Objective To study the clinical diagnosis and treatment of juxtapapillary duodenal diverticula with biliary deseases.Methods Eighteen duodenal diverticulum treated in our department in recent 5 years were retrospectivly analyzed, especially investigated the postcholecystectomy cases whose symptoms were continuing existence after operatoins. Articles about the surgical treatment were reviewed. Results The total of 18 duodenal diverticulum with 17 cases of juxtapapillary duodenal diverticulum were included in this study. The ages of 12 cases were over 50 years old. Sixteen cases(88.89%) presented biliary stones. Seven cases once had performed cholecystectomy or cholecystectomy plus choledochotomy,but symptoms persisted after operations. The duodenal diverticulum were found by endoscopic retrograde cholangiopancreatography (ERCP) and hypotonic duodenography. Sixteen patients underwent surgical treatment with good effect. Conclusion The juxtapapillary duodenal diveticula has the close relationship with biliary stones. ERCP and hypotonic duodenogrphy are the most reliable methods to get the correct diagnosis. In case of recurrent common bile duct stones after operations or persisting billiary symptoms after cholecystectomy, the coexistence of juxtapapillary duodenal diverticulum should be ruled out. The surgical treatment is only considered for the duodenal diverticulum with complication.
目的:探讨MRI不同检查方法对十二指肠乳头旁憩室(periampullary diverticulum,PAD)的诊断价值。方法:应用MRI多序列检查方法诊断PAD23例,并进行分析。结果:T1WI显示为囊状低信号影,与十二指肠相通者1例,其余22例表现为不均匀略低及高低混杂信号,均未明确诊断;横断位压脂T2WI显示含气液平面囊性病灶15例;冠状位FIESTA序列表现为混杂高信号或高信号影15例;呼吸触发3D MRCP表现为高或混杂高信号影16例;冠状位屏气3DCE LAVA动态增强扫描均清晰显示。其中合并胆系结石13例,胆系炎症及感染13例,胰腺炎3例,胆胰管扩张3例,十二指肠炎症3例。结论:MRI能多序列、多方位、直观、无创的清晰显示PAD的部位、大小、范围及与邻近结构的关系,同时显示胆胰疾病形态学改变。故MRI多序列检查非常必要,是PAD诊断及鉴别诊断的重要方法。
ObjectiveTo discuss the reason and treatment strategy of gallbladder muddy stones after cholecysto-lithotomy. MethodsThe clinical data of 62 patients with gallbladder muddy stones after cholecystolithotomy who were treated in our hospital from December 2008 to December 2014 was analyzed retrospectively. ResultsThere were 43 patients without any symptom and 19 patients with acute cholecystitis in 62 patients. Four patients were diagnosed with septation gallbladder, 6 patients with long and tortuous cystic duct, 3 patients with calculus of cystic duct, 4 patients with common bile duct stones, 39 patients with periampullary diverticula, 18 patients with pancreaticobiliary maljunction, 6 patients with duodenal papilla stenosis, 29 patients with duodenal papillitis, and 3 patients with duodenal papilla adenocarcinoma. Two patients were treated with laparoscopic cholecystectomy (LC), 1 patient with endoscopic sphincterotomy (EST) /endoscopic balloon dilation (EPBD) and LC, 1 patient with percutaneous transhepafic gallbladder drainage (PTGD) and open cholec-ystectomy, 14 patients with PTGD and EST/EPBD, 1 patient with PTGD and hepatocholangioplasty with the use of gallbladder (HG), 34 patients with EST/EPBD, 3 patients with EST/EPBD and endoscopic biliay metal stent drainage (EBMSD), 5 patients with HG, and 1 patient with EST/EPBD and HG. The gallbladder muddy stones disappeared after operations in 55 patients with gallbladder reserved, and gallbladder ejection fraction increased from (42±12) % to (59±16) %. Of the 62 patients, 53 patients were followed up for 6 months to 6 years (the median time was 3.6-year). During the follow-up period, 3 patients were diagnosed with gallbladder stones, 2 patients with common bile duct stones, and 2 patients with intrahepatic and extrahepatic bile duct stones. ConclusionBile efferent tract obstruction is the important reason for the formation of gallbladder stones. HG, EST, and balloon expansion are the efficient methods to resolve the bile efferent tract obstruction.
Objective To summarize our experience and the early and midterm outcomes of stented elephant trunk procedure for right-sided aortic arch (RAA) with Kommerell's diverticulum (KD). Methods From April 2013 to July 2020, patients with RAA and KD who underwent stented elephant trunk procedure at our center were collected. Surgery was performed under moderate hypothermic circulatory arrest combined with selective antegrade cerebral perfusion via median sternotomy. Results A total of 8 patients were included, including 7 males and 1 female with a mean age of 51.88±9.61 years. All patients had an aneurysmal KD and aberrant left subclavian artery. Preoperative comorbidities included acute Stanford type B aortic dissection in 1 patient, aortic arch pseudoaneurysm in 1 patient, acute type B intramural hematoma in 2 patients, and coronary artery disease in 1 patient. Concomitant procedures included reconstruction of the left subclavian artery in all patients and coronary artery bypass grafting in 1 patient. The mean time of operation, cardiopulmonary bypass, aortic cross-clamping, and selective cerebral perfusion was 6.25±1.16 h, 157.75±40.07 min, 77.75±33.10 min, and 28.50±5.55 min, respectively. No intraoperative death occurred. There was 1 in-hospital death. Follow-up was completed in all patients with a mean period of 3.58±2.08 years. No late death occurred. A persistent anastomotic leak of the proximal arch was detected in 1 patient, but reintervention was not performed because neither aortic dilatation nor symptoms of tracheal and esophageal compression were observed during the follow-up. The remaining 6 patients showed positive aortic remodeling with complete thrombosis of the aneurysmal KD, and neither aortic event nor tracheal and esophageal compression occurred. Conclusion Stented elephant trunk procedure is a safe and feasible technique for selected patients with RAA and KD, which can achieve favorable early and midterm outcomes.