SpyGlass单人操作胆道镜系统治疗胆道疾病的初步临床研究

目的探讨SpyGlass单人操作胆道镜系统在治疗胆胰疾病中的应用价值。方法选取巨大胆管结石患者4例,尚未确诊的胆管狭窄患者5例。对胆管巨大结石者,行SpyGlass直视下激光碎石治疗,常规取石。对胆管狭窄者,SpyGlass直视下观察病变情况,SpyBite活检钳直视下活检取样。患者均放置鼻胆引流管,术后检测血常规以及血尿淀粉酶,予抑酸、预防感染治疗。结果9例患者均手术成功,平均SpyGlass操作时间21．2min,平均总操作时间46．2rain。4例巨大胆管结石患者均成功完成碎石及取石,术后2d鼻胆管造影显示无结石残留。5例胆管狭窄患者,病理诊断胆管癌2例,胆管炎性狭窄3例。术后出现胰腺炎2例,均为轻度,经治疗后恢复。结论SpyGlass单人操作胆道镜系统对于胆管疾病的诊治是较为安全有效的。     

经口胰管镜在胰管内疾病诊疗中的应用分析(含视频)

回顾性分析南京医科大学第一附属医院胰腺中心2020年8月—2022年10月收治的23例因考虑胰管内疾病行经口胰管镜检查的患者资料,分析术中所见、术后并发症情况及胰管镜对胰管疾病的诊疗价值。所有患者接受胰管镜检查,并达到技术成功。其中7例患者确诊为胰腺导管内乳头状黏液性肿瘤,3例确诊为胰腺恶性肿瘤,8例胰管结石患者在胰管镜下行激光或液电碎石术,2例慢性胰腺炎患者经治疗后腹痛好转,2例胰管内出血和胰肠吻合口炎症患者经保守治疗后黑便消失,1例胰肠吻合口狭窄患者经球囊扩张后症状改善。23例患者均未出现手术并发症,手术操作时间为35~90 min。经口胰管镜在胰管内疾病的诊疗中安全有效,且有独特的优势。     

Preclinical characterization of the Spyglass peroral cholangiopancreatoscopy system for direct access, visualization, and biopsy

BACKGROUND: Current cholangioscopes are restricted to 2 deflection angles and require more than 1 operator. The newly developed Spyglass peroral cholangiopancreatoscopy system provides 4-way deflected steering by a single operator. OBJECTIVE: To evaluate access and biopsy in all simulated biliary-duct quadrants with the Spyglass system, high-level disinfection of the reusable Spyglass optical probe, and feasibility of in vivo biopsy. DESIGN: Laboratory simulations comparing biliary-duct access and biopsy with the Spyglass versus a conventional system, laboratory determination of high-level disinfection effectiveness, and observational investigation of biopsies in a porcine model. SETTING: Research laboratories. MAIN OUTCOME MEASUREMENTS: Rate ratios (RR) and 95% confidence intervals (CI) for successful access to all quadrants and simulated biopsy. RESULTS: Success rates for access in all quadrants were significantly higher with the Spyglass system than with the control system, both without (RR 1.71, 95% CI 1.39-2.29) and with (RR 2.00, 95% CI 1.56-2.78) biopsy forceps loaded. Higher success rates were also attained by using the Spyglass system to access biopsy targets (RR 2.09, 95% CI 1.60-2.91) and to perform simulated biopsies (RR 2.94, 95% CI 2.05-4.52). Microbial species log reductions of 6.0 to 7.0 were achieved by high-level disinfection of Spyglass optical probes. In 31 in vivo porcine biopsies yielding adequate gross specimens, the quality for histologic examination was excellent to adequate for 90% of specimens. LIMITATIONS: Study procedures were performed by a single nonblinded operator. All data were collected ex vivo or in animals, and clinical applicability remains to be determined. CONCLUSIONS: The Spyglass system allows access and biopsy in all quadrants and merits clinical investigation.     

SpyGlass DS直视胆道镜系统在胆道疾病诊治中的初步临床研究(含视频）

目的 探讨SpyGlass DS直视胆道镜系统在胆道疾病诊治中的临床应用价值。方法 使用SpyGlass DS直视胆道镜系统对7例胆道疾病患者（包括3例胆总管巨大结石,4例不明原因胆管狭窄）进行镜下诊断和治疗。对胆总管巨大结石患者,行SpyGlass DS胆道镜直视下激光碎石,继之行常规ERCP取石;对不明原因胆管狭窄患者,在SpyGlass DS胆道镜直视下观察病变情况,必要时取活检。结果 7例患者均成功完成SpyGlass DS镜下诊治, SpyGlass DS平均操作时间12.6 min。3例胆总管巨大结石患者均成功完成碎石及取石,术后3 d鼻胆管造影显示无结石残留。4例胆管狭窄患者中,2例镜下诊断为恶性胆管狭窄,并被活检病理证实;另外2例镜下诊断为炎性狭窄,未取活检。术后2例患者出现高淀粉酶血症,均自行恢复正常。结论 SpyGlass DS能成功用于难治性胆管结石及不明原因胆管狭窄患者的诊治。     

SpyGlass经口胆道镜在肝移植术后胆道狭窄诊治中的应用

探讨肝移植术后胆道狭窄在经口胆道镜（SpyGlass）下的表现及SpyGlass在困难狭窄中的治疗作用。方法　2019年1月—2020年12月就诊于西安交通大学第一附属医院肝胆外科的24例肝移植术后胆道狭窄患者,术后15.5个月（2~58个月）接受SpyGlass检查。记录并分析不同类型胆道狭窄在SpyGlass镜下表现及困难胆道狭窄SpyGlass引导下的导丝超选结果。结果　24例患者中,9例为胆道吻合口狭窄（anastomostic stricture,AS）,15例为非吻合口狭窄（non?anastomostic stricture,NAS）。5例初治AS镜下的主要表现为瘢痕性缩窄。15例NAS无论是否初治,镜下肝门部胆管呈明显炎性增生改变,80%（12/15）合并肝内胆管结石。8例脱支架者（AS和NAS各4例）镜下狭窄消失伴局部轻度炎性增生。11例（AS 5例,NAS 6例）需SpyGlass直视下放置导丝,共6例（54.5%）成功,其中AS成功率（4/5）高于NAS（2/6）。结论　肝移植术后AS主要表现为瘢痕性缩窄,NAS主要为炎性增生,困难AS SpyGlass镜下超选具有较高的成功率。     

Role of digital single-operator cholangioscopy in the diagnosis and treatment of biliary disorders

Due to the need for improvement in the diagnosis and minimally invasive therapy of the bile duct disorders new technologies for cholangioscopy have been recently developed. Per-oral cholangioscopy has become an important diagnostic and therapeutic tool leading to avoidance of aggressive and unnecessary surgery in many clinical scenarios. This paper focuses on the newly developed SpyGlass DS technology, its advantages, and the technique of single-operator cholangioscopy(SOC), biliary indications and possible adverse events. We also review the available literature; discuss the limitations and future expectations.Digital SOC(D-SOC) is a useful technique, which provides endoscopic imaging of the biliary tree, optical diagnosis, biopsy under direct vision and therapeutic interventions. The implementations are diagnostic and therapeutic. Diagnostic indications are indeterminate biliary strictures, unclear filling defects, staging of cholangiocarcinoma, staging of ampullary tumors(extension into the common bile duct), unclear bile duct dilation, exploring cystic lesions of the biliary tree,unexplained hemobilia, posttransplant biliary complications. Therapeutic indications are lithotripsy of difficult stones, retrieval of migrated stents, foreign body removal, guide wire placement, transpapillary gallbladder drainage and endoscopic tumor ablative therapy. Most studied and established indications are the diagnosis of indeterminate biliary stricture and intraductal lithotripsy of difficult stones. The adverse events are not different and more common compared to those of Endoscopic retrograde cholangiopancreatography(ERCP)alone. D-SOC is a safe and effective procedure, adjunct to the standard ERCP and the newly available digital technology overcomes many of the limitations of the previous generations of cholangioscopes.     

改良式内镜下逆行阑尾炎治疗术在儿童阑尾炎合并肠套叠的初探（含视频）

探讨改良式内镜下逆行阑尾炎治疗术（endoscopic retrograde appendicitis therapy,ERAT）在儿童急性非复杂性阑尾炎合并肠套叠的有效性和安全性。2018年10月—2020年2月,因急性非复杂性阑尾炎合并肠套叠于唐都医院儿科接受改良ERAT治疗的6例患者纳入回顾性分析,总结肠套叠复位...