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1.
Bing Liu Max Heckler Ulrike Heger Susanne Roth Ulla Klaiber Markus W. Büchler Oliver Strobel Christoph W. Michalski Thilo Hackert 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(11):1028-1033
Background
The number of lymph nodes to be resected in surgery for non-pancreatic periampullary cancer remains unclear.Methods
The Surveillance, Epidemiology, and End Results (SEER) database was used to gather information from a large retrospective cohort. To define a novel, reasonable cut-off associated with survival, we stratified patients into subgroups depending on the number of resected lymph nodes.Results
1481 nodal-negative patients resected for periampullary cancer (excluding pancreatic ductal adenocarcinoma) were included. The median number of resected lymph nodes was ten. Median overall survival in the subgroup with less than 10 removed lymph nodes was 40 months, while median survival for patients with ≥10 lymph nodes was 97 months (p < 0.001). A significant survival benefit was seen if ≥ 16 lymph nodes were harvested (median survival, 117 months), while no further benefit was observed if more than 21 nodes were removed (median survival, >120 months).Conclusion
Sixteen or more resected lymph nodes are associated with improved survival in node-negative periampullary carcinoma. We propose to aim at harvesting and analyzing at least 16 lymph nodes. 相似文献2.
Peter J. Lee Amareshwar Podugu Dong Wu Arier C. Lee Tyler Stevens John A. Windsor 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(6):477-486
Background
Controversy remains about the best pre-operative management of jaundice in patients with resectable pancreatic head cancer (RPC) undergoing planned pancreaticoduodenectomy (PD).Objective
The aim of this study was to compare rates of post-operative complications in patients undergoing four pre-operative approaches (POA): preoperative biliary drainage with plastic stent (PBD-PS), metal stent (PBD-MS), and percutaneous transhepatic drain (PBD-PT), or no pre-operative biliary drainage (NPBD).Method
A study was included in the systematic review if it assessed the effects of PBD on post-operative outcomes in jaundiced patients with RPC. Endpoints were the rate of any post-operative complication, wound infection, intra-abdominal infection and post-operative bleeding. A network meta-analysis (NMA) was performed to rank the POAs from the best to worst, for each outcome.Results
Thirty-two studies were included in the systematic review. Ten out of 32 studies included in the systematic review reported at least one of the 4 outcomes of interest and thus were used for NMA. The calculated odds ratios and P-scores ranked NPBD as the best approach. There was insufficient evidence to determine the best modality of PBD among PBD-PS, PBD-MS and PBD-PT.Conclusions
No preoperative biliary drainage may be the best management of preoperative jaundice in patients with RPC before PD. Further studies are needed to determine the best modality in patients that need PBD. 相似文献3.
Akhil Chawla Tiffany L. Huang Andrew M. Ibrahim Jeffrey M. Hardacre Christopher Siegel John B. Ammori 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(5):398-404
Background
Pretherapy serum neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have both been identified as prognostic in pancreatic ductal adenocarcinoma (PDAC). The aim of this study was to identify the prognostic implication of pretherapy NLR and PLR in patients with resectable PDAC.Methods
Data were collected retrospectively on patients operated at our institution between 2004 and 2014. A Cox proportional hazards model was used to investigate the relationship between clinical and pathological parameters, NLR and PLR to overall survival (OS). Survival data were analyzed using the Kaplan–Meier method.Results
217 patients were analyzed with a median overall survival (OS) of 17.5 months. Factors identified as being predictive of OS by univariate analysis included age, receipt of adjuvant therapy, margin positivity, pathologic angiolymphatic invasion, T-stage, and N-stage (P < 0.05). Factors identified as being independently predictive of OS by multivariate analysis included age and angiolymphatic invasion (P < 0.05). NLR and PLR were not predictive of OS. Survival analysis demonstrated no difference in OS in patients who had high or low NLR or PLR.Discussion
Pretherapy NLR and PLR do not predict survival in patients who underwent pancreatectomy for PDAC at our institution. 相似文献4.
Khalid Khalil Sukhchain Bansal Soofiyah Ayaani James Hodson For Tai Lam Saboor Khan Jawad Ahmad John Isaac Paolo Muiesan Darius Mirza Bobby Dasari Ravi Marudanayagam Robert P. Sutcliffe Gabriele Marangoni Keith J. Roberts 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(9):848-853
Background
Blood group is reported to have an effect upon survival following pancreatoduodenectomy for pancreatic ductal adenocarcinoma. The effect of blood group is not known, however, among patients with other periampullary cancers. This study sought to review this.Methods
Data were collected for a range of factors and survival outcomes from patients treated at two centres. Those with blood groups B and AB were excluded, due to small numbers. Patient survival was compared between patients with blood groups O and A using multivariable analysis which accounted for confounding factors.Results
Among 431 patients, 235 (54.5%) and 196 (45.5%) were of blood groups A and O respectively. Baseline comparisons found a significant difference in the distribution of tumour types (p = 0.011), with blood group O patients having more ampullary carcinomas (33.2% vs 23.4%) and less pancreatic ductal adenocarcinomas (45.4 vs 61.3%) than group A. On multivariable analysis, after accounting for confounding factors including pathologic variables, survival was found to be significantly shorter in those with blood group A than group O (p = 0.047, HR 1.30 [95%CI: 1.00–1.69]).Conclusions
There is a difference in the distribution of blood groups across the different types of periampullary cancers. Survival is shorter among blood group A patients. 相似文献5.
Kim Blakely Paul J. Karanicolas Frances C. Wright Lesley Gotlib Conn 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(7):611-619
Background
Prognosis conversations between surgical oncologists and patients with pancreatic cancer are critically important and challenging. Surgeons and their patients often have discrepant understandings of prognosis despite extensive conversations. Little is known about how surgeons approach prognosis conversations with these patients; patients' experiences with these conversations are also not well understood. This qualitative study sought to better understand surgeon and patient perspectives on communication in pancreatic cancer care with a view toward improvement.Methods
Grounded theory methodology was used. Semi-structured interviews were conducted with surgical oncologists and patients who had undergone surgical resection with curative intent for periampullary cancer. Data were collected and analyzed inductively and iteratively to the point of theoretical saturation.Results
10 surgeons and 10 patients participated. Three inter-linking concepts were found to drive surgeon–patient conversations: understanding, trust and hope. Surgeons delicately and purposefully tailored information for patients, striving to deliver essential though honest, empathetic and hopeful messages. Patients desired simple, truthful explanations that demonstrated caring and fostered optimism.Conclusion
Surgeons and patients with pancreatic cancer value optimistic honesty in tailored prognosis conversations. Perceived discrepancies in surgeon–patient understanding must be contextualized within efforts to establish a sufficient understanding, high level of trust, and optimistic stance of hope. 相似文献6.
Hideo Takahashi Bora Kahramangil Emin Kose Eren Berber 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(12):1157-1162
Background
Microwave thermosphere ablation (MTA) is a new generation technology. The aim of this study was to compare the efficacy of MTA and radiofrequency ablation (RFA) in achieving local tumor control in patients with colorectal liver metastasis (CRLM).Methods
This was a retrospective study of a prospective ablation database. Fifty-four patients with 155 CRLM lesions underwent RFA and 51 patients with 121 lesions underwent MTA. Patients were managed by a multidisciplinary team. Clinical and oncologic data were analyzed. Kaplan–Meier and Cox Proportional Hazards model were used for statistical analysis.Results
Demographics were similar between the two groups. Total ablation and operative times were significantly shorter in MTA group (19 vs. 37 mins, p < 0.001, 154 vs. 202 mins, p = 0.009). With a similar hospital stay (median 1), 90-day morbidity was similar (8 vs. 10%, p = 0.848), without mortality. Local recurrence (LR) rate per lesion was 20% in RFA and 10% in MTA group (p = 0.020). On Cox Proportion Hazards model, ablation modality and tumor size were independent predictors of LR.Conclusions
This is the first study comparing the efficacy of RFA and MTA on CRLM. The results suggest that compared to RFA, MTA improves local tumor control, while significantly shortening operative time. 相似文献7.
Yiyin Chen Marjorie Funk Jia Wen Xianghua Tang Guixiang He Hong Liu 《Heart & lung : the journal of critical care》2018,47(1):24-31
Background
Multidisciplinary disease management programs (MDMP) for patients with heart failure (HF) have been delivered, but evidence of their effectiveness in China is limited.Objective
To determine if a MDMP improves quality of life (QoL), physical performance, depressive symptoms, self-care behaviors and mortality or rehospitalization in patients with HF in China.Methods
This is a randomized controlled single center trial in which patients with HF received either MDMP with discharge education, physical training, follow-up visits and telephone calls for 180 days (n = 31) or standard care (SC, n = 31).Results
Compared with SC, QoL, depressive symptoms, and self-care behaviors were significantly improved by MDMP from baseline to 180 days (37% vs 66%, 20% vs 61%, and 8% vs 33%, respectively, all p < 0.001). There were no differences in physical performance and mortality or rehospitalization during follow-up.Conclusions
A HF MDMP can improve QoL, depressive symptoms and self-care behaviors in China. 相似文献8.
Risa Tamagawa-Mineoka Naoko Yasuoka Mayumi Ueta Norito Katoh 《Allergology international》2018,67(3):388-391
Background
Topical corticosteroids (TCS) can induce adverse effects, such as skin atrophy. Although TCS can cause increases in intraocular pressure (IOP), the effects of daily TCS use on IOP have not been fully elucidated. We evaluated the clinical doses of TCS and the change in the IOP during the daily treatment of atopic dermatitis (AD).Methods
We collected clinical data on a total of 65 patients who were diagnosed with AD and underwent 2 or more IOP measurements at our hospital.Results
Mean monthly facial steroid volumes of ≤11.8 g and ≤15.0 g of TCS were applied to 90% of the patients aged 2–12 years and those aged ≥13 years, respectively. During the treatment, there were no TCS-related increases in IOP in any patient.Conclusions
Our study suggests that TCS might not cause increases in IOP at the abovementioned doses. However, the IOP of steroid responders is known to be highly responsive to steroids. Therefore, patients who have steroids applied to their eyelids had better undergo regular IOP measurements at ophthalmological clinics. 相似文献9.
Keith J. Roberts Pooja Prasad Yvonne Steele Francesca Marcon Thomas Faulkner Hentie Cilliers Bobby Dasari Manuel Abradelo Ravi Marudanayagam Robert P. Sutcliffe Paolo Muiesan Darius F. Mirza John Isaac 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(8):713-720
Introduction
Pancreatoduodenectomy (PD) typically follows preoperative biliary drainage (PBD) despite PBD being potentially harmful. This study evaluated a pathway to avoid PBD within the framework of the UK's NHS.Method
A prospective observational study of jaundiced patients undergoing PD for periampullary cancer. A pathway to provide early surgery without PBD was introduced at the start of the study period.Results
Over 12 months 61 and 32 patients underwent surgery with and without PBD respectively; 95% of patients in the PBD group had been stented before referral. The time from CT scan to surgery was shorter in the no PBD group (16 vs 65 days, p < 0.0001). Significantly more patients underwent PD in the no PBD group (31/32 vs 46/61, p = 0.009) and venous resection (10/31 vs 4/46, p = 0.014). The sensitivity of initial CT scan to define borderline resectable disease was worse in the PBD group (91 vs 50%, p = 0.042).Conclusions
Early surgery to avoid PBD is possible within the NHS. By reducing the time to surgery it appears that more patients undergo potentially curative resection. It is desirable to understand why surgery without PBD is not performed routinely as are the development of strategies to support its more widespread practice. 相似文献10.
Ilgar Aghalarov Torsten Herzog Waldemar Uhl Orlin Belyaev 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(7):676-683
Background
Double-loop (DL) reconstruction after pancreaticoduodenectomy (PD), diverting pancreatic from biliary secretions, has been reported to reduce rates and severity of postoperative pancreatic fistula (POPF) compared to single loop (SL) reconstruction at the price of prolonged operative duration. This study investigated the feasibility of a new reconstruction method combining the advantages of DL with the simplicity of SL in patients with high-risk pancreas.Methods
A modified single-loop (mSL) reconstruction was used in patients undergoing PD with a soft pancreatic remnant and a pancreatic duct smaller than 3 mm (n = 50). The loop between the pancreatic and the biliary anastomoses was left longer and a side-to-side jejunojejunal anastomosis was performed between them at the lowest point to promote isolated flow of pancreatic and biliary secretions. Rate and severity of POPF, mortality, duration of surgery, and POPF-associated morbidity were compared to those of 50 matched patients with SL and 25 patients with DL reconstruction.Results
Duration of surgery was 57 min longer for DL, but equal for mSL and SL. The POPF rate did not differ between the three groups. The severity of POPF was more pronounced in the SL group (62% grade C: p = 0.011). Mortality and major morbidity were lower and hospital stay shorter in the mSL and DL groups compared to the SL group.Conclusions
The new mSL reconstruction was safer than conventional SL and faster to perform than DL reconstruction in patients with a high-risk pancreas. It did not influence the rate of POPF, but reduced its severity, leading to less major morbidity and mortality. 相似文献11.
Chen Lin Hongmei Dai Xiafei Hong Haiyu Pang Xianze Wang Peiran Xu Jialin Jiang Wenming Wu Yupei Zhao 《Pancreatology》2018,18(5):608-614
Background
Whether primary tumor resection benefits patients with synchronous multifocal liver metastases from pancreatic neuroendocrine tumors remains controversial. We investigated whether primary tumor resection significantly affects survival in this study.Methods
A retrospective study of patients with synchronous multifocal liver metastases from pancreatic neuroendocrine tumors between 1998 and 2016 was performed. Patient demographics, operation details, adjuvant treatment, and pathological and survival information were collected, and relevant clinical-pathological parameters were assessed in univariate and multivariate survival analyses.Results
Sixty-three patients were included in this study, including 35 who underwent primary tumor resection. The median survival time and 5-year survival rate of this cohort were 50 months and 44.5%, respectively. Median survival time in the resected group was significantly longer at 72 months than that of 32 months in the nonresected group (p?=?0.010). Multivariate analysis showed that primary tumor surgery was a significant independent prognostic factor (HR 0.312, 95% CI: 0.128–0.762, p?=?0.011).Conclusions
Primary tumor resection significantly benefits patients with synchronous multifocal liver metastases from pancreatic neuroendocrine tumors. 相似文献12.
Elisa Pose Elsa Solà Salvatore Piano Elisabetta Gola Isabel Graupera Mónica Guevara Andrés Cárdenas Paolo Angeli Pere Ginès 《The American journal of medicine》2017,130(3):372-375
Background
Vaptans, vasopressin selective V2-receptor antagonists, represent the first pharmacologic approach to the treatment of hypervolemic hyponatremia in cirrhosis. However, information on the use of vaptans for patients with cirrhosis and hyponatremia in a real-life scenario is limited. Therefore, this study evaluated the effect of tolvaptan on serum sodium in patients with cirrhosis and severe hypervolemic hyponatremia.Methods
Nine patients with cirrhosis and serum sodium ≤125 mEq/L were included.Results
Only 2 of the 9 patients (22%) gained an increase in serum sodium >130 mEq/L that persisted throughout treatment. In the remaining patients, serum sodium did not change or increased during the first days but decreased thereafter despite continuation of treatment. Only 1 patient developed hyperkalemia as a side effect.Conclusions
The efficacy of tolvaptan in patients with cirrhosis and severe hypervolemic hyponatremia seems to be limited. 相似文献13.
Roberta Angelico Shakeeb Khan Bobby Dasari Ravi Marudanayagam Robert P. Sutcliffe Paolo Muiesan John Isaac Darius Mirza Keith J. Roberts 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(4):365-370
Background
Hepaticojejunostomy is routinely performed in patients when inoperable disease is found at planned pancreatoduodenectomy; however, in the presence of self-expanding metal stent (SEMS) hepaticojejunostomy may not be required. The aim of this study was to assess biliary complications and outcomes in patients with unresectable disease at time of planned pancreaticoduodenectomy stratified by the management of the biliary tract.Material and methods
Retrospective analysis of patients undergoing surgery in January 2010–December 2015. Complications were measured using the Clavien–Dindo scale.Results
Of 149 patients, 111 (75%) received gastrojejunostomy and hepaticojejunostomy (double bypass group) and 38 (26%) received a single bypass in the presence of SEMS (single bypass group). Post-operative non-biliary [7 (18%) vs 43 (38%), (p = 0.028)] and biliary [0% vs 12 (11%), (p = 0.037)] complications were lower in the single bypass group. Hospital readmissions were significantly higher in the double bypass group (p = 0.021). Overall survival and the time to start chemotherapy were equivalent (p = n.s.).Conclusions
Complications are more common following double bypass compared to single bypass with SEMS suggesting that gastric bypass is adequate surgical palliation in presence of SEMS. This study adds further evidence that preoperative SEMS should be used in preference to plastic stents for suspected periampullary malignancy. 相似文献14.
Cynthia Arslanian-Engoren Joseph J. Sferra Milo Engoren 《Heart & lung : the journal of critical care》2018,47(1):47-53
Background
Approximately three million U.S. adult women have heart failure (HF), increasing their risk of adverse perioperative outcomes. While gender and racial differences are reported in surgical outcomes, less is known about 30-day perioperative outcomes in HF patients.Objectives
To characterize and compare gender and racial differences in 30-day perioperative outcomes in adults with new or acute/worsening HF.Methods
The 2012–2013 American College of Surgeons National Surgical Quality Improvement Program database of surgical patients (n = 9458) with HF was analyzed. Logistic regression was used to adjust for gender and racial differences in baseline covariates.Results
No gender difference in mortality (odds ratio = 0.922, 95% confidence interval = 0.0792–1.073, p = 0.294) was noted. Whites were more likely than Blacks to die 30 days after surgery (14% vs 9%, p < 0.001); after adjustment, Blacks were more likely to experience complications and be readmitted compared to Whites.Conclusions
There was no gender difference in mortality. White patients with HF were more likely to die after surgery than Black patients. 相似文献15.
David P.J. van Dijk Frans C.H. Bakers Sebastian Sanduleanu Rianne D.W. Vaes Sander S. Rensen Cornelis H.C. Dejong Regina G.H. Beets-Tan Steven W.M. Olde Damink 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(8):715-720
Background
Myosteatosis, characterized by inter- and intramyocellular fat deposition, is strongly related to poor overall survival after surgery for periampullary cancer. It is commonly assessed by calculating the muscle radiation attenuation on computed tomography (CT) scans. However, since magnetic resonance imaging (MRI) is replacing CT in routine diagnostic work-up, developing methods based on MRI is important. We developed a new method using MRI-muscle signal intensity to assess myosteatosis and compared it with CT-muscle radiation attenuation.Methods
Patients were selected from a prospective cohort of 236 surgical patients with periampullary cancer. The MRI-muscle signal intensity and CT-muscle radiation attenuation were assessed at the level of the third lumbar vertebra and related to survival.Results
Forty-seven patients were included in the study. Inter-observer variability for MRI assessment was low (R2 = 0.94). MRI-muscle signal intensity was associated with short survival: median survival 9.8 (95%-CI: 1.5–18.1) vs. 18.2 (95%-CI: 10.7–25.8) months for high vs. low intensity, respectively (p = 0.038). Similar results were found for CT-muscle radiation attenuation (low vs. high radiation attenuation: 10.8 (95%-CI: 8.5–13.1) vs. 15.9 (95%-CI: 10.2–21.7) months, respectively; p = 0.046). MRI-signal intensity correlated negatively with CT-radiation attenuation (r=?0.614, p < 0.001).Conclusions
Myosteatosis may be adequately assessed using either MRI-muscle signal intensity or CT-muscle radiation attenuation. 相似文献16.
Yi-Nan Shen Xue-Li Bai Gang Jin Qi Zhang Jun-Hua Lu Ren-Yi Qin Ri-Sheng Yu Yao Pan Ying Chen Pei-Wei Sun Cheng-Xiang Guo Xiang Li Tao Ma Guo-Gang Li Shun-Liang Gao Jian-Ying Lou Ri-Sheng Que Wan Y. Lau Ting-Bo Liang 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(11):1034-1043
Background
Pancreatic head adenocarcinoma is commonly diagnosed at an advanced stage when adjacent vascular invasion is present. This study aimed to establish a preoperative prognostic nomogram for patients who underwent attempted curative resectional surgery for pancreatic head cancer with suspected peripancreatic venous invasion.Methods
Data on all consecutive patients were retrospectively collected from 2012 to 2016 at four academic institutions. The demographic and radiological parameters were analyzed using univariate and multivariate Cox regression analyses. The final nomogram was established using the concordance Harrell's C-indices and calibration curves from data obtained in three institutions and validated in the cohort of patients coming from the fourth institution.Results
The nomogram was constructed using data from 178 patients while the validation cohort consisted of 61 patients. Age, length of tumor contact, peripancreatic venous abnormalities and lymph node staging were independent factors of overall survival. The nomogram showed good probabilities of survival on calibration curves. The C-index of the model in predicting overall survival (OS) was 0.824 for the validation cohort.Conclusions
The nomogram accurately predicted OS in patients with pancreatic head cancer with suspected peripancreatic venous invasion after attempted curative pancreatic resectional surgery. 相似文献17.
L. Tanno D. Mayo S. Mills A. Takhar J. Cave L. Nolan B. Stedman F.X. Sundram M. Abu Hilal H. Connor N. Pearce T. Armstrong 《Pancreatology》2018,18(3):304-312
Background/objectives
Primary and metastatic pancreatic neuroendocrine tumours (PNET) can be treated with combination of surgery, locoregional and systemic therapy. Survival benefits from individual treatments have been well reported, however, the combined outcome from multimodal treatments are not well described in the literature. We report outcomes in a cohort of PNET patients treated with proactive, multimodality therapy.Methods
106 patients were identified from a single tertiary referral centre prospective database. Outcomes of treatment were studied, with the primary end point being death from any cause.Results
Median follow-up was 71 months and overall 5-year survival of 62%. In patients with stage I-III disease (51 patients) estimated 5-year survival was 90%. Median survival in patients with stage IV disease was 51 months with an estimated 5-year survival of 40% in this group. A total of 80 patients (75%) had surgery of which 16% suffered complications requiring intervention. There was no perioperative mortality.Conclusions
This study demonstrates that proactive multimodal treatment is safe and may confer a survival benefit to patients in this cohort compared to historical data. 相似文献18.
Sara Massironi Stefano Partelli Maria C. Petrone Alessandra Zilli Dario Conte Massimo Falconi Paolo G. Arcidiacono 《Pancreatology》2018,18(7):792-798
Background/Objectives
The pancreatic localization of serotonin-staining neuroendocrine neoplasms is extremely rare. This is a retrospective study aimed at analyzing the endoscopic ultrasound appearance of pancreatic serotoninoma.Methods
Between 2010 and 2016, all consecutive patients with histologically proven pancreatic serotoninoma who had undergone endoscopic ultrasound were enrolled.Results
Eight patients (six F, median age 68.5 years) had a diagnosis of pancreatic serotoninoma and underwent endoscopic ultrasound examinations. Median diameter of the lesion was ten mm. The nodule echotexture was hypoechoic in seven out of eight cases. The most frequent localization was the pancreatic neck (four); in three cases, the tumor was located in the pancreatic head and in one in the body. In seven cases the tumor caused a main pancreatic duct dilation; in three cases also the secondary ducts were dilated. In one case a dilation of the common bile duct was observed. At contrast-enhanced endoscopic ultrasound no one showed the typical contrast-enhancement. Elastography (available in two patients) showed a rigid pattern of the lesion.Conclusions
From this case series a specific endoscopic ultrasound appearance resulted for pancreatic serotoninoma, different from other types of pancreatic neuroendocrine neoplasm, but it is difficult to differentiate it from a pancreatic adenocarcinoma or an intraductal papillary mucinous neoplasm. 相似文献19.
Wujie Wang Changjun Wang Hongjun Qi Yongzheng Wang Yuliang Li 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(4):327-331
Background
Percutaneous procedures to treat common bile duct (CBD) stones typically require access via intrahepatic bile ducts. This study aimed to describe the outcomes of a percutaneous transcystic approach that expelled the CBD stones into the duodenum after percutaneous transcystic balloon dilation of the ampulla (PTCBDA) for high-risk patients who present with acute cholecystitis and CBD stones.Methods
Patients diagnosed with acute cholecystitis and CBD stones who were deemed too high-risk for surgery or general anesthesia and were treated with PTCBDA and CBD stone removal between March 2010 and November 2015 were included for further analysis. Patients underwent emergency percutaneous transhepatic gallbladder drainage under ultrasound. Staged PTCBDA and CBD stone expulsion were performed. Outcomes evaluated included the success rate, causes of failure, and complications.Results
Eighteen patients met the inclusion criteria. CBD stones were successfully expelled in 16 patients. A second procedure was performed in one patient because of residual stones. The procedure failed in two patients because their stones were large. One patient developed bile peritonitis and underwent percutaneous catheter drainage.Discussion
Percutaneous transcystic anterograde expulsion of CBD stones may be a feasible and effective method for treating high-risk surgical patients with acute cholecystitis and co-existing CBD stones. 相似文献20.
Tamaki Noie Yasushi Harihara Masaaki Akahane Junichi Kazaoka Astuki Nagao Shoichi Sato Kazuteru Watanabe Satoshi Nara Kaoru Furushima Ryuji Yoshioka Yukinori Yamagata Emiko Takeshita Takashi Okuyama Shinichi Sameshima Masatoshi Oya 《Pancreatology》2018,18(8):1005-1011