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胆总管结石内镜治疗术后安置鼻胆管的临床价值 总被引:1,自引:1,他引:0
目的:评估胆总管结石行十二指肠乳头切开术(EST)后放置鼻胆管引流(ENBD)的临床价值。方法:112例胆总管结石患者行EST,其中45例术后放置ENBD,根据腹痛消失时间、血淀粉酶正常时间、发热降至正常时间、平均住院时间等指标进行评估。结果:治疗组在各项指标上均优于对照组(P<0.05)。结论:胆总管结石行EST后放置ENBD能起到减压、冲洗胆道、加强抗炎等作用,明显减少了患者的痛苦及并发症的发生、缩短住院时间,具有一定的临床价值。 相似文献
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[目的]探讨胆总管下段结石腹部超声检查的技巧.[方法]对161例胆总管下段结石患者术前行腹部超声检查,采用二次谐波成像技术和改变体位的超声检查手法,将超声诊断结果与手术结果进行比较,探讨各种超声检查技巧在诊断胆总管下段结石中的应用价值.[结果]161例患者超声检查结果与手术结果比较,其中151例超声诊断为胆总管下段结石,经手术诊断143确诊,误诊8例;10例超声诊断无胆总管下段结石者,经超声造影诊断结石6例,经手术诊断1例为Vater壶腹小结石.超声诊断胆总管下段结石灵敏度为99.3%.[结论]应用腹部探头扫查方便、实用、无创、安全,只要熟练掌握胆道解剖、操作技巧,腹部探头同样能达到与腔内探头相同的效果. 相似文献
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目的:探讨超声引导下经内镜治疗胆总管结石的有效性及安全性.方法:52例经超声和磁共振胰胆管造影检查确诊的胆总管结石患者,行超声引导下经内镜十二指肠乳头括约肌切开取石治疗.结果:成功取出结石48例,成功率92.3%;发生一过性血清淀粉酶增高3例、胆管炎1例,未发生出血、穿孔等并发症.结论:超声引导下经内镜治疗胆总管结石安全、有效,同时可避免X线对医患双方的辐射. 相似文献
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预置鼻胆管联合腹腔镜治疗胆囊结石合并胆总管结石 总被引:1,自引:3,他引:1
目的 探讨预置鼻胆管引流联合腹腔镜治疗胆囊结石合并胆总管结石的方法。方法 对于胆囊结石合并单纯性胆总管结石的病人 ,术前行ERCP检查 ,证实为胆总管结石 ,胆道无狭窄 ,胆总管下端通畅 ,肝内胆管无结石 ,术前 1~ 5d预置鼻胆管引流。腹腔镜下常规切除胆囊 ,显露胆总管 ,用弯剪刀纵行切开胆总管 ,通过胆石钳、加压冲洗、挤压胆总管、胆道镜取石等方法取尽结石 ,保留鼻胆管引流 ,胆总管一期缝合 ,置腹腔引流管。结果 本组 2 7例 ,手术时间 75~ 190min ,平均 (12 3.6± 4 5 .4 )min ,2 7例病人均于术后 4~ 9d出院。平均住院时间 (6 .1± 1.2 )d。术后 3~ 5d或黄疸明显消退后拔除鼻胆管 ,观察 1~ 2d无异常出院。放置鼻胆管时间为 6~ 10d ,平均 (7.2± 1.3)d。 7例黄疸病人术后黄疸均有明显减退。 3例发生胆漏 ,1例引流4d ,1例引流 8d胆漏停止。 1例病人带管出院 ,1月后拔除引流管。结论 对于胆囊结石合并单纯胆总管结石的病人 ,术前ERCP检查可以明确诊断同时预置鼻胆管引流 ,对于梗阻性黄疸的病人可以达到减黄的目的。术中胆总管切开 ,结石取尽后 ,保留鼻胆管可以进行胆道减压、预防胆漏的发生。梗阻性黄疸的病人可以起到继续减黄的作用。 相似文献
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目的 探讨胃大部切除术后胆总管结石患者行超声内镜检查术(EUS)的价值和意义。方法 回顾性分析2020年-2021年该院收治的83例远端胃大部切除术后因胆管总结石行内镜逆行胰胆管造影术(ERCP)的患者的临床资料。根据是否行EUS分为观察组(n = 40)和对照组(n = 43),观察组采用EUS+ERCP,对照组采用ERCP,分析观察组EUS诊断胆总管结石的准确率,对比两组患者ERCP成功率、插管次数、操作时间、不良事件发生率、透视时间和总辐射剂量,采用单因素和Logistic多因素分析影响入组患者ERCP手术成功率的因素。结果 EUS诊断准确率(90.00%)高于磁共振胰胆管成像(MRCP)(79.52%),但差异无统计学意义(χ2 = 2.10,P = 0.203);观察组手术时间和透视时间明显短于对照组,插管次数和辐射剂量明显少于对照组,取石成功率高于对照组,差异均有统计学意义(t = -14.64、t = -3.64、t = -4.33、t = -8.64和χ2 = 4.60,P < 0.05);单因素分析发现,EUS、腹腔镜手术和多发结石是影响ERCP取石成功率的因素(χ2 = 16.32、χ2 = 12.22和χ2 = 7.47,P < 0.05);Logistic多因素分析发现,EUS和腹腔镜手术是影响ERCP取石成功率的独立危险因素(95%CI:0.573~1.215,95%CI:0.958~1.969)。结论 对于胃大部切除术后胆总管结石患者,ERCP取石前行EUS,可以减少手术时间,提高取石成功率,具有一定的临床意义。 相似文献
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目的探讨胆系结石术后肝胆管超声检查的临床价值。方法通过观察肝、胆管及邻周表现,对137例胆系结石术后4d至11年的声像图表现进行分析.并与手术方式对照。结果137例中超声诊断:(1)肝胆管正常57例;(2)肝外胆管扩张26例;(3)残留胆囊管扩张5例,其中1例并肝外胆管扩张,2例并胆管残留结石;(4)胆管积气11例;(5)胆管残留结石或再发结石39例;(6)胆管损伤2例。分别占41.6%,19.0%,3.6%,8.0%,28.5%,1.5%。结论术后超声检查对评价手术效果、发现并发症、指导临床治疗具有重要的临床应用价值。 相似文献
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经内镜乳头气囊扩张术治疗胆总管结石 总被引:3,自引:1,他引:2
经内镜乳头气囊扩张术 (EndoscopicPapillaryBalloonDilation ,EPBD)是近年来发展起来的一种内镜治疗胆总管结石的方法 ,最早于 1983年由Staritz等人首先提出并应用于临床。目前已在日本、美国、德国、爱尔兰、荷兰 ,我国大陆及台湾等地的一些内镜中心广泛开展 ,并对其临床使用效果、安全性、并发症等做了一定程度的研究 ,总体结果令人满意。由于EPBD操作较现已成熟的内镜括约肌切开术(EndoscopicSphincterotomy ,EST)简单、安全 ,且不损伤乳头括约肌功能 ,因… 相似文献
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目的探讨超声诊断胆总管结石的价值。方法回顾分析210例胆总管结石患者的术前超声检查、手术记录,对比分析超声检查方法与手术结果。结果超声检查胆总管结石的准确率为97.6%(205例),漏诊率为1.8%(4例)误诊率0.6%(1例)。结论采取多种方法检查可以提高胆总管结石诊断率。 相似文献
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目的探讨术中留置鼻胆管引流在腹腔镜下胆总管一期缝合中的价值和意义。方法 62例胆总管结石患者随机分为两组,研究组行腹腔镜胆总管切开(LCBDE)一期缝合+内镜下鼻胆管引流术(ENBD),而对照组行腹腔镜胆总管切开、胆道探查+T管引流术,比较两组的临床效果。结果两组患者均成功实施腹腔镜手术,无1例病患中转开放手术。研究组术后肠道功能恢复时间、拔除引流管时间和术后平均住院时间等均少于对照组,两组资料比较,差异具有统计学意义(P0.05)。而手术持续时间、术中总出血量及手术后并发症如胆漏、胆道残余结石和胆道狭窄等的发生率等两组患者比较差异无统计学意义(P0.05)。所有患者出院后均随访6~12个月,平均9个月,没有发现胆道狭窄、胆管残余结石等并发症。结论鼻胆管引流能有效引流胆汁,减轻胆道压力,保障腹腔镜胆总管切开一期缝合的安全,缩短住院时程,提升患者满意度,临床应用安全、有效、可行。 相似文献
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目的 对比胆道支架和鼻胆管引流在腹腔镜胆总管探查术(LCBDE)后一期缝合中的临床疗效。方法 回顾性分析2016年8月-2021年1月在该院行内镜逆行胰胆管造影术(ERCP)取石失败的74例患者的临床资料,分为支架引流组(n = 38)和鼻胆管引流组(n = 36)。支架引流组ERCP取石失败后放置胆道支架引流,鼻胆管引流组ERCP取石失败后放置鼻胆管引流,两组患者均行腹腔镜胆总管切开取石一期缝合术。比较两组患者手术时间、术后住院时间、术后并发症发生率、术后肠道功能恢复时间、术后胆总管结石复发率和住院时间。结果 两组患者胆管缝合方式、手术时间、术中出血量、术后并发症总发生率和住院费用比较,差异均无统计学意义(P > 0.05)。鼻胆管引流组术后胆瘘发生率明显低于支架引流组,住院时间明显短于支架引流组,术后肠道功能恢复时间明显长于支架引流组,术后总补液量多于支架引流组,差异均有统计学意义(P < 0.05)。结论 ERCP取石失败后放置鼻胆管引流,可降低LCBDE术后一期缝合的胆瘘发生率,缩短住院时间,但放置胆道支架引流患者肠道功能恢复更快,补液量更少。因此,在临床操作中,应根据患者具体情况,选择相应的个体化引流方式。 相似文献
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线阵超声内镜对胆总管结石的诊断价值研究 总被引:1,自引:0,他引:1
目的探讨线阵超声内镜对胆总管结石的诊断价值。方法对35例腹部B超发现胆总管扩张,临床怀疑胆总管结石的患者行线阵超声内镜检查,并在3d内再行ERCP及乳头扩约肌切开胆总管取石,以取石的结果计算线阵超声内镜诊断的准确率、灵敏度、特异度、阳性预测值、阴性预测值及Youden指数。结果35例患者中,经线阵超声内镜检查及胆总管取石结石均阳性者22例,阳性率为62.8%(22/35),均阴性者12例。线阵超声内镜检查有1例假阳性,无假阴性。与胆总管取石比较,线阵超声内镜诊断胆总管结石的准确率为97.1%,灵敏度为100%,特异度为92.3%,阳性预测值为95.6%,阴性预测值100%,Youden指数为92.3%,且未出现并发症。结论线阵超声内镜检查是诊断胆总管结石安全而可靠的方法。 相似文献
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腹腔镜胆总管切开取石术后胆道引流方法的改进 总被引:7,自引:2,他引:5
胆总管切开取石术后能否一期缝合的争论由来已久[1],一般认为胆总管一期缝合前须放置适当的胆道引流。我们在临床工作中探索制作了一胆道内置引流管,在腹腔镜胆总管切开取石术后用胆道内置管引流,胆总管一期缝合,效果较满意[2],现将我们的经验介绍如下。1资料与方法1.1临床资料 相似文献
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目的比较分析腹腔镜胆总管探查取石术后鼻胆管引流与T管引流治疗胆囊结石合并胆总管结石(CBDS)的临床疗效。探讨腹腔镜胆总管探查、一期缝合并经腹置鼻胆管引流术的临床经验。方法回顾性分析成都市第二人民医院肝胆胰外科2014年5月-2015年5月55例胆囊结石合并CBDS患者分别行腹腔镜下胆囊切除术+胆总管探查+一期缝合术+经腹置鼻胆管引流30例(鼻胆管组)及腹腔镜下胆囊切除术+胆总管探查+T管引流25例(T管组)的临床资料,对比分析两组患者的临床治疗情况。结果两组手术时间、术后住院时间、胃肠功能恢复时间和胆道引流管留置时间差异有统计学意义(P0.05),鼻胆管组更具优势;术中出血量,术后第1天胆汁引流量差异无统计学意义(P0.05);术后第2和3天胆汁引流量差异有统计学意义(P0.05),T管组优势更明显。T管组术后并发症共11例(44.0%),鼻胆管组共10例(33.3%),差异无统计学意义(P0.05),但术后水、电解质紊乱致厌食、恶心等消化道症状几乎均由T管引流造成,两组差异有统计学意义(P0.05)。结论腹腔镜胆总管探查取石术后鼻胆管引流扩大了胆总管一期缝合的适应证,避免了T管引流的一系列弊端,并未增加胆漏、结石残留及胆道狭窄等并发症发生率,体现了微创外科技术的优越性,适应证范围内治疗胆囊结石合并CBDS安全、有效。 相似文献
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Maddalena Zippi Isabella De Felici Roberta Pica Giampiero Traversa Giuseppe Occhigrossi 《World Journal of Clinical Cases》2013,1(1):19-24
AIM: To evaluate the efficacy and safety of endoscopic balloon dilation (EBD) performed for common bile duct (CBD) stones.METHODS: From a computer database, we retrospectively analyzed the data relating to EBD performed in patients at the gastrointestinal unit of the Sandro Pertini Hospital of Rome (small center with low case volume) who underwent endoscopic retrograde cholangiopancreatography (ERCP) for CBD from January 1, 2010 to February 29, 2012. All patients had a proven diagnosis of CBD stones studied with echography, RMN-cholangiography and, when necessary, with computed tomography of the abdomen (for example, in cases with pace-makers). Prophylactic therapies, with gabexate mesilate 24 h before the procedure and with an antibiotic (ceftriaxone 2 g) 1 h before, were administered in all patients. The duodenum was intubated with a side-viewing endoscope under deep sedation with intravenous midazolam and propofol. The patients were placed in the supine position in almost all cases. EBD of the ampulla was performed under endoscopic and fluoroscopic guidance with a balloon through the scope (Hercules, wireguided balloon®, Cook Ireland Ltd. and CRE®, Microvasive, Boston Scientific Co., Natick, MA, United States).RESULTS: A total of 14 patients (9 female, 5 male; mean age of 73 years; range 57-82 years) were enrolled in the study, in whom a total of 15 EBDs were performed. All patients underwent minor endoscopic sphincterotomy (ES) prior to the EBD. The size of balloon insufflation depended on stone size and CBD dilation and this was performed until it reached 16 mm in diameter. EBD was performed under endoscopic and fluoroscopic guidance. The balloon was gradually filled with diluted contrast agent and was maintained inflated in position for 45 to 60 s before deflation and removal. The need for precutting the major papilla was 21.4%. In one patient (an 81-year-old), EBD was performed in a Billroth II. Periampullary diverticula were found only in a 74-year-old female. The adverse event related to the procedures (ERCP + ES) was only an intra procedural bleeding (6.6%) that occurred after ES and was treated immediately with adrenaline sclerotherapy. No postoperative complications were reported.CONCLUSION: With the current endoscopic techniques, very few patients with choledocholithiasis require surgery. EBD is an efficacious and safe procedure. 相似文献
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目的 探讨利胆药物预防内镜逆行胰胆管造影(ERCP)术后胆总管结石复发的远期疗效。方法 回顾性分析2017年接受ERCP胆总管取石术患者的临床资料,分析患者病例资料特点,包括患者年龄、初次ERCP和再次ERCP比例、是否留置支架、是否服用利胆药物、结石复发情况,分析结石复发与十二指肠乳头旁憩室的关系。入选胆总管结石复发高危人群,建议应用胆宁片24周以上,观察用药后患者结石复发情况。结果 共911例胆总管结石患者在ERCP术后完成随访。其中男性457例、女性454例,中位年龄69岁。605例患者初次行ERCP术,306例患者既往行取石术或乳头切开术。术后留置胆道支架患者370例,其中初次ERCP患者301例,再次ERCP患者中有69例更换胆道支架。再次ERCP患者留置支架比例低于初次ERCP患者(22.5%vs 49.8%,P<0.000 1)。初次ERCP患者中,253例有乳头旁憩室、176例结石复发,有憩室患者结石复发率高于无憩室患者(34.0%vs 25.6%,P<0.05)。分别有80例入选长程组(治疗24周以上)和短程组(治疗不足12周),长程组58例、短程组64例... 相似文献
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Yong-Gang He Jing Li Xue-Hui Peng Jing Wu Ming-Xun Xie Yi-Chen Tang Lu Zheng Xiao-Bing Huang 《World Journal of Clinical Cases》2021,9(22):6254-6267
BACKGROUNDEndoscopic retrograde pancreatic drainage (ERPD) and stent implantation has become the major treatment method for pancreatic pseudocysts. However, it is associated with a high recurrence rate and infection.AIMTo manage pancreatic pseudocysts by sequential therapy with endoscopic naso-pancreatic drainage (ENPD) combined with ERPD and evaluate the treatment outcome.METHODSOne hundred and sixty-two cases of pancreatic pseudocyst confirmed by endoscopic examination at our hospital between January 2014 and January 2020 were retrospectively analyzed. There were 152 cases of intubation via the duodenal papilla, of which 92 involved pancreatic duct stent implantation and 60 involved sequential therapy with combined ENPD and ERPD (two-step procedure). The success rate of the procedure, incidence of complications (infection, bleeding, etc.), recurrence, and length and cost of hospitalization were compared between the two groups.RESULTSThe incidence of infection was significantly higher in the ERPD group (12 cases) than in the two-step procedure group (2 cases). Twelve patients developed infection in the ERPD group, and anti-infection therapy was effective in five cases but not in the remaining seven cases. Infection presented as fever and chills in the two-step procedure group. The reoperation rate was significantly higher in the ERPD group with seven cases compared with zero cases in the two-step procedure group (P < 0.05). Similarly, the recurrence rate was significantly higher in the ERPD group (19 cases) than in the two-step procedure group (0 cases).CONCLUSIONSequential therapy with combined ENPD and ERPD is safe and effective in patients with pancreatic pseudocysts. 相似文献
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Karincaoglu M Yildirim B Seckin Y Kantarceken B Aladag M Hilmioglu F 《Abdominal imaging》2003,28(4):0531-0535
Background: One of the most reliable, frequently used imaging techniques in cholestasis is ultrasonography (US) for the diagnosis of common bile duct (CBD) stones.
Methods: In this study, changes in diameters of CBD were determined ultrasonographically before and after endoscopic sphincterotomy (ES) in 46 patients with stone-induced dilated CBD.
Results: There was a significant decrease in CBD diameter measured 1 week after ES and extraction of stone (p < 0.001). In 87% of cases, the difference was more significantly pronounced during the first 24 h of ES. The mean CBD diameters on US were 13.70 ± 3.00 mm (10–21 mm) before and 9.13 ± 2.90 mm (4.2–18 mm) 24 h after endoscopic treatment (p < 0.001). After ES, six patients (13%) with inadequate decreases in CBD diameters were found to have residual stones.
Conclusion: US can show residual stones in the CBD with the same efficacy as endoscopic retrograde cholangiopancreatography. 相似文献
20.
目的:探讨经内镜鼻胆管引流术(ENBD)在老年重症胆管炎治疗中的安全性。方法:对2007年5月—2011年5月经ENBD诊治的重症胆管炎病例共42例进行回顾性分析。按年龄将其分为65-75岁年龄组和75岁以上年龄组,比较两组ENBD操作成功率及术后并发症发生率。结果:65-75岁年龄组ENBD操作成功率90.0%(18/20),75岁以上年龄组成功率86.4%(19/22),两组比较差异无统计学意义(P〉0.05)。并发症发生率65-75岁年龄组为3.7%,75岁以上年龄组为4.8%,两组比较差异无统计学意义(P〉0.05)。但75岁以上年龄组有1例患者死亡。结论:高龄对ENBD操作成功率及操作相关并发症发生率并无明显影响,同时有心、肺、脑功能并发症时ENBD操作仍有较大风险。 相似文献