全方位护理干预对ERCP围术期患儿及家属应激及心理状况的影响

目的探讨全方位护理干预对ERCP围术期患儿及家属应激及心理状况的影响。方法选取2018年1月10日至2019年10月10日行ERCP患儿100例,采用抽签法分为观察组及对照组各50例,分别对两组实施全方位护理及常规护理干预,观察ERCP围术期患儿应激情况和并发症发生率,对患儿家属进行焦虑和抑郁评分。结果观察组患儿轻度应激30例(60.00%)、中度应激20例(40.00%),应激程度低于对照组患儿(P<0.05);观察组患儿并发症发生率为4.00%,低于对照组患儿(P<0.05);观察组患儿家属的焦虑评分14.01±0.11、抑郁评分15.23±1.48,低于对照组患儿家属(P<0.05)。结论全方位护理干预能有效减少ERCP围术期患儿应激,降低并发症发生率,改善患儿家属负面情绪,从而促进患儿早期康复。     

柴芍四金汤预防ERCP术后胆总管结石复发的临床观察

目的 研究柴芍四金汤预防ERCP术后胆总管结石复发的临床疗效。方法 选取昆山市中医医院脾胃肝胆科2014年1月至2016年12月因胆总管结石行ERCP取石病例120例，按随机数字表法将120例病例随机分为治疗组和对照组，每组各60例，治疗组口服自拟柴芍四金汤，每日1剂，水煎400 mL，分早晚两次温服，随证加减；对照组口服熊去氧胆酸250 mg/次，3次/d，2组均连续药物治疗6月，观察术后2周血清中总胆红素（Tbil）、直接胆红素（Dbil）、碱性磷酸酶（ALP）、谷氨酰转肽酶（GGT）指标、术后半年临床症状（包括腹痛、腹胀、恶心、纳差）及术后6月、12月、18月胆总管结石复发情况。结果 治疗组术后6月、12月及18月结石复发率略低于对照组，但两者差异无统计学意义（ P >0.05）；治疗组在改善腹痛、腹胀、恶心、纳差症状方面优于对照组（ P <0.05）；治疗组在改善血清Tbil、Dbil、ALP、GGT水平方面优于对照组（ P <0.01）。结论 柴芍四金汤能有效预防ERCP术后胆总管结石的复发，且能改善胆总管结石引起的临床症状及血清生化指标。      

Cholangiocarcinoma: Clinical manifestations and diagnosis

Cholangiocarcinoma (CCA) is the most common malignancy of the biliary tract. CCA is most commonly present with perihilar tumor location, the so-called “Klatskin tumor.” However, mass-forming CCAs can also occur. The most important mimicker of CCA is IgG4-associated cholangiopathy, which can create strictures radiologically resembling CCA. Long-standing inflammatory processes in the liver and biliary tree may be involved in biliary carcinogenesis. Liver fluke infestation and oriental cholangiohepatitis are seen primarily in Asia, and increase the risk of CCA. Primary sclerosing cholangitis (PSC) is a risk factor for CCA; CCA in patients with primary sclerosing cholangitis presents 1-2 decades earlier than sporadic CCA cases. Choledochal cysts and Caroli disease are also associated with a higher incidence of CCA. Perihilar CCA can be challenging to diagnose and treat. The Bismuth-Corlette anatomical classification presents an important touchstone for planning therapy. Magnetic resonance imaging and magnetic resonance cholangiopancreatography are the most important imaging tests in the evaluation of CCA; magnetic resonance cholangiopancreatography is extremely important for treatment planning, whether by surgery, endoscopic retrograde cholangiopancreatography (ERCP) stent placement, or percutaneous drainage. ERCP can sample ductal strictures to assess for malignancy. Cytologic or histologic diagnosis is critical to plan treatment, but yields from a variety of sampling methods are often disappointing. Adjunctive labaratory testing, particularly serum CA 19-9, is commonly used to aid in diagnosis. The use of fluorescent in situ hybridization may increase sensitivity and specificity of cytologic sampling. Newer imaging techniques that can be used at ERCP may play an increased role in diagnosis of CCA in the future. Endoscopic stent placement by ERCP is a standard treatment except in those rare resectable cases.     

中药合并针刺结合西医治疗ERCP术后胰腺炎临床研究

目的：观察常规西医治疗基础上加用中药合并针刺治疗ERCP术后胰腺炎的临床疗效。方法：收集2012年1月-2015年1月期间于我院进行ERCP手术且术后出现胰腺炎的患者120例,随机数表法分为观察组和对照组,每组60例,对照组采用西医基础治疗,观察组在西医治疗的基础上,加用中药联合针刺治疗。对比两组患者的症状及体征恢复时间、生化指标恢复时间和局部并发症发生率、转外科手术率、死亡率及临床疗效。结果：相比对照组,治疗组患者的腹痛消失时间、腹胀消失时间、自主排便出现时间及住院时间均显著下降,差异具有统计学差异(t=3.028,2.894,2.743,3.244；P=0.003,0.005,0.007,0.002),而两组患者消化道出血、胰腺囊肿发生率均无显著性差异(P＞0.05),胰腺假性囊肿发生率显著降低(X₂=5.926,P=0.015)。治疗组患者血淀粉酶、C-反应蛋白、白细胞总数、碱性磷酸酶、谷氨酰转肽酶、总胆红素恢复正常值的时间均较对照组显著缩短,差异具有显著性(t=3.874,2.459,2.485,3.105,3.300,3.725；P=0.000,0.015,0.014,0.002,0.001,0.000)。结论：中西医结合治疗ERCP术后急性胰腺炎临床疗效显著,且优于单独西医治疗,建议在临床可以推广使用。