急性胆源性胰腺炎内镜治疗作用的探讨

目的:探讨内镜对急性胆源性胰腺炎的诊治作用。方法:收集1997年经内镜诊治的急性胆源性胰腺炎患者20例,并以同时期作保守治疗或手术治疗的15例患者作对照。结果:ERCP操作成功率为85％,对胆源性胰腺炎的诊断准确率为100％,呵同时采用Oddi括约肌切开、取石和/或置鼻胆管引流。治疗成功率为100％。内镜治疗减少了胰腺炎并发症发生率和患者住院天数,降低医疗费用。结论:内镜是胆源性胰腺炎的最佳诊治手段。     

腹腔镜胆囊切除联合胆总管切开取石T管引流术治疗胆囊结石合并胆总管结石术后复发率及影响因素

目的探讨腹腔镜胆囊切除联合胆总管切开取石T管引流术治疗胆囊结石合并胆总管结石术后复发情况及影响因素。方法对310例胆囊结石合并胆总管结石患者行腹腔镜胆囊切除联合胆总管切开取石T管引流术治疗,术后随访1 a统计复发率,采用单因素分析及多因素Logistic回归分析探讨术后结石复发影响因素。结果入组患者术后结石复发率为4.8%,单因素分析显示,年龄≥60岁、结石数目≥10个、胆总管直径<15 mm、胆总管扩张、胆囊管扩张、碎石术治疗、合并胆管或胰腺炎症、术后饮食不合理的患者术后复发率更高(P<0.05或0.01);多因素Logistic回归分析显示,结石数目、胆总管直径、胆总管扩张、胆囊管扩张、碎石术、合并胆管或胰腺炎症是术后结石复发的影响因素(P<0.01)。结论腹腔镜胆囊切除联合胆总管切开取石T管引流术治疗胆囊结石合并胆总管结石术后复发率略高,其影响因素众多,临床应根据患者情况予以有针对性的干预措施预防复发。     

胆囊5-羟色胺3受体功能受损在胆囊结石形成中的作用

目的 通过5-羟色胺(5-HT)和恩丹西酮观察胆囊结石惠者胆囊平滑肌5-羟色胺3受体(5-HT3R)功能,探讨5-HT及5-HT3R参与胆石症形成的可能机制. 方法 慢性结石性胆囊炎、正常对照胆囊各15例,5-HT作用于胆囊平滑肌条,观察收缩曲线的改变;在10-7~10-1mol/L恩丹西酮作用下,重新加入5-HT,根据恩丹西酮产生的张力变化,获得5-HT3R激动后的张力和恩丹西酮50%抑制作用的药物浓度(IC50). 结果 胆石症患者胆囊5-HT产生的最大张力小于对照组(P<0.05),而达到最大张力的时间较长;5-HT3R激动引起的收缩力显著下降(P<0.05).胆石症患者的恩丹西酮IC50较对照下降(P<0.05). 结论 慢性胆囊炎胆囊结石患者胆囊5-HT及5-HT3R系统受到损害,由此系统引发的收缩能力下降,在胆囊结石的形成和发展中起到一定的作用.     

肝细胞高密度脂蛋白受体在兔胆囊结石形成中的动态变化

采用高胆固醇膳食诱发兔胆囊胆固醇结石模型，分别对高胆固醇膳食后１、２、３、４周及对照组高密度脂蛋白受体（ Ｈ Ｄ Ｌｒ）活性，胆汁中胆汁酸及胆固醇变化进行了研究。结果发现：①高胆固醇膳食后１周肝细胞 Ｈ Ｄ Ｌｒ Ｂｍ ａｘ 明显增大而 Ｋｄ 值明显变小，与对照组相比有显著性差异（ Ｐ＜ ０．０５），２周组两者降至对照组水平，３周及４周组 Ｂｍ ａｘ 明显变小而 Ｋｄ 值明显增大，有显著性差异（ Ｐ＜ ０．０５），②１周组胆汁中总胆汁酸含量增加，２周组与对照组相近，３周组胆汁酸含量减少（ Ｐ＞ ０．０５），４周组则明显减少（ Ｐ＜ ０．０５）；③随着高胆固醇膳食进食时间增加，胆汁中胆固醇含量持续增加，３周组及４周组与对照组有显著性差异（ Ｐ＜ ０．０５）。成石中肝细胞 Ｈ Ｄ Ｌｒ 活性及胆汁中胆汁酸含量均表现为先升后降，提示肝细胞 Ｈ Ｄ Ｌｒ 活性下降可能引起 肝细胞摄取用于胆汁酸合成的底物减少，并可能在胆囊结石形成中起重要作用。     

Urgent and emergency endoscopic retrograde cholangiopancreatography for gallstone-induced acute cholangitis and pancreatitis

Urgent or emergency endoscopic retrograde cholangiopancreatography (ERCP) is indicated for gallstone-induced acute cholangitis and pancreatitis. The technique and optimal timing of ERCP depend on the disease state, its severity, anatomy, patient background, and the institutional situation. Endoscopic transpapillary biliary drainage within 24 h is recommended for moderate to severe acute cholangitis. The clinical outcomes of biliary drainage with nasobiliary drainage tube placement and plastic stent placement are comparable, and the choice is made on a case-by-case basis considering the advantages and disadvantages of each. The addition of endoscopic sphincterotomy (EST) is basically not necessary when performing drainage alone, but single-session stone removal following EST is acceptable in mild to moderate cholangitis cases without antithrombotic therapy or coagulopathy. For gallstone pancreatitis, early ERCP/EST are recommended in cases with impacted gallstones in the papilla. In some cases of gallstone pancreatitis, a gallstone impacted in the papilla has already spontaneously passed into the duodenum, and early ERCP/EST lacks efficacy in such cases, with unfavorable findings of cholangitis or cholestasis. If it is difficult to diagnose the presence of gallstones impacted in the papilla on imaging, endoscopic ultrasonography can be useful in determining the indication for ERCP.     

腹腔镜、胆道镜、胃镜三镜联合治疗胆囊结石伴胆总管结石的疗效分析

目的：探讨腹腔镜、胆道镜和胃镜三镜联合在治疗胆囊结石伴胆总管结石中的临床价值。方法：回顾性分析2019年1月—2021年12月在天津市第五中心医院普外科进行治疗的137例胆囊结石合并胆总管结石患者的临床资料。根据患者采取的手术方式，将研究对象分为三组：观察组、对照1组、对照2组。观察组采取腹腔镜、胆道镜、胃镜联合行胆囊切除、胆道探查取石+BD管引流+胆管一期缝合的治疗方式；对照1组采取腹腔镜下胆囊切除+胆总管切开胆道镜探查取石+T管引流的治疗方式；对照2组采取经内镜逆行性胰胆管造影术胆道取石+腹腔镜胆囊切除术；比较三组的相关临床指标。结果：三组在手术时间、术中出血量、术后腹引管拔管时间方面无统计学差异(P>0.05)，观察组住院时间、住院费用均低于对照组，差异有统计学意义(P <0.05)。三组单次结石取尽率差异无统计学意义。观察组腹腔感染、出血、胆漏、窦道断裂等并发症少于对照组，有统计学差异(P <0.05)。结论：对于胆囊结石合并胆总管结石患者，通过腹腔镜、胆道镜、胃镜三镜联合行胆囊切除+胆管探查取石+BD管引流+胆管一期缝合，能明显提高治疗效果，患者痛苦小，术后...     

The Natural History of Asymptomatic Gallstones: A Longitudinal Study and Prediction Model

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Gallstone Ileus with COVID‐19 Infection: An Unintended Sequela of Non‐Operative Management of Acute Cholecystitis During the COVID‐19 Pandemic

Appropriate risk stratification and careful follow‐up are mandated in elderly patients with comorbidities. Herein, we report a case presenting 5 months after the nonoperative management of acute cholecystitis during the height of the COVID‐19 pandemic.     

Gallstone ileus: A rare cause of small intestine obstruction

Gallstone ileus is a very rare cause of mechanical bowel obstruction with often‐delayed presentation and nonspecific symptoms. Aerobilia is found in approximately 50% of patients with gallstone ileus.