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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.     

Variations of common bile duct diameter after endoscopic sphincterotomy

Diameters of the common bile duct (CBD) and common hepatic duct (CHD) were measured before and after endoscopic sphincterotomy (EPT) in 100 patients. There was a significant reduction of the lumen diameter in both the CBD and CHD (p<0.01) after EPT. A comparison between 32 patients without symptoms (such as pain, residual stones, and elevated levels of liver enzymes) and 19 patients with remaining symptoms after EPT, showed a statistically significant reduction in both CBD and CHD diameters (p< 0.001) in the former group, and no statistically proven changes in the diameters in the latter group, since a change of <1.5 mm was not considered significant. Therefore, the absence of a reduction or a dilatation of the diameter of the CBD after EPT may suggest that these patients may have persisting complaints after EPT.Measurements on models (phantoms) show that body position of the patient during endoscopic retrograde cholangiopancreatography (ERCP) has little and negligible influence on the measured diameters of the CBD and CHD.     

Endoscopic papillary balloon dilation for difficult common bile duct stones: Our experience

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.     

Difference of CBD width on US vs. ERCP

Purpose To investigate the relationship between US and ERCP in the measurement of common bile duct (CBD) width after application of Compound and Harmonic imaging on ultrasound. Methods We prospectively evaluated the CBD width as measured on endoscopic retrograde cholangiopancreatography (ERCP) and ultrasonography (US), applying Compound and Harmonic US techniques, on 100 patients. Furthermore, we retrospectively re-examined US and ERCP images of 48 patients who underwent ERCP and US during the same hospitalization period. Results The average difference in measurements by US compared to ERCP was 2.3 mm (P < 0.01) in the retrospective and 1.9 mm in the prospective study (P < 0.001). The average difference in measurements between US and ERCP in post-cholecystectomy patients was 4.0 mm in the retrospective study (10 patients), and 3.8 in the prospective study (25 patients). The difference between the measurements on both examinations decreased with increasing CBD width. There was a good correlation between ERCP and US measurements of CBD width (r = 0.73 for all patients and r = 0.88 for patients with intact gallbladder, P < 0.001). Conclusions There is a gap between measurement of CBD width on US and ERCP of about 2 mm. The application of Compound and Harmonic techniques in the prospective study probably enabled a more accurate sonographic measurement.     

Outcomes of laparoscopic bile duct exploration for choledocholithiasis with small common bile duct

BACKGROUNDLaparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct (CBD) exploration (LCBDE) is one of the main treatments for choledocholithiasis with CBD diameter of larger than 10 mm. However, for patients with small CBD (CBD diameter ≤ 8 mm), endoscopic sphincterotomy remains the preferred treatment at present, but it also has some drawbacks associated with a series of complications, such as pancreatitis, hemorrhage, cholangitis, and duodenal perforation. To date, few studies have been reported that support the feasibility and safety of LCBDE for choledocholithiasis with small CBD.AIMTo investigate the feasibility and safety of LCBDE for choledocholithiasis with small CBD.METHODSA total of 257 patients without acute cholangitis who underwent LC + LCBDE for cholecystolithiasis from January 2013 to December 2018 in one institution were reviewed. The clinical data were retrospectively collected and analyzed. According to whether the diameter of CBD was larger than 8 mm, 257 patients were divided into large CBD group (n = 146) and small CBD group (n = 111). Propensity score matching (1:1) was performed to adjust for clinical differences. The demographics, intraoperative data, short-term outcomes, and long-term follow-up outcomes for the patients were recorded and compared.RESULTSIn total, 257 patients who underwent successful LC + LCBDE were enrolled in the study, 146 had large CBD and 111 had small CBD. The median follow-up period was 39 (14-86) mo. For small CBD patients, the median CBD diameter was 0.6 cm (0.2-2.0 cm), the mean operating time was 107.2 ± 28.3 min, and the postoperative bile leak rate, rate of residual CBD stones (CBDS), CBDS recurrence rate, and CBD stenosis rate were 5.41% (6/111), 3.60% (4/111), 1.80% (2/111), and 0% (0/111), respectively; the mean postoperative hospital stay was 7.4 ± 3.6 d. For large CBD patients, the median common bile duct diameter was 1.0 cm (0.3-3.0 cm), the mean operating time was 115.7 ± 32.0 min, and the postoperative bile leak rate, rate of residual CBDS, CBDS recurrence rate, and CBD stenosis rate were 5.41% (9/146), 1.37% (2/146), 6.85% (10/146), and 0% (0/146), respectively; the mean postoperative hospital stay was 7.7 ± 2.7 d. After propensity score matching, 184 patients remained, and all preoperative covariates except diameter of CBD stones were balanced. Postoperative bile leak occurred in 11 patients overall (5.98%), and no difference was found between the small CBD group (4.35%, 4/92) and the large CBD group (7.61%, 7/92). The incidence of CBDS recurrence did not differ significantly between the small CBD group (2.17%, 2/92) and the large CBD group (6.52%, 6/92).CONCLUSIONLC + LCBDE is safe and feasible for choledocholithiasis patients with small CBD and did not increase the postoperative bile leak rate compared with chole-docholithiasis patients with large CBD.     

Direct peroral cholangioscopy using an ultraslim upper endoscope for management of residual stones after mechanical lithotripsy for retained common bile duct stones

Background and study aims: The incidence of residual stones after mechanical lithotripsy for retained common bile duct (CBD) stones is relatively high. Peroral cholangioscopy using a mother - baby system may be useful for confirming complete extraction of stones, but has several limitations regarding routine use. We evaluated the role of direct peroral cholangioscopy (DPOC) using an ultraslim upper endoscope for the evaluation and removal of residual CBD stones after mechanical lithotripsy.Patients and methods: From August 2006 to November 2010, 48 patients who had undergone mechanical lithotripsy for retained CBD stones with no evidence of filling defects in balloon cholangiography were recruited. The bile duct was inspected by DPOC after balloon cholangiography. Detected residual CBD stones were directly retrieved with a basket or balloon catheter under DPOC. The incidence of residual stones detected by DPOC, and the success rate of residual stone retrieval under DPOC were investigated.Results: DPOC was successfully performed in 46 of the 48 patients (95.8 %). Of these, 13 patients (28.3 %) had residual CBD stones (mean number 1.4, range 1 - 3; mean diameter 4.5 mm, range 2.3 - 9.6). The residual stones were removed directly under DPOC in 11 of these patients (84.6 %). There were no complications associated with DPOC or stone removal. Conclusion: DPOC using an ultraslim upper endoscope is a useful endoscopic procedure for the evaluation and extraction of residual stones after mechanical lithotripsy for retained CBD stones.     

Effect of cholecystectomy on common bile duct diameters: a longitudinal prospective ultrasonographic study

The medium-term effect of cholecystectomy on common bile duct diameters (CBD) was investigated prospectively in 64 patients with gallstone disease examined by ultrasonography immediately before and 27 months to 39 months after the operation. In 32 patients with chronic cholecystitis and patent cystic ducts, CBD diameters increased slightly (median 4.6 mm pre- and 5.3 mm postoperatively; p less than 0.05). A group of 19 patients with acute cholecystitis or cystic duct occlusion showed a significant decrease (median 7.7 mm pre- and 5.5 mm postoperatively; p less than 0.05). In 13 patients with common bile duct stones, the CBD diameters also decreased significantly after surgical intervention (median 7.5 mm pre- and 5.0 mm postoperatively; p less than 0.05). The widest CBD diameter after cholecystectomy observed in this study was 10 mm. We conclude that either increases or decreases of the CBD diameters may occur after cholecystectomy in patients with calculous gallbladder disease, and that the postoperative evolution is governed by the exact nature of the underlying biliary disease at the time of the index operation.     

Accuracy of linear endoscopic ultrasonography in the evaluation of patients with suspected common bile duct stones

BACKGROUND AND STUDY AIMS: Endoscopic ultrasonography (EUS) with radial scanning is an efficient diagnostic tool where there is suspicion of common bile duct (CBD) stones. Little is known about the use of linear EUS in this condition. The aim of this study was to evaluate the diagnostic efficiency of linear EUS in a large group of patients suspected to have bile duct stones, using endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy and exploration of the CBD using a Dormia basket, or surgical choledochotomy with choledochoscopy, as diagnostic "gold standards." PATIENTS AND METHODS: 134 patients with clinical suspicion of CBD stones were included in the study and prospectively evaluated, using EUS, and ERCP with endoscopic sphincterotomy (127 patients), or choledochotomy with choledochoscopy where ERCP was unsuccessful (seven patients). EUS was done before ERCP using an echo endoscope (Pentax FG 32 UA; 5 - 7.5 MHz) and Hitachi EUB 405 ultrasound machine. ERCP was done using the TFJ 100 or TJ 20 Olympus duodenoscope. ERCP was carried out within a mean of 2 days after EUS. The longest time between EUS and ERCP was 3 days. The examiners were blinded to the results of the other method used. RESULTS: CBD stones were found in 91 (68 %) patients at ERCP with ES or at surgery. The correct diagnosis was established by EUS in 85 patients. The remaining 43 patients without CBD stones were correctly diagnosed in 41 cases by means of EUS, giving an accuracy of 94 %, sensitivity of 93 %, specificity of 93 %, a positive predictive value of 98 %, a negative predictive value of 87 %, and a Youden's index of 89 %. CONCLUSIONS: Linear EUS is a fairly reliable method for the evaluation of patients with high suspicion for CBD stones. The usefulness of linear EUS in the evaluation of patients with low or moderate suspicion for CBD stones warrants further study.     

Factors related to the spontaneous passage of common bile duct stones through the papilla: a single-center retrospective cohort study

ObjectiveCommon bile duct (CBD) stones can spontaneously pass through the papilla. This study explored factors associated with stone passage by comparing differences in the clinical features of stones retained in the CBD and excreted stones.MethodsData were retrospectively collected for all patients who were hospitalized in our center between March 2016 and May 2021 with clinical, laboratory, or imaging evidence of CBD stones. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and were classified into two groups: group A (stones extracted by ERCP, n = 86) and group B (stones discharged before ERCP, n = 15). Demographic data, biochemical and radiological findings were compared between the groups.ResultsStone size (0.82 vs. 0.33 cm), and levels of total bilirubin (58.2 vs. 28.8 μmol/L), gamma-glutamyl transpeptidase (416.7 vs. 193.9 U/L), alkaline phosphatase (191.9 vs. 123.1 U/L), carbohydrate antigen 19-9 (603.7 vs. 37.2 U/mL), and α-L-fucosidase (37.4 vs. 22.6 U/L) were significantly higher in group A than in group B. Logistic regression analyses showed that stone size was the only factor significantly associated with spontaneous passage of CBD stones.ConclusionsCBD stones less than 0.33 cm in size may be self-expelled through the papilla.     

内镜逆行胰胆管造影术在不同类型困难胆管结石中的诊疗体会

目的 探讨内镜逆行胰胆管造影术（ERCP）在胆总管巨大结石、胆总管多发结石和消化道重建术后患者中的治疗效果，分析手术失败的原因及其影响因素。方法 回顾性分析2016年－2019年解放军联勤保障部队第九〇九医院收治的146例经ERCP治疗的困难胆管结石患者的临床资料。其中，A组（n = 43）结石直径 > 15 mm，B组（n = 21）结石数量 > 10枚，C组（n = 82）行上消化道重建。根据ERCP取石是否成功，分为取石成功组（n = 106）和取石失败组（n = 40），比较两组患者ERCP操作时间、插管次数、取石成功率、结石残余率、不良事件发生率、结石直径和消化道重建方式等，采用单因素和多因素分析困难胆管结石患者ERCP手术失败的原因。结果 3组患者操作时间、平均插管次数、结石直径、残余结石和激光碎石比较，差异均有统计学意义（P < 0.05）；单因素分析结果显示：困难胆管结石患者中，ERCP取石成功组与取石失败组ERCP操作时间、插管次数、结石数目、消化道重建和是否首次ERCP比较，差异均有统计学意义（P < 0.05）；多因素分析结果显示：ERCP操作时间、插管次数、多发结石和消化道重建是困难胆管结石患者ERCP取石失败的危险因素（P < 0.05）。结论 ERCP取石在困难胆管结石患者中安全、可行，但需根据个体情况制定合理的治疗方案。     

Preoperative determinants of common bile duct stones during laparoscopic cholecystectomy

Introduction: The aim of this study is to determine whether there are any clinical or biochemical predictors of common bile duct (CBD) stones in patients undergoing laparoscopic cholecystectomy. Methods: A prospective database of nearly 1000 laparoscopic cholecystectomies performed under the care of a single surgeon with a standardised technique between 1999 and 2006, was analysed. Clinical presentation, ultrasound and immediate preoperative biochemical results as well as the operative cholangiogram findings were reviewed. Routine cholangiography was attempted in most patients and the primary outcome variable was the detection of bile duct stones. The data was analysed using chi‐squared test for categorical variables. The significant variables on univariate analysis were further characterised to identify the independent predictors of bile duct stones using a logistic regression model (significance p < 0.05). Results: A total of 757 of 988 patients (77%) underwent cholangiography. Male‐to‐female ratio was 1 : 3 with a median age of 54 years (range: 17–93). Ten per cent of patients had bile duct stones identified on cholangiography. On univariate analysis, jaundice (p = 0.019), cholangitis (p < 0.001), alanine transaminase > 100 (p = 0.024), alkaline phosphatase (ALP) > 350 (p < 0.001) and CBD > 10 mm (p = 0.01) were significant markers for predicting bile duct stones. Bilirubin > 30 (×2 normal) was found not to be significant (p = 0.145). On a logistic regression model, ALP > 350 and/or cholangitis were found to be independent predictive factors of CBD stones (odds ratio 6.1). Conclusions: If a policy of routine intra‐operative cholangiography is not adopted, a history of cholangitis or a raised ALP immediately preoperatively should lead to a high suspicion of CBD stones.     

Virtual CT cholangiography in patients with choledocholithiasis

Background: We evaluated the feasibility and accuracy of virtual computed tomographic cholangiography (VCTC) in detecting choledocholithiasis and imaging anatomic variations of the biliary tree. Methods: Thirty-three consecutive patients with clinical and biological signs of choledocholithiasis underwent spiral CT after intravenous infusion of iotroxindimeglumine. Patients with total serum bilirubin levels above 3 mg/dL were not included in this study. Spiral data sets were used to construct intralumenal images of the biliary tree. The images were reviewed by two abdominal radiologists. The biliary ducts were divided into three segments, so the analysis was based on 99 segments. The diagnosis obtained by VCTC was compared with the final diagnosis established by endoscopic retrograde cholangiography or intraoperative cholangiography. Results: VCTC correctly depicted biliary stones in nine of 10 patients and anatomic variations in all five patients, and no false-positive cases were observed. VCTC showed excellent endolumenal visualization of 87 of 99 segments of the biliary tree. The processing time (9.3 ± 2.1 min) was particularly short. Conclusion: VCTC with intravenous infusion of iotroxindimeglumine may be a feasible clinical tool, with acceptable accuracy in selected cases.     

Common bile duct morphology is associated with recurrence of common bile duct stones in Billroth II anatomy patients

BACKGROUNDEndoscopic retrograde cholangiopancreatography (ERCP) is the primary choice for removing common bile duct (CBD) stones in Billroth II anatomy patients. The recurrence of CBD stones is still a challenging problem.AIMTo evaluate CBD morphology and other predictors affecting CBD stone recurrence.METHODSA retrospective case-control analysis was performed on 138 CBD stones patients with a history of Billroth II gastrectomy, who underwent therapeutic ERCP for stone extraction at our center from January 2011 to October 2020. CBD morphology and other predictors affecting CBD stone recurrence were examined by univariate analysis and multivariate logistic regression analysis.RESULTSCBD morphology (P < 0.01) and CBD diameter ≥ 1.5 cm (odds ratio [OR] = 6.15, 95% confidence interval [CI]: 1.87-20.24, P < 0.01) were the two independent risk factors. In multivariate analysis, the recurrence rate of patients with S type was 16.79 times that of patients with straight type (OR = 16.79, 95%CI: 4.26-66.09, P < 0.01), the recurrence rate of patients with polyline type was 4.97 times that of patients with straight type (OR = 4.97, 95%CI: 1.42-17.38, P = 0.01), and the recurrence rate of S type patients was 3.38 times that of patients with polyline type (OR = 3.38, 95%CI: 1.07-10.72, P = 0.04).CONCLUSIONCBD morphology, especially S type and polyline type, is associated with increased recurrence of CBD stones in Billroth II anatomy patients.     

Electrohydraulic lithotripsy and rendezvous nasal endoscopic cholangiography for common bile duct stone: A case report

BACKGROUND In patients with large stones in the common bile duct(CBD),advanced treatment modalities are generally needed.Here,we present an interesting case of a huge CBD stone treated with electrohydraulic lithotripsy(EHL)by the percutaneous approach and rendezvous endoscopic retrograde cholangiography(ERC)using a nasal endoscope.CASE SUMMARY A 91-year-old woman underwent ERC for a symptomatic large CBD stone with a diameter of 50 mm.She was referred to our institution after the failure of lithotomy by ERC,and after undergoing percutaneous transhepatic biliary drainage.We attempted to fragment the stone by transhepatic cholangioscopy using EHL.However,the stones were too large and partly soft clay-like for lithotripsy.Next,we attempted lithotomy with ERC and cholangioscopy by the rendezvous technique using a nasal endoscope and achieved complete lithotomy.No complication was observed at the end of this procedure.CONCLUSION Cholangioscopy by rendezvous technique using a nasal endoscope is a feasible and safe endoscopic method for removing huge CBD stones.     

胆总管结石术后经鼻胆引流管注射生理盐水在超声检查残留结石中的应用

目的 探讨胆总管结石术后经鼻胆引流管注射生理盐水在超声检查残留结石中的应用价值。方法 对50例经内镜逆行胰胆管造影术（ERCP）、十二指肠镜下乳头括约肌切开术（EST）、内镜鼻胆管引流术（ENBD）诊治胆总管结石的术后患者行常规超声及超声联合鼻胆引流管注射生理盐水检查,对比注射生理盐水前后超声测量胆总管长度、宽度及残留结石的检出率。结果 50例患者注射生理盐水前后胆总管全程显示率分别为18.00%（9/50）、90.00%（45/50）;注射生理盐水前后超声检查胆总管长度分别为（2.63±0.26）cm、（5.79±2.17）cm,宽度分别为（0.49±0.35）cm、（0.99±0.35）cm,差异均有统计学意义（t=11.03、10.81,P均<0.01）。注射生理盐水前疑似胆总管结石1例,注射生理盐水后另增5例疑似存在胆总管结石,其中5例行ERCP检查：ERCP检查4例证实为胆总管结石,1例未见明显结石;1例经手术证实为胆总管结石。结论 经鼻胆管引流管注射生理盐水可提高胆总管显示率,进而提高对残留结石的检出率。     

Combined endoscopic and laparoscopic treatment of common bile duct stones

In a consecutive series of 228 patients reterred to Kalundborg Sygehus, Surgical Department, for treatment of gall bladder disease, 17 patients had common bile duct (CBD) stones. Nine were found pre-operatively and treated with endoscopic retrograde cholangiography (ERC), papillotomy and stone extraction. In two cases, however, the ERC procedure failed and the patients were treated successfully using laparoscopic therapy. Six CBD stones were found during laparoscopic surgery. Four of these patients were treated with laparoscopic stone extraction. In two patients laparoscopic stone extraction was not possible and they were treated post-operatively with ERC and stone extraction. Two CBD stones were discovered after laparoscopic cholecystectomy. One was treated with ERC and stone extraction, the other with open surgery. By combining endoscopic and laparoscopic procedures, it is possible in most cases to avoid open surgery for the treatment of CBD stones.     

线阵超声内镜对胆总管结石的诊断价值研究

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。     

Dynamic MRI in indirect estimation of microvessel density,histologic grade,and prognosis in colorectal adenocarcinomas

The relations of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters to microvessel density (MVD), histologic grade, and presence of metastasis were evaluated to establish new prognostic indicators in colorectal cancer (CRC). Fast-low angle shot DCE-MRI parameters (time-intensity curves, TICs; maximal relative enhancement within the first minute, E_max/1; maximal relative enhancement of the entire study, E_max; steepest slope of the contrast enhancement curve; and time to peak enhancement) of 21 CRCs (seven Duke stage B, 12 Duke stage C, and two Duke stage D) were retrospectively evaluated and correlated with corresponding postoperative MVD measurements, histologic grades, and presence of metastasis at 2 years. TICs were classified as type A in nine (43%), type B in seven (33%), and type C in five cases (24%). There was a significant difference between TIC types with regard to MVD (p < 0.05–0.001). Time to peak enhancement, steepest slope of TIC, and E_max/1 were strongly correlated with MVD (r = –0.765, p < 0.01; r = 0.681, p < 0.01; r = 0.634, p < 0.01; respectively). MVD, steepest slope of the enhancement curve, E_max/1, and E_max strongly correlated with histologic grade (r = 0.475, p < 0.05; r = 0.683, p < 0.01; r = 0.687, p < 0.01; r = 0.791, p < 0.01; respectively). There was a significant difference between groups of patients with and without metastasis with regard to histologic grade (p < 0.05) and two of the DCE-MRI parameters (p < 0.005 for E_max/1 and p < 0.05 for time to peak enhancement). Discriminant analysis correctly predicted the metastatic occurrence at 2 years in 90.5% of cases using E_max/1 (p < 0.001). Histologic grade resulted in lower rates of discrimination (66.7%; p < 0.05). DCE-MRI parameters may help in the prediction of MVD and histologic grade in CRC and may be used to predict therapeutic outcome.     

胆道留置导丝取石法在胆管大结石治疗中的应用

目的 探讨胆道留置导丝取石在胆管大结石治疗中的安全性及应用价值。方法 回顾性分析2017年1月-2019年12月该院收治的308例胆管大结石（1.2～1.5 cm）患者的临床资料。其中,网篮组152例,气囊组42例,联合组38例,导丝组76例,分析不同取石方法的效果。结果 308例患者均成功取石或置入胆道塑料支架。导丝组取石成功率高于其他组,但差异无统计学意义（P> 0.05）;导丝组结石嵌顿率较其他组低,差异有统计学意义（P <0.05）;导丝组内镜逆行胰胆管造影术（ERCP）后并发症总发生率为10.5%(8/76),低于其他组,但差异无统计学意义（P> 0.05）。其中,术后胰腺炎和高淀粉酶血症低于其他组,但差异无统计学意义（P> 0.05）,4组患者术后胆管炎比较,差异无统计学意义（P> 0.05）,网篮组和联合组各有1例术后迟发性出血,经内镜止血后好转,4组患者均未发生穿孔或死亡等严重并发症。导丝组手术时间明显短于其他组,差异有统计学意义（P <0.05）,住院时间较其他组短,但差异无统计学意义（P> 0.05）。结论 应用胆道导丝留置...     

胆囊切除术后残留胆总管结石的内镜诊治

目的：探讨经内镜逆行胰胆管造影（ERCP）在胆囊切除术后残留胆总管结石诊治中的应用价值。方法：对胆囊切除术后腹痛、发热、黄疸或肝功能异常而经B超、CT或磁共振胰胆管造影（MRCP）证实或怀疑残留胆总管结石的患者进行ERCP检查，对发现胆总管结石的患者行EST或EPBD后取石。结果：ERCP检查的成功率为96．4％（108／112）。85例证实胆总管结石的患者行EST或EPBD后取石，79例（92．9％）取石治疗成功；6例因合并肝内胆管多发结石而行外科手术治疗。并发症发生率为4．5％，其中消化道出血2例，急性胰腺炎3例。结论；对于胆囊切除术后残留胆总管结石的患者，ERCP是理想的诊断方法，而且还可以同时进行治疗。