目的 探讨饮食干预对内镜胆管内引流(ERBD)术后单猪尾胆管支架脱落的影响。方法 前瞻性选择2022年1月至2023年12月同济大学附属东方医院胆石病中心因胆总管结石行内镜逆行胰胆管造影(ERCP)取石及ERBD置入7 Fr 5cm单猪尾胆管支架治疗的...目的 探讨饮食干预对内镜胆管内引流(ERBD)术后单猪尾胆管支架脱落的影响。方法 前瞻性选择2022年1月至2023年12月同济大学附属东方医院胆石病中心因胆总管结石行内镜逆行胰胆管造影(ERCP)取石及ERBD置入7 Fr 5cm单猪尾胆管支架治疗的患者作为研究对象,术后对病区A的患者进行饮食干预(试验组,n=209),病区B的患者采取常规饮食干预(对照组,n=106),比较两组患者餐后腹痛发生率、不同时间段支架脱落率、并发症发生率、残石率。结果 试验组餐后腹痛发生率低于对照组[6.22%(13/209) vs 25.47%(27/106)],差异有统计学意义(P<0.001)。试验组术后单猪尾胆管支架总脱落率高于对照组[86.60%(181/209) vs 85.85%(91/106),P=0.854],其中试验组术后1~2 d支架脱落率低于对照组[4.78%(10/209) vs 12.26%(13/106),P=0.016],术后3~7 d支架脱落率低于对照组[27.14%(54/199) vs38.71%(36/93),P=0.046],但术后8~30 d支架脱落率高于对照组[80.69%(117/145) vs 73.68%(42/57),P=0.274]。试验组术后早期并发症发生率低于对照组[4.69%(3/64) vs 18.37%(9/49),P=0.022],术后晚期并发症发生率也低于对照组[4.83%(7/145) vs 5.26%(3/57),P=0.898]。试验组术后残石率低于对照组[0.96%(2/209) vs 7.55%(8/106),P=0.002]。结论 特定的饮食干预能显著降低内镜胆管内引流术后单猪尾胆管支架早期脱落率、近远期并发症发生率及残石率,符合快速康复护理理念。展开更多
Endoscopic ultrasound(EUS)-guided biliary drainage has emerged as a minimally invasive alternative to percutaneous and surgical interventions for patients with biliary obstruction who had failed endoscopic retrograde ...Endoscopic ultrasound(EUS)-guided biliary drainage has emerged as a minimally invasive alternative to percutaneous and surgical interventions for patients with biliary obstruction who had failed endoscopic retrograde cholangiopancreatography(ERCP).EUSguided biliary drainage has become feasible due to the development of large channel curvilinear therapeutic echo-endoscopes and the use of real-time ultrasound and fluoroscopy imaging in addition to standard ERCP devices and techniques.EUS-guided biliary drainage is an attractive option because of its minimally invasive,single step procedure which provides internal biliary decompression.Multiple investigators have reported high success and low complication rates.Unfortunately,high quality prospective data are still lacking.We provide detailed review of the use of EUS for biliary drainage from the perspective of practicing endoscopists with specific focus on the technical aspects of the procedure.展开更多
Endosonography-guided biliary drainage (ESBD) is a new method enabling internal drainage of an obstructed bile duct. However,the histological conditions associated with fistula development via the duodenum to the bile...Endosonography-guided biliary drainage (ESBD) is a new method enabling internal drainage of an obstructed bile duct. However,the histological conditions associated with fistula development via the duodenum to the bile duct have not been reported. We performed ESBD 14 d preoperatively in a patient with an ampullary carcinoma and histologically confirmed changes in and around the fistula. The female patient developed no complications relevant to ESBD. Levels of serum bilirubin and hepatobiliary enzymes declined quickly,and pancreatoduodenectomy was carried out uneventfully. The resected specimen was sliced and stained with hematoxylin-eosin. Histological evaluation of the puncture site in the duodenum and bile-duct wall,and the sinus tract revealed no hematoma,bile leakage,or abscess in or around the sinus tract. Little sign of granulation,fibrosis,and inflammatory cell infiltration was observed. Although further large-scale confirmatory studies are needed,the findings here may encourage more active use of ESBD as a substitute for percutaneous transhepatic drainage in cases with failed/difficult endoscopic biliary stenting.展开更多
In this case report we present an elderly patient who was referred to our hospital with recurrent episodes of cholangitis that persisted after placement of fi ve metal stents for a distal common bile duct(CBD) stenosi...In this case report we present an elderly patient who was referred to our hospital with recurrent episodes of cholangitis that persisted after placement of fi ve metal stents for a distal common bile duct(CBD) stenosis.All metal stents were endoscopically removed from the CBD by forceps after balloon dilatation of the papilla.A profoundly dilated CBD with sludge and concrements was seen.To ensure adequate bile drainage an enteral metal stent was inserted in the CBD.This case shows that proximally migrated uncovered metal stents in the CBD can be safely removed endoscopically under certain circumstances.We suggest that in the case of a CBD drainage problem due to an extremely dilated CBD,placement of an enteral metal stent in the CBD could be considered,especially in patients who are unfi t for surgery.展开更多
文摘目的 探讨饮食干预对内镜胆管内引流(ERBD)术后单猪尾胆管支架脱落的影响。方法 前瞻性选择2022年1月至2023年12月同济大学附属东方医院胆石病中心因胆总管结石行内镜逆行胰胆管造影(ERCP)取石及ERBD置入7 Fr 5cm单猪尾胆管支架治疗的患者作为研究对象,术后对病区A的患者进行饮食干预(试验组,n=209),病区B的患者采取常规饮食干预(对照组,n=106),比较两组患者餐后腹痛发生率、不同时间段支架脱落率、并发症发生率、残石率。结果 试验组餐后腹痛发生率低于对照组[6.22%(13/209) vs 25.47%(27/106)],差异有统计学意义(P<0.001)。试验组术后单猪尾胆管支架总脱落率高于对照组[86.60%(181/209) vs 85.85%(91/106),P=0.854],其中试验组术后1~2 d支架脱落率低于对照组[4.78%(10/209) vs 12.26%(13/106),P=0.016],术后3~7 d支架脱落率低于对照组[27.14%(54/199) vs38.71%(36/93),P=0.046],但术后8~30 d支架脱落率高于对照组[80.69%(117/145) vs 73.68%(42/57),P=0.274]。试验组术后早期并发症发生率低于对照组[4.69%(3/64) vs 18.37%(9/49),P=0.022],术后晚期并发症发生率也低于对照组[4.83%(7/145) vs 5.26%(3/57),P=0.898]。试验组术后残石率低于对照组[0.96%(2/209) vs 7.55%(8/106),P=0.002]。结论 特定的饮食干预能显著降低内镜胆管内引流术后单猪尾胆管支架早期脱落率、近远期并发症发生率及残石率,符合快速康复护理理念。
文摘Endoscopic ultrasound(EUS)-guided biliary drainage has emerged as a minimally invasive alternative to percutaneous and surgical interventions for patients with biliary obstruction who had failed endoscopic retrograde cholangiopancreatography(ERCP).EUSguided biliary drainage has become feasible due to the development of large channel curvilinear therapeutic echo-endoscopes and the use of real-time ultrasound and fluoroscopy imaging in addition to standard ERCP devices and techniques.EUS-guided biliary drainage is an attractive option because of its minimally invasive,single step procedure which provides internal biliary decompression.Multiple investigators have reported high success and low complication rates.Unfortunately,high quality prospective data are still lacking.We provide detailed review of the use of EUS for biliary drainage from the perspective of practicing endoscopists with specific focus on the technical aspects of the procedure.
文摘Endosonography-guided biliary drainage (ESBD) is a new method enabling internal drainage of an obstructed bile duct. However,the histological conditions associated with fistula development via the duodenum to the bile duct have not been reported. We performed ESBD 14 d preoperatively in a patient with an ampullary carcinoma and histologically confirmed changes in and around the fistula. The female patient developed no complications relevant to ESBD. Levels of serum bilirubin and hepatobiliary enzymes declined quickly,and pancreatoduodenectomy was carried out uneventfully. The resected specimen was sliced and stained with hematoxylin-eosin. Histological evaluation of the puncture site in the duodenum and bile-duct wall,and the sinus tract revealed no hematoma,bile leakage,or abscess in or around the sinus tract. Little sign of granulation,fibrosis,and inflammatory cell infiltration was observed. Although further large-scale confirmatory studies are needed,the findings here may encourage more active use of ESBD as a substitute for percutaneous transhepatic drainage in cases with failed/difficult endoscopic biliary stenting.
文摘In this case report we present an elderly patient who was referred to our hospital with recurrent episodes of cholangitis that persisted after placement of fi ve metal stents for a distal common bile duct(CBD) stenosis.All metal stents were endoscopically removed from the CBD by forceps after balloon dilatation of the papilla.A profoundly dilated CBD with sludge and concrements was seen.To ensure adequate bile drainage an enteral metal stent was inserted in the CBD.This case shows that proximally migrated uncovered metal stents in the CBD can be safely removed endoscopically under certain circumstances.We suggest that in the case of a CBD drainage problem due to an extremely dilated CBD,placement of an enteral metal stent in the CBD could be considered,especially in patients who are unfi t for surgery.
