目的探讨胰管结石的诊断、治疗及发病原因。方法 回顾分析1998年1月1日至2004年11月31日期间收治的有完整病史资料的88例胰管结石患者的临床特点、诊断和治疗方法。结果88例患者病史不典型，以上腹部疼痛最常见，所有病例均伴有慢性胰腺炎。B超检查81例，诊断为胰管结石76例，胰腺钙化5例； CT检查51例，诊断为胰管结石47例，钙化4例，其中有5例疑伴胰腺癌； MRCP检查47例，诊断为胰管结石45例，胰腺钙化1例，胰腺钙化伴胰管扩张1例，其中6例疑伴胰腺癌。56例行手术治疗，53例痊愈出院，2例好转出院，1例胰管结石伴酒精性肝硬变，门静脉高压症患者术后第23 d死于肝、肾功能衰竭。25例行中西医结合治疗，17例痊愈，8例好转出院。另7例主动放弃治疗。结论 B超是胰管结石的首选检查方法，MRCP对其诊断和治疗有指导意义； 胰管结石伴有严重的临床症状或疑伴胰腺癌时，手术是其最佳选择。
ObjectiveTo study the value of magnetic resonance multiple sequence examination in the diagnosis of biliary sludges. MethodsThe display rates of biliary sludges were obtained from 56 cases of biliary sludges between February 2011 and March 2013 examined with trans T1 weighted imaging (T1WI), T2 weighted imaging with fat suppression (T2WI-FS), true fast imaging with steady-state precession (True FISP), and MR cholangiopancreatography (MRCP) proved by operations or endoscopic retrograde cholangio-pancreatography. Then we carried out a statistical comparison study. ResultsThe display rate combined with trans T1WI, T2WI-FS, True FISP, and MRCP sequence was statistically higher than any other single sequence (P<0.005). Diagnostic sensitivity, specificity and accuracy of MRI for biliary sludges were 85.7%, 84.1% and 84.5%, respectively. ConclusionTo improve the display rate of biliary sludges on MRI, multiple sequences including trans T1WI, T2WI-FS, True FISP, and MRCP should be used.
目的 探讨胰腺结石的临床特点及诊治方法。方法 回顾性分析我院1993年5月至2011年5月期间收治的25例胰腺结石患者的临床资料。结果 本组25例中经手术及EST确诊为胰腺真性结石（胰管结石）5例，胰腺假性结石（胰实质内钙化）20例。X线、B超、CT、ERCP及MRCP诊断符合率分别为40.0%（10/25）、88.0% (22/25)、84.2%(16/19)、88.9% (8/9)和100%（2/2)。手术治疗18例，无手术死亡病例，术后患者腹痛症状均明显减轻或消失，术后3d1例发生胆漏，经充分引流治愈；非手术治疗7例，1例行EST后发生出血，经保守治疗治愈。所有患者均获随访，随访时间9个月～10年，平均5.2年，其中2例合并胰腺癌患者分别于术后9个月和11个月因肿瘤复发和转移死亡，18例手术治疗患者3年内胰管结石复发2例（11.1%），7例非手术治疗患者3年内胰管结石复发2例（28.6%），4例复发患者均经非手术治疗好转。结论 胰腺结石大多继发于慢性胰腺炎，B超为首选诊断方法；手术仍是最有效的治疗手段，手术和内镜十二指肠乳头内切开取石为主的各种治疗方法的联合应用，能提高胰腺结石的疗效。
Analysis of hospital cases of cholelithiasis in every four years of the recent 3 decades clearly shows the tendency of changes of cholelithiasis in clinical appearance in Chengdu.Constituent ratio of gallbladder stone was 12.56% in 70’s,47.54% in 80’s and 81.38% in 90’s.Bill duct stones including acute obstructive suppurative cholangitis was 71.01%, 46.08%,and 15.82% respectively. Biliary ascariasis was 11.67%, 2.75% and 0.68% respectively. Age incidence shows right moving, i.e. old patients increased. Urban patients increased.The influencing factors listed are: improvement of diagnostic methods; improvement of livelihood and diet; increased life expectancy; more health follow up examinations; technical improvements in rural areas and etc.
Ｃｈｏｌｅｄｏｃｈｏｊｅｊｕｎａｌ ｓｈｕｎｔ ｗａｓ ｐｅｒｆｏｒｍｅｄ ｉｎ ｒａｂｂｉｔｓ ｂｙ ｉｎｓｅｒｔｉｎｇ ｔｕｂｅｓ ｏｆ ｄｉｆｆｅｒｅｎｔ ｃａｌｉｂｒｅ ｉｎｔｏ ｔｈｅ ｈｅｐａｔｉｃ ｄｕｃｔ ａｎｄ ｐｒｏｘｉｍａｌ ｊｅｊｕｎｕｍ ｓｅｐａｒａｔｅｌｙ ｗｉｔｈ ｌｉｇａｔｉｏｎ ｏｆ ｃｏｍｍｏｎ ｂｉｌｅ ｄｕｃｔ ａｎｄ ｃｏｎｎｅｃｔｉｎｇ ｔｗｏ ｔｕｂｅｓ ｕｎｄｅｒ ｔｈｅ ｓｋｉｎ ｏｆ ａｂｄｏｍｉｎａｌ ｗａｌｌ ｆｏｒ ｓｕｂｓｅｑｕｅｎｔ ｃｏｌｌｅｃｔｉｏｎｓ ｏｆ ｂｉｌｅ ｔｏ ｄｅｔｅｃｔ ｔｈｅ ｉｍｍｕｎｅ ｃｏｍｐｌｅｘ．Ｔｈｅ ｃｏｎｓｅｃｕｔｉｖｅ ｏｂｓｅｒｖａｔｉｏｎ ｄｅｍｏｎｓｔｒａｔｅｄ ａ ｒｅｇｕｌａｒｉｔｙ ｏｆ ｉｍｍｕｎｅ ｃｏｍｐｌｅｘ ｉｎ ｂｉｌｅ ｉｎｃｒｅａｓｉｎｇ ｆｒｏｍ ｔｈｅ ｌｏｗｅｒ ｔｏ ｔｈｅ ｈｉｇｈｅｒ ｌｅｖｅｌ ｉｎ ｔｈｅ ｐｒｏｃｅｓｓ ｏｆ ｆｏｒｍａｔｉｏｎ ｏｆ ｐｉｇｍｅｎｔａｌ ｓｔｏｎｅ．
Objective To investigate therapeutic effect of endoscopic sphincterotomy with small incision (SES) combined with endoscopic papillary balloon dilation (EPBD) in treatment of larger common bile duct stones. Methods The clinical data of 80 patients with common bile duct stones treated in our hospital from February 2014 to October 2015 were retrospectively analyzed. These patients were divided into endoscopic sphincterotomy (EST) group (n = 40) and SES+EPBD group (n = 40) according to the therapeutic methods. The diameter of common bile duct stone was 10–20 mm. The operation status, recurrence rate and residual rate of common bile duct stone, and complications rate within 3 months after operation were compared between these two groups. Results The age and gender had no significant differences between these two groups (P>0.05). The operation time was shorter (P<0.05) and the intraoperative bleeding was less (P<0.05) in the SES+EPBD group as compared with the EST group. There were no significant differences in the hospital stay and recovery time of gastrointestinal function between these two groups (P>0.05). The levels of ALT, AST, DBIL, and TBIL in these two groups before treatment had no significant differences (P>0.05); after treatment, the above indicators of liver function in the SES+EPBD group were significantly lower than those in the EST group (P<0.05), and which were significantly decreased more in the same group (P<0.05). The residual stone, stone recurrence, and complications such as acute pancreatitis, acute cholangitis, bile leakage and postoperative hemorrhage were not found in the SES+EPBD group, the rates of these indicators in the SES+EPBD group were significantly lower than those in the EST group (P<0.05). Conclusion SES combined with EPBD has a good therapeutic effect on larger common bile duct stones (diameter of common bile duct stone is 10–20 mm) and recurrence rate is low.
Four hundred and eighty two paients suffering from intrahepatic bile duct stone undergoing lobectomy and segmental resection (from 1975 to 1994,9) has reported. 63% of the patient in this group underwent 1-5 operations, including different types of biliary-intestinal anastomosis (21.6%). 482 cases underwent different types of hepatectomy, including left lateral-lobetomy 321 cases (66.6%),left hemihepatectomy 80 cases(16.6%), right hemihepatectomy 19 cases (3.9%), and multiple segmental resections 39 cases (8.1%, including Ⅴ+Ⅷ 11 cases, Ⅵ+Ⅶ 28 cases). Other type hepatectomy combined with guadrate lobectomy 20 cases (4.1%). Postoperative complication rate was 10.2%, including diliary fistula. hemobilia and subdiaphragmatic and resectional surface infectioin, 85% of the patients were followed up with an excellent result of 88%. The authors emphsize that hepatic lobectomy nad segmental resection is the core of treatment and selection of operative methods depends on clinical-patholigic types of the disease.
Objective To investigate feasibility and curative effect of ultrasound-guided percutaneous transhepatic cholangioscopy in treatment of complicated hepatolithiasis. Methods The data of 42 patients with complicated hepatolithiasis from June 2012 to June 2017 in the Hepatobiliary Surgery, the First Affiliated Hospital of Xi’an Jiaotong University were retrospectively analyzed. All the patients were treated with ultrasound-guided percutaneous transhepatic cholangioscopy, including the first stage of dilation and drainage and the second stage choledochoscopy. Results The operations of the 42 patients were successfully performed. No case was converted to the conventional laparotomy. The puncture sites of 10 cases were at the right intrahepatic bile duct, 25 cases were at the left intrahepatic bile duct, and 7 cases were at the bilateral intrahepatic bile duct. The residual stones were removed by two stage choledochoscopy in the 31 patients, 11 patients had the residual stones. After the first stage, there were 4 cases of the bile duct hemorrhage, 8 cases of the cholangitis, 1 case of the pleural effusion and 1 case of the infection, 2 cases of the postoperative drainage tube shedding. After the second stage, there were 3 cases of the cholangitis and 3 cases of the postoperative drainage tube shedding. The stones of the 10/31 patients with stone removal occurred and the diseases of 9/11 patients with stone residual were stable during the following-up of (18.6±7.8) months. Conclusion Ultrasound-guided percutaneous transhepatic cholangioscopy including the first stage of dilation and drainage plus the second stage choledochoscopy is safe and effective in treatment of complex intrahepatic bile duct stones, it is an effective supplement to traditional surgery.
Objective To evaluate the clinical effectiveness of ERCP/S+LC and LC+LCBDE in cholecystolithiasis and choledocholithiasis. Methods A fully recursive literature search was conducted in MEDLINE, EMbase, Cochrane Central Register of Controlled Trials in any language. By using a defined search strategy, both the randomized controlled trials (RCTs) and controlled clinical trials on comparing ERCP/ S+LC with LC+LCBDE in cholecystolithiasis and choledocholithiasis were identified. Data were extracted and evaluated by two reviewers independently. The quality of the included trials was evaluated. Meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.0.2 software. Results Fourteen controlled clinical trials (1 544 patients) were included. The results of meta-analyses showed that: a) There were no significant difference in the stone clearance rate between the two groups (RR=0.96, 95%CI 0.92 to 1.01, P=0.14); b) There were no significant difference in the residual stone rate between the two groups (OR=1.05, 95%CI 0.65 to 1.72, P=0.83); c) There were no significant difference in the complications morbidity between the two groups (OR=1.12, 95%CI 0.85 to 1.55, P=0.48); d) There were no significant difference in the mortality during follow-up visit between the two groups (RD= 0.00, 95%CI –0.03 to 0.03, P=0.84); e) The length of hospital stay in the LC+LCBDE group was shorter than that of the ERCP/S+LC group with significant difference (WMD= 1.78, 95%CI 0.94 to 2.62, Plt;0.000 1); and f) The LC+LCBDE group was superior to the ERCP/S+LC group in the aspects of procedure time and total hospital charges. Conclusion Although there aren’t differences in the effectiveness and safety between the ERCP/S+LC group and the LC+LCBDE group, the latter is superior to the former in procedure time, length of hospital stay and total hospital charges. For the influencing factors of lower quality and astable statistical outcomes of the included studies, this conclusion has to be verified with more strictly designed large scale RCTs.