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基于PSM法探讨胆总管结石ERCP后并发胰腺炎的影响因素 认领 引用
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作者 侯秀峙 吕坤 孔世杰 《淮海医药》 CAS 2026年第1期36-40,共5页
目的:基于倾向性评分匹配(PSM)法探讨胆总管结石内镜下逆行胰胆管造影(ERCP)后并发胰腺炎的影响因素。方法:回顾性选取2018年1月—2023年11月某院388例胆总管结石行ERCP的患者为研究对象,按照ERCP后是否并发胰腺炎分为胰腺炎组(53例)和... 目的:基于倾向性评分匹配(PSM)法探讨胆总管结石内镜下逆行胰胆管造影(ERCP)后并发胰腺炎的影响因素。方法:回顾性选取2018年1月—2023年11月某院388例胆总管结石行ERCP的患者为研究对象,按照ERCP后是否并发胰腺炎分为胰腺炎组(53例)和无胰腺炎组(335例)。以性别、年龄、BMI、合并基础疾病情况为协变量,以1:1比例对2组进行PSM,成功匹配51对患者。采用单因素、多因素Logistic回归方程分析胆总管结石ERCP后并发胰腺炎的影响因素。结果:单因素分析结果显示,胰腺炎组Oddi括约肌功能障碍、十二指肠乳头外观2型、十二指肠憩室、内镜下乳头括约肌球囊扩张术(EPBD)、乳头括约肌预切开插管、插管困难、胰管显影占比及γ-谷氨酰转移酶(GGT)、丙氨酸氨基转移酶(ALT)水平高于无胰腺炎组,白蛋白(Alb)水平及常规插管、经内镜鼻胆管引流术(ENBD)占比低于无胰腺炎组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,Oddi括约肌功能障碍(OR=1.881)、十二指肠乳头外观2型(OR=1.669)、十二指肠憩室(OR=1.815)、高GGT、ALT、EPBD水平(OR=1.642、1.629、1.761)、插管困难(OR=1.883)、胰管显影(OR=1.741)是胆总管结石ERCP后并发胰腺炎的危险因素(P<0.05);高Alb(OR=0.592)、ENBD(OR=0.539)水平是保护因素(P<0.05)。结论:经PSM法发现,胆总管结石患者Oddi括约肌功能障碍、十二指肠乳头外观2型、十二指肠憩室、高GGT、ALT、EPBD水平、插管困难、胰管显影是其ERCP后并发胰腺炎的危险因素,高Alb、ENBD水平是保护因素。 展开更多
关键词 胆结石,胆总管 内镜下逆行胰胆管造影 胰腺炎 倾向性评分匹配 影响因素
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Current status of peroral cholangioscopy in biliary tract diseases 认领 引用 被引量：5
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作者 Stefania Ghersi Lorenzo Fuccio +2 位作者 Marco Bassi Carlo Fabbri Vincenzo Cennamo 《World Journal of Gastrointestinal Endoscopy》 2015年第5期510-517,共8页
Peroral cholangioscopy(POC) is an important tool for the management of a selected group of biliary diseases. Because of its direct visualization, POC allows targeted diagnostic and therapeutic procedures. POC can be p... Peroral cholangioscopy(POC) is an important tool for the management of a selected group of biliary diseases. Because of its direct visualization, POC allows targeted diagnostic and therapeutic procedures. POC can be performed using a dedicated cholangioscope that is advanced through the accessory channel of a duodenoscope or via the insertion of a small-diameter endoscope directly into the bile duct. POC was first described in the 1970 s, but the use of earlier generation devices was substantially limited by the cumbersome equipment setup and high repair costs. For nearly ten years, several technical improvements, including the single-operator system, high-quality images, the development of dedicated accessories and the increased size of the working channel, have led to increased diagnostic accuracy, thus assisting in the differentiation of benign and malignant intraductal lesions, targeting biopsies and the precise delineation of intraductal tumor spread before surgery. Furthermore, lithotripsy of difficult bile duct stones, ablative therapies for biliary malignancies and direct biliary drainage can be performed under POC control. Recent developments of new types of conventional POCs allow feasible, safe and effective procedures at reasonable costs. In the current review, we provide an updated overview of POC, focusing our attention on the main current clinical applications and on areas for future research. 展开更多
关键词 Peroral cholangioscopy Biliary tract disease Direct visualization Indeterminate biliary strictures Bileduct stones
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Endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: From guidelines to clinical practice 认领 引用 被引量：5
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作者 Joana Magalhes Bruno Rosa José Cotter 《World Journal of Gastrointestinal Endoscopy》 2015年第2期128-134,共7页
AIM: To study the practical applicability of the American Society for Gastrointestinal Endoscopy guidelines in suspected cases of choledocholithiasis.METHODS: This was a retrospective single center study, covering a 4... AIM: To study the practical applicability of the American Society for Gastrointestinal Endoscopy guidelines in suspected cases of choledocholithiasis.METHODS: This was a retrospective single center study, covering a 4-year period, from January 2010 to December 2013. All patients who underwent endoscopic retrograde cholangiopancreatography(ERCP) for suspected choledocholithiasis were included. Based on the presence or absence of predictors of choledocholithiasis(clinical ascending cholangitis, common bile duct(CBD) stones on ultrasonography(US), total bilirubin > 4 mg/d L, dilated CBD on US, total bilirubin 1.8-4 mg/d L, abnormal liver function test, age > 55 years and gallstone pancreatitis), patients were stratified in low, intermediate or high risk for choledocholithiasis. For each predictor and risk group we used the χ2 to evaluate the statistical associations with the presence of choledocolithiasis at ERCP. Statistical analysis was performed using SPSS version 21.0. A P value of less than 0.05 was considered statistically significant. RESULTS: A total of 268 ERCPs were performed for suspected choledocholithiasis. Except for gallstone pancreatitis(P = 0.063), all other predictors of cho-ledocholitiasis(clinical ascending cholangitis, P = 0.001; CBD stones on US, P ≤ 0.001; total bilirubin > 4 mg/dL, P = 0.035; total bilirubin 1.8-4 mg/dL, P = 0.001; dilated CBD on US, P ≤ 0.001; abnormal liver function test, P = 0.012; age > 55 years, P = 0.002) showed a statistically significant association with the presence of choledocholithiasis at ERCP. Approximately four fifths of patients in the high risk group(79.8%, 154/193 patients) had confirmed choledocholithiasis on ERCP, vs 34.2%(25/73 patients) and 0(0/2 patients) in the intermediate and low risk groups, respectively. The definition of "high risk group" had a sensitivity of 86%, positive predictive value 79.8% and specificity 56.2% for the presence of choledocholithiasis at ERCP. CONCLUSION: The guidelines should be considered to optimize patients' selection for ERCP. For high risk patients specificity is still low, meaning that some patients perform ERCP unnecessarily. 展开更多
关键词 Choledocholithiasis Endoscopic retrograde cholangiopancreatography Cholangitis Common bileduct stones Dilated common bile duct
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Endoscopic ultrasound guided interventional procedures 认领 引用 被引量：6
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作者 Vishal Sharma Surinder S Rana Deepak K Bhasin 《World Journal of Gastrointestinal Endoscopy》 2015年第6期628-642,共15页
Endoscopic ultrasound(EUS) has emerged as an important diagnostic and therapeutic modality in the field of gastrointestinal endoscopy. EUS provides access to many organs and lesions which are in proximity to the gastr... Endoscopic ultrasound(EUS) has emerged as an important diagnostic and therapeutic modality in the field of gastrointestinal endoscopy. EUS provides access to many organs and lesions which are in proximity to the gastrointestinal tract and thus giving an opportunity to target them for therapeutic and diagnostic purposes. This modality also provides a real time opportunityto target the required area while avoiding adjacent vascular and other structures. Therapeutic EUS has found role in management of pancreatic fluid collections, biliary and pancreatic duct drainage in cases of failed endoscopic retrograde cholangiopancreatography, drainage of gallbladder, celiac plexus neurolysis/blockage, drainage of mediastinal and intra-abdominal abscesses and collections and in targeted cancer chemotherapy and radiotherapy. Infact, therapeutic EUS has emerged as the therapy of choice for management of pancreatic pseudocysts and recent innovations like fully covered removable metallic stents have improved results in patients with organised necrosis. Similarly, EUS guided drainage of biliary tract and pancreatic duct helps drainage of these systems in patients with failed cannulation, inaccessible papilla as with duodenal/gastric obstruction or surgically altered anatomy. EUS guided gall bladder drainage is a useful emergent procedure in patients with acute cholecystitis who are not fit for surgery. EUS guided celiac plexus neurolysis and blockage is more effective and less morbid vis-à-vis the percutaneous technique. The field of interventional EUS is rapidly advancing and many more interventions are being continuously added. This review focuses on the current status of evidence vis-à-vis the established indications of therapeutic EUS. 展开更多
关键词 Endosonography Pancreatic pseudocyst Celiac plexus Choledochostomy Cholecystostomy Photochemotherapy Abdominal abscess Common bileduct Pancreatic duct Endoscopic ultrasound-guidedfine needle aspiration
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Vanishing bile duct and Stevens-Johnson syndrome associated with ciprofloxacin treated with tacrolimus 认领 引用 被引量：3
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作者 Gokhan Okan Serpil Yaylaci +2 位作者 Onder Peker Sabahattin Kaymakoglu Murat Saruc 《World Journal of Gastroenterology》 SCIE CAS 2008年第29期4697-4700,共4页
Stevens-Johnson syndrome (SJS) is a serious and potentially life-threatening disease. Vanishing bile duct syndrome (VBDS) is a rare cause of progressive cholestasis. Both syndromes are mostly related with drugs. We re... Stevens-Johnson syndrome (SJS) is a serious and potentially life-threatening disease. Vanishing bile duct syndrome (VBDS) is a rare cause of progressive cholestasis. Both syndromes are mostly related with drugs. We report a case of a patient with ciprofloxacin-induced SJS and acute onset of VBDS, and reviewed the related literature. It is the fi rst case of ciprofloxacin-induced VBDS successfully treated with tacrolimus. This case reminds physicians of the importance of drug reactions, their severity, techniques for diagnosis and methods of management. 展开更多
关键词 Stevens-Johnson syndrome Vanishing bileduct syndrome Ciprofloxacin Tacrolimus
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0.025-inch vs 0.035-inch guide wires for wire-guided cannulation during endoscopic retrograde cholangio pancreatography:A randomized study 认领 引用 被引量：1
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作者 Katsuya Kitamura Akira Yamamiya +5 位作者 Yu Ishii Yoshiki Sato Tomoyuki Iwata Tomohiro Nomoto Akitoshi Ikegami Hitoshi Yoshida 《World Journal of Gastroenterology》 SCIE CAS 2015年第30期9182-9188,共7页
AIM:To compare the clinical outcomes between 0.025-inch and 0.035-inch guide wires(GWs) when used in wire-guided cannulation(WGC).METHODS:A single center,randomized study was conducted between April 2011 and March 201... AIM:To compare the clinical outcomes between 0.025-inch and 0.035-inch guide wires(GWs) when used in wire-guided cannulation(WGC).METHODS:A single center,randomized study was conducted between April 2011 and March 2013. This study was approved by the Medical Ethics Committee at our hospital. Informed,written consent was obtained from each patient prior to study enrollment. Three hundred and twenty-two patients with a na?ve papilla of Vater who underwent endoscopic retrograde cholangiopancreatography(ERCP) for the purpose of selective bile duct cannulation with WGC were enrolled in this study. Fifty-three patients were excluded based on the exclusion criteria,and 269 patients were randomly allocated to two groups by a computer and analyzed:the 0.025-inch GW group(n = 109) and the 0.035-inch GW group(n = 160). The primary endpoint was the success rate of selective bile duct cannulation with WGC. Secondary endpoints were the success rates of the pancreatic GW technique and precutting,selective bile duct cannulation time,ERCP procedure time,the rate of pancreatic duct stent placement,the final success rate of selective bile duct cannulation,andthe incidence of post-ERCP pancreatitis(PEP).RESULTS:The primary success rates of selective bile duct cannulation with WGC were 80.7%(88/109) and 86.3%(138/160) for the 0.025-inch and the 0.035-inch groups,respectively(P = 0.226). There were no statistically significant differences in the success rates of selective bile duct cannulation using the pancreatic duct GW technique(46.7% vs 52.4% for the 0.025-inch and 0.035-inch groups,respectively; P = 0.884) or in the success rates of selective bile duct cannulation using precutting(66.7% vs 63.6% for the 0.025-inch and 0.035-inch groups,respectively; P = 0.893). The final success rates for selective bile duct cannulation using these procedures were 92.7%(101/109) and 97.5%(156/160) for the 0.025-inch and 0.035-inch groups,respectively(P = 0.113). There were no significant differences in selective bile duct cannulation time(median ± interquartile range:3.7 ± 13.9 min vs 4.0 ± 11.2 min for the 0.025-inch and 0.035-inch groups,respectively; P = 0.851),ERCP procedure time(median ± interquartile range:32 ± 29 min vs 30 ± 25 min for the 0.025-inch and 0.035-inch groups,respectively; P = 0.184) or in the rate of pancreatic duct stent placement(14.7% vs 15.6% for the 0.025-inch and 0.035-inch groups,respectively; P = 0.832). The incidence of PEP was 2.8%(3/109) and 2.5%(4/160) for the 0.025-inch and 0.035-inch groups,respectively(P = 0.793).CONCLUSION:The thickness of the GW for WGC does not appear to affect either the success rate of selective bile duct cannulation or the incidence of PEP. 展开更多
关键词 Endoscopic retrograde cholangiopancreatography Guide wire Post-endoscopic retrogradecholangiopancreatography pancreatitis Selective bileduct cannulation Wire-guided cannulation
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腹腔镜联合纤维胆道镜与常规开腹术式治疗胆囊并胆总管结石的临床对比 认领 引用 被引量：16
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作者 程利民 刘洋 +2 位作者 孙志德 刘淑敏 张学军 《世界华人消化杂志》 CAS 2016年第8期1264-1268,共5页
目的:探讨腹腔镜联合纤维胆道镜与常规开腹术式治疗胆囊并胆总管结石临床效果及安全性差异.方法:回顾性分析承德医学院附属医院普外科2014-05/2015-05收治胆囊并胆总管结石患者共140例临床资料,其中行常规开腹术式治疗72例设为对照组,... 目的:探讨腹腔镜联合纤维胆道镜与常规开腹术式治疗胆囊并胆总管结石临床效果及安全性差异.方法:回顾性分析承德医学院附属医院普外科2014-05/2015-05收治胆囊并胆总管结石患者共140例临床资料,其中行常规开腹术式治疗72例设为对照组,行腹腔镜联合纤维胆道镜术式治疗68例设为试验组;比较两组患者结石清除率,手术时间,术中出血量、术后首次排气时间、住院时间,镇痛药物使用率及术后并发症发生率等.结果:两组患者结石清除率比较差异无显著性意义(P>0.05);试验组患者手术时间、术中出血量、术后首次排气时间及住院时间均显著优于对照组,差异有显著性意义(P<0.05),试验组患者术后镇痛药物使用率和患者术后并发症发生率显著低于对照组,差异有显著性意义(P<0.05).结论:相较于常规开腹术式,腹腔镜联合纤维胆道镜术式治疗胆囊并胆总管结石具有微创、操作简便及术后恢复快等优势,有助于缓解术后疼痛和降低术后并发症发生风险. 展开更多
关键词 腹腔镜 纤维胆道镜 开腹 胆囊结石 胆总管结石
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手术切除肝内胆管细胞癌预后相关因素分析 认领 引用 被引量：9
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作者 李书红 王俊 +2 位作者 张金野 崔伯康 李升平 《中华肿瘤防治杂志》 CAS 2011年第24期1956-1959,共4页
目的:探讨手术切除肝内胆管细胞癌(ICC)患者的预后影响因素。方法:回顾性分析1999-07-2009-07中山大学肿瘤防治中心接受手术切除且经病理确诊的59例ICC患者的临床病理资料。Kaplan-Meier法计算生存率,Log-rank法进行各组间的生存比较;Co... 目的:探讨手术切除肝内胆管细胞癌(ICC)患者的预后影响因素。方法:回顾性分析1999-07-2009-07中山大学肿瘤防治中心接受手术切除且经病理确诊的59例ICC患者的临床病理资料。Kaplan-Meier法计算生存率,Log-rank法进行各组间的生存比较;Cox回归模型进行多因素分析。结果:59例患者中R0切除者30例(50.8%),R1+R2切除者29例(49.2%)。R0切除组和R1+R2切除组的中位生存期分别为41.0和12.3个月,R0切除组中位生存期明显高于R1+R2切除组,χ2=9.262,P=0.002。Cox多因素回归分析提示,手术切缘(RR=3.358;95%CI为1.644～6.858;P=0.001)及术前CA19-9>35 U/mL(RR=2.505;95%CI为1.188～5.283;P=0.016)为ICC患者术后生存的独立预后因素。CA19-9>35U/mL(RR=3.266;95%CI为1.019～10.469;P=0.046)、肝硬化(RR=3.072;95%CI为1.125～8.386;P=0.029)和肿瘤邻近器官侵犯(RR=5.518;95%CI为1.054～28.889;P=0.043)是R0切除术后复发的独立预后因素。结论:手术切除患者术前CA19-9>35U/mL是影响生存的危险因素,R0切除是延长ICC患者生存期的治疗手段。术前血清CA19-9>35U/mL、肝硬化、肿瘤侵犯邻近器官是R0切除患者术后复发的危险因素。 展开更多
关键词 胆管肿瘤 手术切除 预后 回顾性研究
胆管癌组织CIP2A和Survivin蛋白表达及其与预后相关性的探讨 认领 引用 被引量：9
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作者 许鹏 黄强 +2 位作者 刘臣海 谢放 邵峰 《中华肿瘤防治杂志》 CAS 2011年第24期1933-1937,共5页
目的:探讨胆管癌组织蛋白磷酸酶2A的癌性抑制因子(CIP2A)和Survivin蛋白的表达情况及其临床意义。方法:采用免疫组织化学方法,检测57例胆管癌组织和23例癌旁正常胆管组织中CIP2A和Survivin蛋白的表达情况,采用SPSS 13.0软件分析CIP2A和S... 目的:探讨胆管癌组织蛋白磷酸酶2A的癌性抑制因子(CIP2A)和Survivin蛋白的表达情况及其临床意义。方法:采用免疫组织化学方法,检测57例胆管癌组织和23例癌旁正常胆管组织中CIP2A和Survivin蛋白的表达情况,采用SPSS 13.0软件分析CIP2A和Sur-vivin蛋白表达与临床特征的关系以及可能对生存的影响。结果:在胆管癌组织中CIP2A和Survivin蛋白表达均高于癌旁正常胆管组织,差异有统计学意义,P0.05;Survivin蛋白的表达与胆管癌组织的分化程度、TNM分期和淋巴结转移有关,P<0.05。Kaplan-Meier生存分析表明,CIP2A和Survivin蛋白阳性表达组患者的总体生存时间短于阴性表达患者组,差异有统计学意义,P<0.05;Cox多因素回归分析显示,CIP2A和Survivin蛋白表达是胆管癌患者预后的独立因素,P<0.05。结论:胆管癌组织中CIP2A和Survivin的表达存在正相关,CIP2A和Survivin蛋白表达可能是胆管癌生存的独立影响因子。 展开更多
关键词 胆管肿瘤 CIP2A Survivn 免疫组织化学
晚期恶性梗阻性黄疸的姑息性治疗 认领 引用 被引量：5
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作者 余立权 张道权 +3 位作者 姜波 陈江明 谢胜学 耿小平 《外科理论与实践》 2015年第2期121-125,共5页
目的:分析晚期恶性梗阻性黄疸的三种姑息性引流方法的临床疗效。方法 :回顾性分析我院2010年3月至2012年7月58例晚期恶性梗阻性黄疸病人的临床资料。按照治疗方法分为3组:胆肠内引流组16例,经皮肝穿刺胆管支架置入(percutaneous transhe... 目的:分析晚期恶性梗阻性黄疸的三种姑息性引流方法的临床疗效。方法 :回顾性分析我院2010年3月至2012年7月58例晚期恶性梗阻性黄疸病人的临床资料。按照治疗方法分为3组:胆肠内引流组16例,经皮肝穿刺胆管支架置入(percutaneous transhepatic biliary stent,PTBS)组18例,内镜胆管金属支架引流(endoscopic bile duct metal stents drainage,EBMSD)组24例。观察3组治疗前后的血胆红素、丙氨酸转氨酶水平,并随访生存时间。结果:引流1周后,3组总胆红素及直接胆红素水平均较术前明显下降(P0.05),3组间谷氨酸转氨酶等肝功能指标恢复情况及生存时间无统计学差异(P>0.05)。胆肠内引流组术后胃肠道功能恢复时间较另两组明显延长(P<0.05),EBMSD组术后并发症发生率较另外两组更低。结论:相对于传统开腹胆肠内引流术,EBMSD和PTBS具有微创及全身情况恢复快等优点,但PTBS由于其并发症发生率相对较高,可在内镜治疗失败后考虑应用。EBMSD治疗的适应证广,并发症发生率低。 展开更多
关键词 梗阻性黄疸 胆汁引流 经皮肝穿刺胆管支架置入术 内镜胆管金属支架引流术
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腹腔镜胆道探查术对胆囊结石合并胆总管结石的疗效及安全性评价 认领 引用 被引量：13
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作者 李敏献 邢人伟 鲁葆春 《中国现代医生》 2014年第32期139-141,144,共3页
目的探讨腹腔镜胆道探查术在胆囊结石合并胆总管结石治疗中的临床疗效及安全性。方法 148例胆囊结石合并胆总管结石患者分别行胆囊管胆道探查术(胆囊管组,26例)、胆管切开胆道探查并胆总管一期缝合(一期缝合组,65例)和胆管切开胆道探查... 目的探讨腹腔镜胆道探查术在胆囊结石合并胆总管结石治疗中的临床疗效及安全性。方法 148例胆囊结石合并胆总管结石患者分别行胆囊管胆道探查术(胆囊管组,26例)、胆管切开胆道探查并胆总管一期缝合(一期缝合组,65例)和胆管切开胆道探查并胆总管T管引流术(T管引流组,57例),比较三组患者的手术情况、术后恢复情况及并发症发生情况。结果三组患者的手术时间(F=36.789,P<0.01)、术中出血量(F=13.467,P<0.01)、胃肠功能恢复时间(F=29.615,P<0.01)、住院天数(F=39.610,P<0.01)有显著差异;一期缝合组的手术时间(t=5.76,P<0.01)、术中出血量(t=4.71,P<0.01)、胃肠功能恢复时间(t=6.78,P<0.01)、住院天数(t=9.94,P<0.01)均小于T管引流组;住院费用高于T管引流组(t=15.78,P<0.01)。结论经胆囊管途径的腹腔镜胆道探查术的临床疗效优于腹腔镜下胆管切开后一期缝合和T管引流术。 展开更多
关键词 腹腔镜胆道探查术 胆囊结石 胆总管结石
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经皮穿肝经口腔双途径联合支架置入治疗胆管和十二指肠恶性梗阻 认领 引用 被引量：3
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作者 张希全 刘长伟 +4 位作者 王胜强 潘晓琳 董戈 朱伟 郭锋 《放射学实践》 2007年第5期514-517,共4页
目的：探讨胆管和十二指肠恶性梗阻双途径联合支架置入介入治疗的方法和效果。方法：23例胆管和十二指肠恶性梗阻,17例先经皮肝穿刺置入金属支架解除胆管梗阻,出现十二指肠梗阻后,再在X线透视下,经口腔置入记忆合金网状十二指肠内支架。... 目的：探讨胆管和十二指肠恶性梗阻双途径联合支架置入介入治疗的方法和效果。方法：23例胆管和十二指肠恶性梗阻,17例先经皮肝穿刺置入金属支架解除胆管梗阻,出现十二指肠梗阻后,再在X线透视下,经口腔置入记忆合金网状十二指肠内支架。6例因胆管与十二指肠恶性梗阻并存,先置入十二指肠内支架并同时置入胆管支架。测定术前、术后血清总胆红素水平及体重并进行t检验。结果：23例患者双途径联合支架置入成功后,术前、术后血清总胆红素水平及体重比较差异均有显著性意义（P〈0.05）。十二指肠支架置入后,消化道梗阻症状迅即解除,当日即能进食,均无严重并发症发生。随访1～20个月进食情况均良好。结论：经皮肝穿经口腔双途径联合支架置入治疗胆管和十二指肠恶性梗阻是首选的有效治疗方法。 展开更多
关键词 胆管 十二指肠 梗阻 支架 放射学,介入性
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True left-sided gallbladder with variations of bile duct and cholecystic vein 认领 引用
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作者 Hiromichi Ishii Akinori Noguchi +9 位作者 Mie Onishi Koji Takao Takahiro Maruyama Hiroaki Taiyoh Yasunobu Araki Takeshi Shimizu Hiroyuki Izumi Naoki Tani Masahide Yamaguchi Tetsuro Yamane 《World Journal of Gastroenterology》 SCIE CAS 2015年第21期6754-6758,共5页
A left-sided gallbladder without a right-sided round ligament,which is called a true left-sided gallbladder,is extremely rare.A 71-year-old woman was referred to our hospital due to a gallbladder polyp.Computed tomogr... A left-sided gallbladder without a right-sided round ligament,which is called a true left-sided gallbladder,is extremely rare.A 71-year-old woman was referred to our hospital due to a gallbladder polyp.Computed tomography(CT) revealed not only a gallbladder polyp but also the gallbladder located to the left of the round ligament connected to the left umbilical portion.CT portography revealed that the main portal vein diverged into the right posterior portal vein and the common trunk of the left portal vein and right anterior portal vein.CT cholangiography revealed that the infraportal bile duct of segment 2 joined the common bile duct.Laparoscopic cholecystectomy was performed for a gallbladder polyp,and the intraoperative finding showed that the cholecystic veins joined the round ligament.A true left-sided gallbladder is closely associated with several anomalies; therefore,surgeons encountering a true left-sided gallbladder should be aware of the potential for these anomalies. 展开更多
关键词 True left-sided gallbladder Infraportal bileduct of segment 2 Anomaly of the cholecystic vein Anomaly of the portal vein Laparoscopic cholecystectomy
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肝叶切除术在肝内胆管结石中的应用 认领 引用 被引量：2
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作者 孟元普 柴新群 +1 位作者 储鸿鹏 杨轩 《世界华人消化杂志》 CAS 北大核心 2014年第32期5001-5004,共4页
目的:探讨肝叶切除术(hepatic resection,HR)在肝内胆管结石(hepatolithiasis,HL)中的治疗价值.方法:回顾性分析华中科技大学同济医学院附属协和医院肝胆外科2005-06/2014-05共实施HR的130例HL病历资料.结果:肝左外叶切除术87例;左半肝... 目的:探讨肝叶切除术(hepatic resection,HR)在肝内胆管结石(hepatolithiasis,HL)中的治疗价值.方法:回顾性分析华中科技大学同济医学院附属协和医院肝胆外科2005-06/2014-05共实施HR的130例HL病历资料.结果:肝左外叶切除术87例;左半肝切除19例;肝方叶切除9例;规则性肝段切除8例;肝右叶部分切除及肝左外叶切除3例;右半肝及肝左外叶切除1例;左内叶切除3例;结石清除率为87%;发现胆管癌15例;术后结石残留13例.术后主要并发症:切口感染、胆漏、肺部感染、胸腔积液.并发肝功能衰竭死亡1例.结论:HR是治疗HL的一种安全、有效的治疗方法,充分的术前评估、合理的手术方案能够减少或避免胆道再次手术. 展开更多
关键词 肝内胆管结石 肝叶切除术 胆道再次手术
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液电碎石联合胆道镜在经胆囊管腹腔镜胆道探查术中的应用 认领 引用 被引量：1
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作者 魏晓平 田大广 +2 位作者 于恒海 王秋虹 胡明道 《世界华人消化杂志》 CAS 北大核心 2013年第28期3004-3007,共4页
目的:探讨液电碎石联合胆道镜在经胆囊管腹腔镜胆道探查术(laparoscopic transcystic common bile duct exploration,LTCBDE)中的应用技巧及效果.方法:回顾分析24例LTCBDE患者临床资料,术前均经磁共振胰胆管成像(magnetic resonance cho... 目的:探讨液电碎石联合胆道镜在经胆囊管腹腔镜胆道探查术(laparoscopic transcystic common bile duct exploration,LTCBDE)中的应用技巧及效果.方法:回顾分析24例LTCBDE患者临床资料,术前均经磁共振胰胆管成像(magnetic resonance cholangiopancreatography,MRCP)确诊胆囊结石合并胆管结石,胆管结石直径≥1.6 cm,记录手术时间,住院时间及术后并发症发生率.结果:手术均获成功,无1例中转开腹.手术时间75-210 min,住院时间3-7 d,1例(4.2%)发生胆管残余结石,自行排出.结论:液电碎石联合胆道镜应用于LTCBDE可在具备适应症情况下安全有效处理较大胆管结石,是治疗胆管结石较好方法之一. 展开更多
关键词 液电碎石 胆道镜 经胆囊管腹腔镜胆道探查
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消化系统神经内分泌肿瘤的诊断和治疗现状 认领 引用 被引量：10
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作者 黄颖秋 《世界华人消化杂志》 CAS 2016年第17期2625-2636,共12页
神经内分泌肿瘤(neuroendocrine neoplasm,NEN)是一组起源于肽能神经元和神经内分泌细胞、生物学行为呈多样性表现的少见异质性肿瘤.近年来,NEN的发病率呈上升趋势,其主要来源于胰腺和胃肠道.嗜铬粒素A(chromogranin A,CgA)已作为NEN重... 神经内分泌肿瘤(neuroendocrine neoplasm,NEN)是一组起源于肽能神经元和神经内分泌细胞、生物学行为呈多样性表现的少见异质性肿瘤.近年来,NEN的发病率呈上升趋势,其主要来源于胰腺和胃肠道.嗜铬粒素A(chromogranin A,CgA)已作为NEN重要的肿瘤标志物.CgA的组织病理学阳性结果以及胃泌素、胰岛素原、血管活性肠肽(vasoactive intestinal peptide,VIP)、胰高糖素等特异性激素检测可作为NEN的病理和定性诊断依据.此外,计算机断层扫描(computed tomography,CT)、正电子发射计算机断层扫描(positron emission tomography/computed tomography,PET/CT)、磁共振成像(magnetic resonance imaging,MRI)、超声(ultrasound,US)、超声内镜(endoscopic ultrasound,EUS)、生长抑素受体闪烁成像(somatostatin receptor scintigraphy,SRS)等技术也用于NEN的定位诊断.外科手术仍是NEN的首选治疗.本文结合2010年第4版《世界卫生组织(WHO)消化系统肿瘤分类》对NEN的命名、分类和分级修订标准以及2013年中国临床肿瘤学会(Chinese Society of Clinical Oncology,CSCO)对胃肠胰NEN(gastroenteropancreatic neuroendocrine neoplasm,GEP-NEN)的诊治共识意见,对近年来消化系统NEN的诊断和治疗进展,包括原发性食管NEN、胃NEN、十二指肠NEN、小肠NEN、阑尾NEN、结肠NEN、直肠NEN、肝脏NEN、胆囊NEN、肝外胆管NEN、胰腺NEN进行了详尽阐述. 展开更多
关键词 胃肠神经内分泌肿瘤 肝脏神经内分泌肿瘤 胆囊神经内分泌肿瘤 胆管神经内分泌肿瘤 胰腺神经内分泌肿瘤 诊断 治疗
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超声和CT诊断胆道梗阻的对比研究 认领 引用 被引量：1
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作者 杨瑞敏 崔书君 +3 位作者 刘昭 康燕华 舒丽莎 李卫东 《张家口医学院学报》 2001年第2期36-38,共3页
目的:探讨多普勒与CT在胆道梗阻诊断中的价值。方法:60例胆道梗阻患者分别经多普勒与CT检查。结果:对梗阻部位的诊断,CT与多普勒无明显差异,在写性方面二者有一定的区别。结论:多普勒时胆道结石及良性病变所致梗阻方面优于CT,在胰头病... 目的:探讨多普勒与CT在胆道梗阻诊断中的价值。方法:60例胆道梗阻患者分别经多普勒与CT检查。结果:对梗阻部位的诊断,CT与多普勒无明显差异,在写性方面二者有一定的区别。结论:多普勒时胆道结石及良性病变所致梗阻方面优于CT,在胰头病变的诊断中CT较佳。 展开更多
关键词 超声检查 多普勒 CT 胆道 梗阻
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胆管扩张综合征患者行胆胰共通道冲洗的临床效果分析 认领 引用
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作者 黄锐 伍刚 蒋佶朋 《西部医学》 2013年第3期434-435,共2页
目的探讨利用胆胰共通道冲洗治疗先天性胆管扩张综合征患者的临床效果。方法回顾性分析2006年3月至2010年1月治疗的92例胆管扩张综合征患者治疗情况。对照组46例行扩张胆总管、胆囊切除和肝总管空肠Roux-en-Y吻合;观察组46例在此基础上... 目的探讨利用胆胰共通道冲洗治疗先天性胆管扩张综合征患者的临床效果。方法回顾性分析2006年3月至2010年1月治疗的92例胆管扩张综合征患者治疗情况。对照组46例行扩张胆总管、胆囊切除和肝总管空肠Roux-en-Y吻合;观察组46例在此基础上对胆管狭窄者加做胆管成形术并行胆胰共通道冲洗;所有患者均采用时序分组进行研究。结果观察组患者术后腹痛、黄疸等胆道感染情况明显好于对照组(P<0.05),随访半年黄疸无复发,远期疗效较好。结论在标准治疗的基础上对患者肝内胆管狭窄进行成形治疗并冲洗胆胰共通道,对降低术后并发症及提高远期疗效具有重要意义。 展开更多
关键词 先天性胆管扩张症 肝内胆管扩张 肝内胆管狭窄
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肝门部胆管癌切除术不同手术方式的选择 认领 引用
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作者 李建国 李辉 +2 位作者 林志川 蔡铭智 韩明瑞 《中国现代手术学杂志》 2005年第5期327-329,共3页
目的探讨肝门部胆管癌切除术不同手术方式的选择. 方法近五年来我院共收治肝门部胆管癌25例,其中手术切除17例,切除率为68%,参照Bismuth-Corlette分型选择不同的手术方式,包括Ⅰ型(肝总管癌)5例,Ⅱ型(汇合部肝管癌)3例,Ⅲa型(肝总管、... 目的探讨肝门部胆管癌切除术不同手术方式的选择. 方法近五年来我院共收治肝门部胆管癌25例,其中手术切除17例,切除率为68%,参照Bismuth-Corlette分型选择不同的手术方式,包括Ⅰ型(肝总管癌)5例,Ⅱ型(汇合部肝管癌)3例,Ⅲa型(肝总管、右肝管癌)4例,Ⅲb型(肝总管、左肝管癌)4例,Ⅳ型(左或右肝管癌侵犯二级以上肝管)1例. 结果术后发生胆漏5例,均于手术后5～30 d自愈;发生膈下感染2例, 经引流治愈;术后出血2例, 其中1例因出现肝衰、DIC死亡,1例经用止血药、输血后痊愈.目前存活7例,平均生存25(12～42)个月.全组病例1、2、3年生存率分别为75.0%(12/16)、31.2%(5/16)、25.0%(4/16).结论肝门部胆管癌手术根治性切除应根据肿瘤的分型选择不同的术式. 展开更多
关键词 胆管肿瘤
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缺血再灌注后胆管上皮细胞凋亡和bcl-2/bax的表达及意义 认领 引用 被引量：2
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作者 徐文辉 蔡方刚 +1 位作者 叶启发 夏穗生 《中国现代医学杂志》 CAS 北大核心 2005年第1期61-63,共3页
目的探讨肝脏经不同时间热缺血再灌注后胆管上皮细胞的凋亡和bcl-2/bax的表达及意义。方法以大鼠肝脏原位缺血再灌注为模型,经15、30和60 min缺血再灌注6 h后取材,用TUNEL法原位检测胆管上皮细胞的凋亡,免疫组织化学方法检测bcl-2/bax... 目的探讨肝脏经不同时间热缺血再灌注后胆管上皮细胞的凋亡和bcl-2/bax的表达及意义。方法以大鼠肝脏原位缺血再灌注为模型,经15、30和60 min缺血再灌注6 h后取材,用TUNEL法原位检测胆管上皮细胞的凋亡,免疫组织化学方法检测bcl-2/bax在胆管上皮细胞中的表达。结果随着缺血时间延长,经再灌注后发生凋亡的胆管上皮细胞逐渐增多,bcl-2/bax蛋白表达指数呈进行性降低,bax则随凋亡细胞的增多表达增强。结论热缺血再灌注损伤引起胆管上皮细胞的凋亡,并随缺血时间的延长而加重,bcl-2/bax凋亡基因介导了缺血再灌注后损伤引起的胆管上皮细胞的凋亡,bcl-2对细胞凋亡具有抑制作用。 展开更多
关键词 缺血再灌注损伤 胆管上皮细胞 bcl-2/bax
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