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
目的评价内镜下鼻胆管引流术(ENBD)与经皮经肝胆管穿刺引流术(PTCD)两种胆道引流方式对急性重症胆管炎的临床疗效并探讨其临床应用价值。方法检索PubMed、EMBASE、Medline、Web of Science、中国知网、万方数据知识服务平台数据库中发...目的评价内镜下鼻胆管引流术(ENBD)与经皮经肝胆管穿刺引流术(PTCD)两种胆道引流方式对急性重症胆管炎的临床疗效并探讨其临床应用价值。方法检索PubMed、EMBASE、Medline、Web of Science、中国知网、万方数据知识服务平台数据库中发表的关于急性重症胆管炎行ENBD与PTCD治疗效果比较的临床研究。检索时间为2010年1月1日至2023年8月31日。观察指标包括手术时间、住院时间、有效率、病死率及总并发症发生率,提取相关数据后用RevMan 5.4软件进行meta分析。结果共纳入符合标准的5篇回顾性队列研究,文献累计样本量为345例,其中ENBD组191例,PTCD组154例。meta分析结果显示,两组住院时间[WMD=-0.96,95%CI(-1.92,0.01),P=0.05]、病死率[OR=0.87,95%CI(0.43,1.73),P=0.68]比较,差异无统计学意义(P>0.05)。ENBD组有效率高于PTCD组[OR=2.43,95%CI(1.09,5.44),P=0.03],PTCD组总并发症发生率高于ENBD组[OR=0.33,95%CI(0.14,0.74),P=0.007],差异有统计学意义(P<0.05)。结论对于急性重症胆管炎患者行ENBD临床治疗效果优于PTCD,是一种安全、有效的胆管引流方式。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
目的对比观察经内镜逆行胰胆管造影(ERCP)置入金属支架与经皮经肝胆管穿刺引流术(PTCD)治疗肝外胆管恶性肿瘤致梗阻性黄疸的临床疗效。方法采用前瞻性研究方法,选取2016年1月至2018年1月首都医科大学附属北京友谊医院收治的90例肝外胆...目的对比观察经内镜逆行胰胆管造影(ERCP)置入金属支架与经皮经肝胆管穿刺引流术(PTCD)治疗肝外胆管恶性肿瘤致梗阻性黄疸的临床疗效。方法采用前瞻性研究方法,选取2016年1月至2018年1月首都医科大学附属北京友谊医院收治的90例肝外胆管恶性肿瘤致梗阻性黄疸患者,采用简单随机分组方法,分为对照组和观察组,每组各45例。对照组患者采用PTCD治疗,观察组患者采用ERCP置入金属支架治疗。比较两组患者的住院天数、术后黄疸缓解率、术后腹痛、术后发热、支架通畅时间、术后并发症发生情况及总生存期等差异。结果观察组患者的住院天数[(12.53±3.98)d]较对照组[(18.77±4.26)d]明显缩短,差异具有统计学意义(P<0.01)。观察组和对照组患者的术后黄疸缓解率(93.33%vs.84.44%)和发热发生率(24.44%vs.33.33%)比较,差异均无统计学意义(P>0.05);观察组患者的术后腹痛发生率(8.89%)较对照组(31.11%)明显下降,差异具有统计学意义(P<0.05);观察组和对照组患者的腹痛消失时间(6.95±1.35 d vs.7.38±1.46 d)和体温恢复正常时间(2.48±0.69 d vs.2.74±0.83 d)比较,差异均无统计学意义(P>0.05)。观察组患者的支架通畅时间[(224.85±48.95)d]和总生存期[(331.14±46.84)d]较对照组[(157.89±42.16)d、(223.16±39.80)d]明显延长,差异具有统计学意义(P<0.01)。观察组患者的术后并发症总发生率(6.67%)较对照组(26.67%)明显降低,差异具有统计学意义(P<0.05)。结论对肝外胆管恶性肿瘤致梗阻性黄疸患者而言,ERCP置入金属支架与PTCD的效果相当,均可有效缓解胆道梗阻性黄疸。但相比于PTCD,ERCP置入金属支架治疗后胆道通畅时间延长,住院时间缩短,并发症发生率低,可促进患者肝功能恢复,延长生存时间,因此,ERCP置入金属支架治疗可作为临床治疗此类患者的一种安全、有效的方法。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.
文摘目的评价内镜下鼻胆管引流术(ENBD)与经皮经肝胆管穿刺引流术(PTCD)两种胆道引流方式对急性重症胆管炎的临床疗效并探讨其临床应用价值。方法检索PubMed、EMBASE、Medline、Web of Science、中国知网、万方数据知识服务平台数据库中发表的关于急性重症胆管炎行ENBD与PTCD治疗效果比较的临床研究。检索时间为2010年1月1日至2023年8月31日。观察指标包括手术时间、住院时间、有效率、病死率及总并发症发生率,提取相关数据后用RevMan 5.4软件进行meta分析。结果共纳入符合标准的5篇回顾性队列研究,文献累计样本量为345例,其中ENBD组191例,PTCD组154例。meta分析结果显示,两组住院时间[WMD=-0.96,95%CI(-1.92,0.01),P=0.05]、病死率[OR=0.87,95%CI(0.43,1.73),P=0.68]比较,差异无统计学意义(P>0.05)。ENBD组有效率高于PTCD组[OR=2.43,95%CI(1.09,5.44),P=0.03],PTCD组总并发症发生率高于ENBD组[OR=0.33,95%CI(0.14,0.74),P=0.007],差异有统计学意义(P<0.05)。结论对于急性重症胆管炎患者行ENBD临床治疗效果优于PTCD,是一种安全、有效的胆管引流方式。
文摘目的对比观察经内镜逆行胰胆管造影(ERCP)置入金属支架与经皮经肝胆管穿刺引流术(PTCD)治疗肝外胆管恶性肿瘤致梗阻性黄疸的临床疗效。方法采用前瞻性研究方法,选取2016年1月至2018年1月首都医科大学附属北京友谊医院收治的90例肝外胆管恶性肿瘤致梗阻性黄疸患者,采用简单随机分组方法,分为对照组和观察组,每组各45例。对照组患者采用PTCD治疗,观察组患者采用ERCP置入金属支架治疗。比较两组患者的住院天数、术后黄疸缓解率、术后腹痛、术后发热、支架通畅时间、术后并发症发生情况及总生存期等差异。结果观察组患者的住院天数[(12.53±3.98)d]较对照组[(18.77±4.26)d]明显缩短,差异具有统计学意义(P<0.01)。观察组和对照组患者的术后黄疸缓解率(93.33%vs.84.44%)和发热发生率(24.44%vs.33.33%)比较,差异均无统计学意义(P>0.05);观察组患者的术后腹痛发生率(8.89%)较对照组(31.11%)明显下降,差异具有统计学意义(P<0.05);观察组和对照组患者的腹痛消失时间(6.95±1.35 d vs.7.38±1.46 d)和体温恢复正常时间(2.48±0.69 d vs.2.74±0.83 d)比较,差异均无统计学意义(P>0.05)。观察组患者的支架通畅时间[(224.85±48.95)d]和总生存期[(331.14±46.84)d]较对照组[(157.89±42.16)d、(223.16±39.80)d]明显延长,差异具有统计学意义(P<0.01)。观察组患者的术后并发症总发生率(6.67%)较对照组(26.67%)明显降低,差异具有统计学意义(P<0.05)。结论对肝外胆管恶性肿瘤致梗阻性黄疸患者而言,ERCP置入金属支架与PTCD的效果相当,均可有效缓解胆道梗阻性黄疸。但相比于PTCD,ERCP置入金属支架治疗后胆道通畅时间延长,住院时间缩短,并发症发生率低,可促进患者肝功能恢复,延长生存时间,因此,ERCP置入金属支架治疗可作为临床治疗此类患者的一种安全、有效的方法。
