经胰管乳头预切开术后胰腺炎风险的回顾性分析

目的 探讨经胰管乳头预切开术是否会增加ERCP术后胰腺炎的风险.方法 比较经胰管预切开+EST组与我院同期未经胰管预切开直接行EST组术后胰腺炎的发生率.结果 经胰管乳头预切开术+EST组术后胰腺炎的发生率5.71%(2/35),EST组术后胰腺炎的发生率4.0%(19/475).两组比较无统计学差异,P＞0.05.结...     

经内镜乳头括约肌切开困难原因分析

为提高对经内镜乳头括约肌切开术（ＥＳＴ）切开困难患者的治疗水平，总结了２２１例困难ＥＳＴ患者的资料。困难的原因１８７例为乳头良性狭窄，壶腹部结石嵌顿或解剖异常，致切开刀未能插入足够的深度；３４例为乳头开口过厚或焦痂形成无法继续切开。改用自制小切开刀和针型切开刀进行治疗，效果满意。认为凡乳头不能满意插入切开刀者，应先改用短小的切开刀作逐段切开，焦痂形成者宜先用针型切开刀切开焦痂，而后再用弓型切开刀向上切开。确难以从乳头开口切开者，则改用针型切开刀作乳头开窗并扩大切开。     

内镜下乳头括约肌切开及并发症防治的体会

内镜下乳头括约肌切开术（ＥＳＴ）已广泛应用于临床,成功率达９０％以上。它可使绝大多数胆总管结石顺利排出,乳头部良恶性狭窄所致的胆总管扩张、梗阻行切开引流,胆总管和肝总管狭窄行内镜下鼻胆管引流（ＥＮＢＤ）及放置胆道内支架。具有创伤小、疗效高的优点。ＥＳ...     

内镜下针状刀乳头开窗术在乳头结石嵌顿中的应用

目的探讨内镜下针状刀乳头开窗术,又称内镜下胆管十二指肠造口术(ECDT)治疗乳头结石嵌顿的价值。方法对有乳头结石嵌顿的患者行经内镜逆行胰胆管造影(ERCP)时,应用针状刀行乳头开窗术,取出嵌顿结石。结果 49例行ECDT术,其中45例患者一次性取出嵌顿结石,取石成功率91.8%,1例先放置鼻胆管,后再次行ERCP成功取石,2例转外科手术,1例放置胆管塑料支架。其中结石直径小于12 mm的患者取石成功率高于直径大于13 mm的患者(P<0.05),而乳头开口处结石暴露患者与未见结石患者取石成功率差异无统计学意义(P>0.05)。结论乳头结石嵌顿造成乳头肿大,行ECDT术可取出嵌顿结石,成功率高,并发症少,能有效缓解症状,值得临床广泛应用。     

经内镜行乳头括约肌切开取石术的配合

内窥镜下十二指肠乳头括约肌切开术(EST)是在内镜下逆行胰胆管造影术(ERCP)的基础上，为扩大乳头胆汁流出道及取石的内镜治疗术。我们2001～2004年行EST192例，疗效较好。现总结报告如下。     

内镜下乳头切开所使用高频电刀设备的比较研究

1973年Kawai等将内镜下乳头切开术（EST）引进临床,对胰胆道系统疾病诊断治疗具很大贡献,但术后胰腺炎、出血等仍为EST早期致命性并发症,除了和术者的经验、技术,患者自身状况等有关外,还和器械有一定关系。因此近年人们开发了各种切开刀包括附导丝的切开刀,可以插入胆     

内镜下乳头切开治疗胆总管结石的长期疗效

自从1974年内镜下逆行胰胆管造影(ERCP)开展以来，ERCP和内镜下乳头切开(EST)已成为诊断和治疗胆总管结石的常用手段。EST治疗胆总管结石早期只是用于高龄及身体状况差的患者，但随着人们对于EST的疗效及并发症的认识，其应用范围已扩大到了年轻的和身体状况好的胆总管结石患者。我国EST起步较晚，不同单位开展EST的深度和广度不同，而且由于多数单位长期随访机制的不健全，国内尚无胆总管结石EST术后长期疗效的报告。     

内镜下十二指肠乳头括约肌切开取石术的护理

胆总管结石是引起胆道梗阻性黄疸及感染的原因之一，以往主要靠外科手术治疗。近年来，我院采用内镜下十二指肠乳头括约肌切开取石(Endoscopic Sphincterotomy EST)治疗胆总管结石21例，具有不开刀、创伤小、费用低、疗效高等优点，现将护理体会报告如下。     

内镜下乳头小切开加球囊扩张术治疗胆总管大结石80例

目的:探讨内镜下乳头小切开加球囊扩张术治疗胆总管大结石的有效性和安全性.方法:2010-01/2011-10我院消化内科住院行内镜下取石的胆总管结石直径>1.2cm的患者,随机分为内镜下乳头括约肌切开术(EST)组及内镜下乳头小切开加球囊扩张术(ESBD)组,每组40例.ESBD组在先行乳头小切开后行乳头球囊扩张;EST组按常规操作.结果:EST组及ESBD组分别有36例(90%)及38例(95%)成功取净结石;机械碎石网篮应用比例分别37.5%(15/40)和10%(4/40),P<0.05;取石时间分别为41.78min±10.41min和36.28min±8.64min,P<0.05;术中EST组有2例出现切开后出血,ESBD组无出血病例;EST组各有1例出现发热和腹痛患者,有2例出现胰腺炎,ESBD组有2例腹痛,无发热患者,1例出现胰腺炎.术后早期并发症总发生率分别为10%(4/40)和7.5%(3/40),P>0.05;无死亡病例.结论:对较大胆总管结石,ESBD取石有与EST取石相近的成功率,术后并发症无明显升高,但在操作时间及碎石网篮使用上,ESBD组更有优势.     

ERCP困难胆管插管时早期预切开术的应用

目的探讨预切开技术在常规ERCP插管失败病例中应用的有效性和安全性。方法回顾性分析在常规ERCP插管失败的98例病例中,应用包括电针切开术和经胰管乳头切开术在内的预切开技术完成插管,观察插管的成功率和并发症的发生率。结果常规插管失败并行预切开术的98例患者中,插管成功率为93.9%(92/98),其中行电针切开术76例,经胰管乳头切开术22例,术后胰腺炎发生率为5.1%(5/98),都为轻型胰腺炎,未发生出血、穿孔等其它严重并发症。结论预切开技术在困难ERCP中应用是安全、有效的,在常规插管失败的病例中预切开术可以显著提高插管成功率,其并发症的发生率与常规插管的发生率没有显著差异。     

乳头预切开术在内镜逆行胰胆管造影术中的应用

目的探讨乳头预切开术在内镜逆行胰胆管造影术中的应用价值。方法对标准乳头切开法不能应用的病例分别采用针状刀预切开法、犁状刀乳头预切开法和经胰管乳头预切开法。结果58例乳头预切开术中,成功53例(91.3%);出现乳头出血3例,经电凝和喷洒副肾止血,2例轻度胰腺炎经内科保守治疗后好转。结论乳头预切开术作为常规逆行胰胆管造影术和内镜下乳头括约肌切开术的补充方法,提高了ERCP的成功率,值得临床推广应用。     

Evaluation of Early Precut with Needle-Knife in Difficult Biliary Cannulation During ERCP

Background

There is scarce information on whether performing the precut procedure early rather than after several cannulation attempts is associated with different success and complication rates.

Objective

The aim of this retrospective study was is to compare the early precut technique with the standard one in terms of the results and complications.

Methods

The contemporary success rate and postoperative complications in 792 endoscopic retrograde cholangiopancreatography cases were frequently observed during the period from June 2007 to May 2011, and 56 of these cases were carried out with precut biliary sphincterotomy after the standard sphincterotomy had failed.

Results

The success rate for standard sphincterotomy was 89.8 %: 51 out of 56 cases were carried out with precut biliary sphincterotomy and succeeded. The total success rate was 96.3 %. The difference was significant (χ ² = 25.62, p < 0.01) compared to the success rate of first cannulation, while the difference in complication rates between precut and standard sphincterotomy was minor (9.9 vs. 12.5 %, p > 0.05).

Conclusion

Early precut with a needle-knife in a difficult biliary cannulation was safe and effective if performed by experienced endoscopists.     

三种心脏停搏液对心肌保护的对比研究

目的     

Precut Papillotomy: A Risky Technique Not Only for Experts but Also for Average Endoscopists Skilled in ERCP

Purpose  

To evaluate the success and complication rates of early precut papillotomy in difficult biliary cannulations performed by an average endoscopist skilled in ERCP.     

三种永久起搏电极慢性阈值的比较

为比较激素电极、靶头电极和螺旋电极的慢性阈值,并探讨其优缺点,对激素电极(26条)、靶头电极(14条)和螺旋电极(20条)的慢性阈值进行了观察。60条电极与单腔或双腔起搏器均系同一公司生产。为提高可比性,仅有5.0 V 电压输出的起搏器不作观察对象。激素电极、非激素电极分别随访18(3～60)和64(3～122)月。结果显示2.5 V 时激素电极的慢性脉宽阈值(0.07±0.03 ms)低于靶头电极(0.11±0.05 ms),后者又低于螺旋电极(0.25±0.13 ms),P 均<0.01。全部病例心房和心室感知均良好。电压输出均采用2.5 V,激素电极、靶头电极和螺旋电极起搏分别置脉宽输出于0.2,0.4和0.8 ms,则80%以上(分别为85%、86%及80%)的病例可达到能量阈值的3倍以上的安全范围。激素电极中有19条可置于1.6 V 和0.3 ms 起搏,其耗能仅为5.0V和0.5 ms(25μJ)的6.1%。即每个脉冲可节能93.9%,从而可延长起搏器的工作寿命。     

Comparison of Three Types of Precut Technique to Achieve Common Bile Duct Cannulation: A Retrospective Analysis of 274 Cases

Background

The aim of this retrospective study was to evaluate the success rate and complications of three precut techniques of sphincterotomy after failure of conventional techniques of cannulation of common bile duct (CBD).

Patients and Methods

Between January 2003 and October 2011, 2,903 consecutive ERCPs were performed in patients with na?ve major papilla. In 283 patients in whom biliary cannulation was not achieved, precut technique was performed and these patients were included in the study.

Results

A total of 274 patients were included in the final analysis. Needle-knife papillotomy (NKP) was performed in 129 cases (47.1?%), suprapapillary fistulotomy (SPF) in 78 patients (28.5?%), and transpancreatic sphincterotomy (TPS) in 67 cases (24.5?%). No significant difference was observed in the initial and eventual success rate of biliary cannulation between the three groups. Overall, complications occurred in 54 patients (19.7?%), of which 33 (25.6?%) were with NKP, 6 (7.7?%) with SPF and 15 (22.4?%) with TPS, respectively, a difference statistically significant favoring the SPF group (p?=?0.006). Post-procedure acute pancreatitis was developed in 27 cases (20.9?%) with NKP, compared to two cases (2.6?%) with SPF and 15 cases (22.4?%) with TPS, a difference statistically significant favoring the SPF group. No difference was observed between the groups with regard to the occurrence of post-procedure hemorrhage and perforation.

Conclusions

The three types of precut sphincterotomy have no different overall CBD cannulation rates; SPF reduces post-ERCP pancreatitis risk.     

Comparison between needle-knife fistulotomy and standard cannulation in ERCP

AIM:To compare the rates of success and complications of two different methods of access into the common bile duct(CBD).METHODS:Between October 2007 and November 2008,173 consecutive patients(71 men,102 women,mean age 68.6 years) requiring endoscopic retrograde cannulation of the papilla and endoscopic treatment were studied.In the first 88 patients CBD cannulation was performed through supra-papillary fistulotomy(group F);in the following 85 patients standard cannulation was performed through the Oddi sphincter(group S).Indications for the procedure were:choledocholithiasis,biliary obstruction,postoperative leak,sclerosing cholangitis,and Mirizzi’s syndrome.RESULTS:Deep CBD cannulation was successful in 85/88 patients(96.5%) in group F vs 60/85 patients(70.6%) in group S(P < 0.0001).The remaining 25 group S patients in whom cannulation failed were shifted to fistulotomy.Fistulotomy was successful in 21/25 patients(84%).As for complications,hyperamilasemia occurred in 7(7.9%) group F patients vs 7(8.2%)group S patients(P = NS);mild pancreatitis in 1(1.1%) group F patient vs 5(5.8%) group S patients(P = NS);bleeding in 3(3.4%) group F patients vs 3(3.5%) group S patients(P = NS).CONCLUSION:Needle-knife fistulotomy should represent either the first approach to therapeutic cannulation or rescue therapy after unsuccessful standard cannulation.     

酒精性肝病患者3种细胞因子变化的初步研究

目的:探讨两种前炎症细胞因子,一种促细胞生长因子在酒精性肝病中的改变。方法:用放免法检测61例酒精性肝病病人血清中的TGF-α,TNF-α,IL-1β。结果:TGF-α(23.84±17.46)pg/ml(t=9.11,P<0.01),TNF-α(1.59±0.77)ng/ml(t=2.75,P<0.05),IL-1β(0.56±0.56)ng/ml(t=4.93,P<0.01)。显著高于正常对照。胆红素升高者的TNF-α、IL-1β显著高于胆红素正常者(P<0.05)。22例病人治疗后TNF-α、IL-1β比治疗前显著降低(P<0.05),而TGF-α则略升高(21.68±21.52 vs 26.25±21.91,t=1.245,P=0.227)。结论:两种前炎症细胞因子在酒精性肝病的发生中可能起重要作用。细胞生长因子则与炎症、坏死致肝细胞再生似有一定联系。