术后3 h血清淀粉酶检测对ERCP术后胰腺炎的预测价值

目的 评估ERCP术后3 h血清淀粉酶值对ERCP术后胰腺炎（post-ERCP pancreatitis,PEP）的预测价值。方法 收集2011年10月1日至2014年12月1日我院328例连续行ERCP的患者术后3 h和24 h血清淀粉酶值,并统计PEP的发生情况。将是否发生PEP作为状态变量,两个时间点的血清淀粉酶作为检验变量,采用SPSS13.0系统作ROC曲线,分析术后3 h和24 h血清淀粉酶对PEP的预测价值。结果 328例患者中诊断PEP共17例（5.18%）。术后3 h血清淀粉酶值≤200 U/L共194例（59.15%）,其中PEP 2例（1.03%）;术后3 h血清淀粉酶值>200 U/L共134例（40.85%）,其中PEP 15例（11.19%）;两者比较有统计学差异（x²=19.731;P<0.001）。术后3 h血清淀粉酶值ROC曲线下面积为0.845,诊断准确度良好,最佳Cut-off值为280 U/L,灵敏度82.4%,特异度74.3%,阳性预测值14.7%,阴性预测值98.7%,准确度74.4%,Youden指数56.4%。术后24 h血清淀粉酶值≤600 U/L共284例（86.59%）,其中PEP 1例（0.35%）;术后24 h血清淀粉酶值>600 U/L共44例（13.41%）,其中PEP 16例（36.36%）;两者比较有统计学差异（x²=93.341;P<0.001）。术后24 h血清淀粉酶值ROC曲线下面积为0.977,诊断价值高,最佳Cut-off值为534.5 U/L,灵敏度100%,特异度89.1%,阳性预测值33.3%,阴性预测值100%,准确度89.6%,Youden指数89.1%。结论 ERCP术后3 h血清淀粉酶值对PEP有较好的早期预测价值,特别是有很好的阴性预测价值;当术后3 h血清淀粉酶值>200 U/L并且有胰管插管时,需高度警惕PEP的发生。     

ERCP术中导丝损伤致肝包膜下血肿1例报告并文献复习

背景与目的：肝包膜下血肿（SHH）是内镜逆行胰胆管造影（ERCP）术后罕见并发症之一,总体病死率可达7.5%,临床医师需引起足够重视。本文报告1例ERCP术后SHH患者的诊治过程,结合既往文献分析病例特点,以期为SHH病因探索及后续SHH术中及术后诊疗提供借鉴。方法：回顾性分析北京大学深圳医院肝胆胰外科收治的1例ERCP术后SHH患者的临床资料,结合前期文献资料进行复习和总结。结果：患者为32岁女性,肝功能检查提示总胆红素（TBIL） 133.1μmol/L、结合胆红素（DBIL） 75.0μmol/L,MRI检查提示胆总管近壶腹部结石伴以上肝内外胆管扩张,予以行ERCP+Oddi括约肌扩张+胆道取石+鼻胆管外引流术,术后15 h患者出现右上腹疼痛伴有肩痛,予以止痛处理后缓解,术后18 h出现心率增快,复查血常规提示血红蛋白进行性降低,急诊CT检查提示肝脏包膜下弧形高密度影,考虑血肿可能;ERCP术后腹腔、盆腔积血积液。予急诊行选择性肝动脉造影+经皮动脉栓塞术,术后患者血红蛋白逐步升高至正常,于动脉栓塞术后2周出院。出院后3 d患者再发右上腹疼痛,急诊CT提示SHH较前范围增大,再次行...     

ERCP治疗老年胆总管结石206例临床分析

目的 探讨ERCP在老年胆总管结石患者治疗中的应用。方法 206例老年胆总管结石患者分成EST组及EST联合EPBD组,回顾性分析其临床资料。结果 EST组80例,结石一次取净71例（88.8%）,二次取净7例（8.8%）,术后并发出血3例,轻症胰腺炎12例;EST联合EPBD组126例,一次性取净115例（91.3%）,二次取净8例（6.3%）,术后并发出血5例,轻症胰腺炎6例。两组均无穿孔、大出血等中转手术病例。两组取石成功率及术后并发症比较无统计学差异（P＞0.05）。结论 ERCP是一项相对安全、有效的微创治疗技术,适合老年胆总管结石患者的治疗。     

止血夹预防高危出血患者ERCP术后迟发性出血的临床效果

目的 探讨出血高危患者在内镜下逆行胰胆管造影（endoscopic retrograde cholangio pancreatography,ERCP）术中即刻留置止血夹对预防术后迟发性出血的临床作用。方法 收集2016年8月至2019年9月来院行ERCP的1 854 例患者,其中符合纳入标准的出血高危患者493 例,包括止血夹组215 例、常规对照组278 例,回顾性分析两组患者术后并发症包括出血、胰腺炎、穿孔,以及操作时间、住院时间和住院费用等指标。结果 止血夹组术后出血发生率低于常规对照组[1.4%（3/215） vs 4.7%（13/278）,P＜0.05],两组在性别、年龄、疾病构成、术后胰腺炎和穿孔、操作时间、取石方式、住院费用等指标上无统计学差异（P＞0.05）。结论 ERCP术中针对出血高危患者预防性实施止血夹,可以显著降低术后迟发性出血发生率,且不额外增加患者费用,是一种安全便捷、值得推广的技术。     

ERCP联合EST治疗胆总管结石的术后远期并发症

目的:评价内镜逆行胰胆管造影术(ERCP)联合内镜下括约肌切开术(EST)术后远期并发症的发生率,检验十二指肠憩室及胆囊切除是否影响远期并发症发生。方法:在我院ERCP手术数据库中选取2009年至2012年成功接受ERCP联合EST治疗的胆总管结石病人进行电话随访,随访内容包括病人术后胆道系统临床症状以及远期并发症发生与否。结果:在172例成功进行ERCP的病人中,术后27~71个月胆总管结石的复发率为25.0%(43/172),急性胆管炎发生率为8.1%(14/172)。以上两类并发症发生与年龄无关(P>0.05)。ERCP术前存在十二指肠憩室以及术前行胆囊切除术并不影响术后并发症发生率(P>0.05)。结论:胆总管结石复发及急性胆管炎是ERCP联合EST术后的主要远期并发症。     

ERCP术后LC的手术时机探讨

目的 探讨经内镜逆行性胰胆管造影术（ERCP）联合腹腔镜胆囊切除术（LC）治疗胆囊结石合并胆总管结石的最佳手术时间间隔.方法 回顾性分析我院自2010年1月至2014年4月56例胆囊结石合并胆总管结石患者,均顺利完成ERCP＋LC的序贯治疗.ERCP术后,其中28例2～4d后行LC（A组）,28例5～14 d后行LC（B组）.对两组患者的LC术前血淀粉酶水平、LC手术时间、术后肛门排气时间、术后并发症、总住院时间及总住院费用进行比较分析.结果 A组总住院时间和总住院费用均低于B组（t=--5.970,P＜0.05; t=-4.304,P＜ 0.05）.LC术前血淀粉酶水平、手术时间、术后肛门排气时间、术后并发症和住院时间在两组之间比较均无明显差异（P＞ 0.05）.结论 ERCP与LC的最佳时间间隔可能是2～4d.     

ERCP术后重症急性胰腺炎6例临床分析

目的 探讨ERCP术后急性胰腺炎（PEP）的预防及治疗方法。方法 回顾性总结南京军区南京总医院普通外科2006年4月至2009年8月由外院转入的6例ERCP术后重症急性胰腺炎病例资料,分析临床诊疗经过及预后。结果 6例病人中5例因胆道症状、1例因右上腹痛行ERCP检查,其中1例病人反复插管后置管失败,2例行胰管造影检查,3例行Oddi括约肌预切开术,均未行Oddi括约肌球囊扩张及胰管括约肌切开术,术前、术后均未预防性用药,术后均未放置胰管支架;6例病人在ERCP术后8~48h诊断为SAP,急性期有4例病人并发急性肺损伤,1例并发急性呼吸窘迫综合征（ARDS）,1例并发ARDS、急性肾功能衰竭,后期有5例病人并发胰腺坏死组织感染而行手术引流,1例死亡。结论 严格掌握ERCP适应证、术前充分评估病人危险因素、术中注意避免操作相关危险因素、术后早期诊断,是预防及治疗PEP的关键。     

儿童胆总管囊肿51例ERCP分析

目的 了解儿童胆总管囊肿的分型、胆管胰管汇合方式与胆总管囊肿形态关系,及胆总管囊肿并发症发生率,探讨儿童胆总管囊肿ERCP检查的诊断价值. 方法 回顾分析1998年6月至2003年3月长海医院ERCP检查诊断儿童先天性胆总管囊肿51例图像及随访资料. 结果 成功行ERCP 45例,行逆行胆管造影(ERC)6例.胆总管囊肿分型,Ⅰ型41例,其中Ⅰ a 17例,Ⅰ b 10例,Ⅰ c 14例.Ⅳ型10例,其中Ⅳa 8例、Ⅳb 2例.合并胰胆管合流异常37例,占82.2%,合流方式为B-P型21例,P-B型16例.并选定Ⅰ c型为胆总管柱状扩张组;Ⅰ a+Ⅰ b+Ⅳ型均为囊状扩张组,对照分析,柱状扩张中P-B型占80%,囊状扩张中B-P型占70.4%.合并有胆道结石8例,胰管扩张2例.测量胰胆管合流异常共同管长度=0.5 cm 4例,>0.5cm且<1.5 cm 20例,≥1.5 cm 13例.14例随访病例中,未发现急性胰腺炎及出血、穿孔等严重并发症. 结论 儿童先天性胆总管囊肿Ⅰ型最多见,且大多数合并胰胆管合流异常.胆管柱状扩张中P-B型较常见,胆管囊状扩张中B-P型较常见.ERCP检查对儿童胆总管囊肿诊断安全有效.     

ERCP临床应用指征探讨

目的探讨临床应用内镜逆行胰胆管造影术(ERCP)的诊治指征。方法回顾性分析2005年1月至2009年12月期间我院采用ERCP方法进行诊断及治疗的患者的临床资料。结果 221例行ERCP的患者中,术中发现胆总管结石99例,占45%;恶性肿瘤44例,占20%;乳头狭窄9例,占4%;阴性45例,占20%;操作失败24例,占11%。年度分类统计显示,行ERCP的患者数逐年减少。ERCP术后并发症发生率为11%(25例),包括术后胰腺炎15例、出血3例、胆道感染5例及网篮头滞留2例。结论在影像学及腹腔镜技术高度发展的时代,应本着无创、微创的原则选择诊治方法,临床上不能无限扩大ERCP的应用指征。     

Nontraumatic subcapsular renal hematoma: report of a case

A case of nontraumatic subcapsular renal hematoma was reported. The patient was a 41-year-old woman. She complained of right flank colic pain. Her excretory pyelography showed right hydronephrosis and ureteral stone, and demonstrated a large mass involving the right kidney and medial displacement of its collecting system. Ultrasonic examination and computed tomography revealed right subcapsular renal hematoma. Since we found no malignancy, we made a puncture and drained the lesion. A bloody aliquot was gained and its cytological examination was negative. Her clinical course was uneventful. After 6 months the hematoma was absorbed clearly. A review was made of 38 cases of nontraumatic subcapsular renal hematoma, including our own case. Of these, the cause was unidentified in 17 cases. Hydronephrosis, mostly associated with calculi, renal infarcts, nephritis and renal cell carcinoma followed. Of 38 cases, 2 (5.3%) were of malignant tumor.     

Case report: subcapsular hepatic hematoma: retraction injury during laparoscopic adrenalectomy

We present a case of subcapsular hepatic hematoma resulting from retraction of the liver during laparoscopic adrenalectomy. We discuss the management and prevention of this rare and important complication.     

Intramural duodenal hematoma after submucosal injection of epinephrine for a bleeding ulcer: case report and review

We present a case of intramural duodenal hematoma as a complication of endoscopic therapy for a bleeding duodenal ulcer in an adult patient with no evidence of other pathologies. A 18-year-old man was admitted in emergency room with gastrointestinal bleeding manifested by melena. Previous medical history revealed that he had endoscopic sclerotherapy for bleeding duodenal ulcer 5 months before. Endoscopy revealed a Forrest 2a ulcer in the duodenal bulb and sclerotherapy was performed by injecting 10 ml of 0.2% epinephrine and 20 ml of NaCl 0.9% solution. Upper occlusion’s signs appeared 36 hours after the procedure. The hematoma, that was identified by endoscopy and confirmed by MRI and CT scan of the abdomen, caused transient duodenal obstruction. Combined conservative management with nasogastric tube and total parenteral nutrition resulted in reduction of obstructive symptoms within 4 weeks.     

A case of subcapsular renal hematoma status post celiac artery thrombectomy

Introduction30 year old male with no significant past medical history presenting to the hospital with significant left-sided abdominal pain.Case presentationPatient was found to have a thrombus within the celiac artery for which he underwent a catheter assisted thrombolysis procedure. Hypercoagulable work-up revealed evidence of a JAK 2 V617F mutation which is indicative of Polycythemia Vera. The patient returned the following day with considerable left-sided flank pain associated with shortness of breath, nausea, and vomiting. CT performed showed evidence of an expanding left renal subcapsular hematoma. Patient was treated conservatively with IV fluids and pain medication before he was discharged hemodynamically stable after a few days.Discussion/conclusionAccessory renal vessels can be a rare finding coming of the celiac artery and so, care must be taken to evaluate vascular anatomy to avoid iatrogenic injuries; a bleed from one of these vessels could lead to the development of a hematomas, as seen with this patient.     

Lumbar spinal epidural hematoma after chiropractic manipulation: A case report

Lumbar epidural hematoma is a very rare condition and can cause permanent neurological deficit needing urgent investigation and prompt intervention. We present here a case of lumbar epidural hematoma after chiropractic manipulation therapy for low back pain without any obvious predisposing factor. A fairly healthy and lively 72-year-old woman was admitted to our hospital because of grade 4 paresis after chiropractic manipulation therapy. She had no history of anticoagulation therapy. Magnetic resonance imaging (MRI) showed a spinal epidural hematoma with dural sac compression at the level of L3–L4. Rapid decompression of the spinal channel was performed. On follow-up 4 weeks after surgery, the patient was fully ambulatory and complained only of slight pain at the surgical site. MRI is the most useful method for diagnosing spinal epidural hematoma, the appropriate treatment for patients with neurological deficits being surgical decompression. Practitioners of chiropractic manipulation therapy should be aware of spinal epidural hematoma as a possible complication and should exercise caution in subgroups of patients on antithrombotic medication. Spinal epidural hematoma is a potentially reversible cause of neurological deterioration if diagnosed early and treated promptly.     

Giant extrathoracic hematoma after thoracoplasty —A case report

A rare case of an extrathoracic giant hematoma developing after a thoracoplasty in a 67 year old man is presented herein. The patient underwent a right thoracoplasty without removal of plombage and a left thoracoplasty with removal of plombage for tuberculosis of the bilateral upper lobes 27 and 24 years prior to presentation, respectively. He presented to us in May, 1987, with a subscapular tumor which had been growing over the last 5 years. A giant tumor, measuring 23×17×12 cm and weighing 2585 g was successfully removed and the patient has since been well without any evidence of recurrence.