHODS： The rendezvous technique was performed in pat...AIM： To investigate the usefulness of a new rendezvous technique for placing stents using the Kumpe （KMP） catheter in angulated or twisted biliary strictures. METHODS： The rendezvous technique was performed in patients with a biliary stricture after living donor liver transplantation （LDLT） who required the exchange of percutaneous transhepatic biliary drainage catheters for inside stents. The rendezvous technique was performed using a guidewire in 19 patients （guidewire group） and using a KMP catheter in another 19 （KMP catheter group）. We compared the two groups retrospectively. RESULTS： The baseline characteristics did not differ between the groups. The success rate for placing insidestents was 100% in both groups. A KMP catheter was easier to manipulate than a guidewire. The mean pro- cedure time in the KMP catheter group （1012 s, range： 301-2006 s） was shorter than that in the guidewire group （2037 s, range： 251-6758 s, P = 0.022）. The cu- mulative probabilities corresponding to the procedure time of the two groups were significantly different （P = 0.008）. The factors related to procedure time were the rendezvous technique method, the number of inside stents, the operator, and balloon dilation of the stric- ture （P 〈 0.05）. In a multivariate analysis, the rendez- vous technique method was the only significant factor related to procedure time （P = 0.010）. The procedural complications observed included one case of mild acute pancreatitis and one case of acute cholangitis in the guidewire group, and two cases of mild acute pancre- atitis in the KMP catheter group. CONCLUSION： The rendezvous technique involving use of the KIVlp catheter was a fast and safe method for placing inside stents in patients with LDLT biliary stric- ture that represents a viable alternative to the guide- wire rendezvous technique,展开更多
AIM:To determine the risk factors of biliary intervention using magnetic resonance cholangiopancreatography(MRCP) after living donor liver transplantation(LDLT).METHODS: We retrospectively enrolled 196 patients who un...AIM:To determine the risk factors of biliary intervention using magnetic resonance cholangiopancreatography(MRCP) after living donor liver transplantation(LDLT).METHODS: We retrospectively enrolled 196 patients who underwent right lobe LDLT between 2006 and 2010 at a single liver transplantation center. Direct duct-to-duct biliary anastomosis was performed in all 196 patients. MRCP images routinely taken 1 mo after LDLT were analyzed to identify risk factors for biliary intervention during follow-up, such as retrograde cholangiopancreatography or percutaneous transhepatic biliary drainage. Two experienced radiologists evaluated the MRCP findings, including the anastomosis site angle on three-dimensional images, the length of the filling defect on maximum intensity projection, bile duct dilatation, biliary stricture, and leakage.RESULTS: Eighty-nine patients underwent biliary intervention during follow-up. The anastomosis site angle [hazard ratio(HR) = 0.48; 95% confidence interval(CI), 0.30-0.75, P < 0.001], a filling defect in the anastomosis site(HR = 2.18, 95%CI: 1.41-3.38,P = 0.001), and biliary leakage(HR = 2.52, 95%CI: 1.02-6.20, P = 0.048) on MRCP were identified in the multivariate analysis as significant risk factors for biliary intervention during follow-up. Moreover, a narrower anastomosis site angle(i.e., below the median angle of 113.3°) was associated with earlier biliary intervention(38.5 ± 4.2 mo vs 62. 1 ± 4.1 mo, P < 0.001). Kaplan-Meier analysis comparing biliary intervention-free survival according to the anastomosis site angle revealed that lower survival was associated with a narrower anastomosis site angle(36.3% vs 62.0%, P < 0.001).CONCLUSION: The biliary anastomosis site angle in MRCP after LDLT may be associated with the need for biliary intervention.展开更多
文摘BACKGROUND Percutaneous hepatobiliary drainage(PTCD)is an effective method for the treatment of biliary obstruction and other diseases,but postoperative complications are still one of the important problems faced by patients.Continuous nursing is a comprehensive nursing model that plays an important role in postoperative recovery.The purpose of this study was to investigate the effect of continuous nursing on the incidence of complications in patients after PTCD surgery through meta-analysis and to evaluate its efficacy and safety.AIM To evaluate the effect of extended nursing on the incidence of complications in discharged patients after percutaneous transhepatic biliary drainage(PTBD).METHODS Randomized controlled studies on PTBD postdischarge extended care were identified in the CNKI,Wanfang,VIP,CBM,PubMed,Cochrane Library,Embase,Web of Science,and other databases.The quality of the included studies was evaluated using the Joanna Briggs Institute of Australia literature quality evaluation tool,and a meta-analysis of the included studies was performed with RevMan 5.4 software.RESULTS Finally,9 studies were included,with a total sample size of 854 patients(425 patients in the control group and 429 patients in the intervention group).Meta-analysis revealed that extended care effectively reduced biliary tract infection(RR:0.42,95%CI:0.30-0.57),puncture wound infection(RR:0.19,95%CI:0.06-0.65),catheter protrusion or displacement in discharged patients after PTBD(RR:0.31,95%CI:0.18-0.54),catheter blockage(RR:0.23,95%CI:0.13-0.42),skin infection around the drainage tube(RR:0.30,95%CI:0.12-0.77),and catheter-related readmissions(RR:0.34,95%CI:0.18-0.65)(P<0.05).CONCLUSION Compared with conventional discharge care,extended care can effectively reduce the occurrence of complications such as biliary tract infection,puncture wound infection,catheter prolapse or displacement,catheter blockage,skin infection around the drainage tube,and catheter-related readmission in discharged patients after PTBD.
文摘BACKGROUND Malignant obstructive jaundice(MOJ)is a condition characterized by varying degrees of bile duct stenosis and obstruction,accompanied by the progressive development of malignant tumors,leading to high morbidity and mortality rates.Currently,the two most commonly employed methods for its management are percutaneous transhepatic bile duct drainage(PTBD)and endoscopic ultrasound-guided biliary drainage(EUS-BD).While both methods have demonstrated favorable outcomes,additional research needs to be performed to determine their relative efficacy.To compare the therapeutic effectiveness of EUS-BD and PTBD in treating MOJ.METHODS This retrospective analysis,conducted between September 2015 and April 2023 at The Third Affiliated Hospital of Soochow University(The First People’s Hospital of Changzhou),involved 68 patients with MOJ.The patients were divided into two groups on the basis of surgical procedure received:EUS-BD subgroup(n=33)and PTBD subgroup(n=35).Variables such as general data,preoperative and postoperative indices,blood routine,liver function indices,myocardial function indices,operative success rate,clinical effectiveness,and complication rate were analyzed and compared between the subgroups.RESULTS In the EUS-BD subgroup,hospital stay duration,bile drainage volume,effective catheter time,and clinical effect-iveness rate were superior to those in the PTBD subgroup,although the differences were not statistically significant(P>0.05).The puncture time for the EUS-BD subgroup was shorter than that for the PTBD subgroup(P<0.05).Postoperative blood routine,liver function index,and myocardial function index in the EUS-BD subgroup were significantly lower than those in the PTBD subgroup(P<0.05).Additionally,the complication rate in the EUS-BD subgroup was lower than in the PTBD subgroup(P<0.05).CONCLUSION EUS-BD may reduce the number of punctures,improve liver and myocardial functions,alleviate traumatic stress,and decrease complication rates in MOJ treatment.
文摘Biliary complications are common after living donor liver transplant(LDLT) although with advancements in surgical understanding and techniques, the incidence is decreasing. Biliary strictures are more common than leaks. Endoscopic retrograde cholangiopancreatography(ERCP) is the first line modality of treatment of post LDLT biliary strictures with a technical success rate of 75%-80%. Most of ERCP failures are successfully treated by percutaneous transhepatic biliary drainage(PTBD) and rendezvous technique. A minority of patients may require surgical correction. ERCP for these strictures is technically more challenging than routine as well post deceased donor strictures. Biliary strictures may increase the morbidity of a liver transplant recipient, but the mortality is similar to those with or without strictures. Post transplant strictures are short segment and soft, requiring only a few session of ERCP before complete dilatation. Long-term outcome of patients with biliary stricture is similar to those without stricture. With the introduction of new generation cholangioscopes, ERCP success rate may increase, obviating the need for PTBD and surgery in these patients.
文摘AIM： To investigate the usefulness of a new rendezvous technique for placing stents using the Kumpe （KMP） catheter in angulated or twisted biliary strictures. METHODS： The rendezvous technique was performed in patients with a biliary stricture after living donor liver transplantation （LDLT） who required the exchange of percutaneous transhepatic biliary drainage catheters for inside stents. The rendezvous technique was performed using a guidewire in 19 patients （guidewire group） and using a KMP catheter in another 19 （KMP catheter group）. We compared the two groups retrospectively. RESULTS： The baseline characteristics did not differ between the groups. The success rate for placing insidestents was 100% in both groups. A KMP catheter was easier to manipulate than a guidewire. The mean pro- cedure time in the KMP catheter group （1012 s, range： 301-2006 s） was shorter than that in the guidewire group （2037 s, range： 251-6758 s, P = 0.022）. The cu- mulative probabilities corresponding to the procedure time of the two groups were significantly different （P = 0.008）. The factors related to procedure time were the rendezvous technique method, the number of inside stents, the operator, and balloon dilation of the stric- ture （P 〈 0.05）. In a multivariate analysis, the rendez- vous technique method was the only significant factor related to procedure time （P = 0.010）. The procedural complications observed included one case of mild acute pancreatitis and one case of acute cholangitis in the guidewire group, and two cases of mild acute pancre- atitis in the KMP catheter group. CONCLUSION： The rendezvous technique involving use of the KIVlp catheter was a fast and safe method for placing inside stents in patients with LDLT biliary stric- ture that represents a viable alternative to the guide- wire rendezvous technique,
文摘AIM:To determine the risk factors of biliary intervention using magnetic resonance cholangiopancreatography(MRCP) after living donor liver transplantation(LDLT).METHODS: We retrospectively enrolled 196 patients who underwent right lobe LDLT between 2006 and 2010 at a single liver transplantation center. Direct duct-to-duct biliary anastomosis was performed in all 196 patients. MRCP images routinely taken 1 mo after LDLT were analyzed to identify risk factors for biliary intervention during follow-up, such as retrograde cholangiopancreatography or percutaneous transhepatic biliary drainage. Two experienced radiologists evaluated the MRCP findings, including the anastomosis site angle on three-dimensional images, the length of the filling defect on maximum intensity projection, bile duct dilatation, biliary stricture, and leakage.RESULTS: Eighty-nine patients underwent biliary intervention during follow-up. The anastomosis site angle [hazard ratio(HR) = 0.48; 95% confidence interval(CI), 0.30-0.75, P < 0.001], a filling defect in the anastomosis site(HR = 2.18, 95%CI: 1.41-3.38,P = 0.001), and biliary leakage(HR = 2.52, 95%CI: 1.02-6.20, P = 0.048) on MRCP were identified in the multivariate analysis as significant risk factors for biliary intervention during follow-up. Moreover, a narrower anastomosis site angle(i.e., below the median angle of 113.3°) was associated with earlier biliary intervention(38.5 ± 4.2 mo vs 62. 1 ± 4.1 mo, P < 0.001). Kaplan-Meier analysis comparing biliary intervention-free survival according to the anastomosis site angle revealed that lower survival was associated with a narrower anastomosis site angle(36.3% vs 62.0%, P < 0.001).CONCLUSION: The biliary anastomosis site angle in MRCP after LDLT may be associated with the need for biliary intervention.
