ERCP合并EST治疗老年胆总管结石256例分析

目的分析内镜逆行性胰胆管造影(ERCP)合并内镜乳头括约肌切开术(EST)治疗老年胆总管结石的临床疗效并讨论其临床意义。方法回顾性分析老年胆总管结石患者256例,通过ERCP掌握患者结石特征,并经内镜乳头括约肌切开术(EST)进行取石治疗。结果 256例胆管结石患者插管成功249例(97.27%),EST取石成功239例(93.36%),其中1次成功后取石199例(83.26%),2次成功40例(16.74%)。有7例患者(2.73%)因多发憩室,乳头位置不佳插管失败转手术治疗。ERCP合并EST后行内镜下鼻胆管引流术(ENBD)64.44%(154/239),引流3~5 d后造影证实结石取净90.91%(140/154)拔除了引流管,14例(9.09%)残余结石行2次内镜取石。术后并发症15例(6.02%),包括急性胰腺炎9例,胆道感染6例,给予相应治疗1周后痊愈。出现一过性血淀粉酶升高39例未做特殊处理,3 d后恢复正常。结论老年胆总管结石行ERCP(或EST)耐受性好,疗效显著且恢复快,有条件医院可以推广应用。     

经内镜逆行胰胆管造影术后并发胰腺炎危险因素分析

目的探讨经内镜逆行胰胆管造影术（ERCP）后并发胰腺炎（PEP）的危险因素,为PEP的预防提供参考。方法回顾性分析1 896例ERCP患者,分为PEP组（n=285）及无PEP组（n=1 161）,对比分析两组各相关危险因素,涉及患者因素、操作因素及术者因素。结果患者因素中女性、年龄（小于60岁）、胰腺炎病史、无胆总管结石、疑有Odd i括约肌功能障碍者易并发PEP（P〈0.05）;而有无胆红素增高、胆总管直径过小（小于0.4 cm）、有无壶腹部憩室、合并糖尿病、高血压与PEP的发生无显著相关性（P〉0.05）。操作因素中胰腺显影、胰管括约肌切开术、胆道括约肌气囊扩张术患者在PEP组所占比例明显高于无PEP组（P〈0.05）;而治疗性或诊断性ERCP、Odd i括约肌测压术、胆道括约肌切开术患者在两组中所占比例无显著差异。术者操作例数少、操作时间长、插管困难或失败与PEP的发生相关（P〈0.05）;而ERCP操作失败与PEP无关（P〉0.05）。结论年龄小于60岁的女性,且有胰腺炎病史和疑有Odd i括约肌功能障碍、胰腺显影差、术者熟练性差、插管困难等是PEP的主要危险因素。     

内镜下治疗老年人胆总管结石47例临床分析

目的 评价内镜下治疗老年人胆总管结石的疗效与安全性.方法 依据临床手术指征,对47例胆总管结石的老年患者行内镜下逆行胰胆管造影(ERCP),十二指肠乳头括约肌切开术(EST)、乳头开窗术、鼻胆管引流术(ENBD)等治疗,对其临床资料进行回顾性分析.结果 本组中45例常规ERCP成功,成功率95.7%,另2例因结石嵌顿乳头深入插管困难者采用乳头开窗术取石成功;一次取结石40例,放置鼻胆管引流后二次取石成功6例,总成功率97.8%.术后出现高淀粉酶血癌2例,急性胰腺炎1例,少量肠道出血2例,无大出血、穿孔等严重并发症,平均住院9d.结论 老年胆总管结石患者内镜治疗安全有效,并发症发生率低,患者痛苦小,术后恢复快,值得临床推广.     

B超、MRCP、ERCP诊断胆总管结石的对比分析

目的探讨B超、磁共振胆胰管成像（MRCP）、内镜逆行胰胆管造影术（ERCP）对胆总管结石的诊断价值。方法收集我院2007年4月至2010年9月胆总管结石患者214例,以内镜下十二指肠乳头括约肌切开术取出结石为诊断标准,对B超、MRCP、ERCP3种检查方法进行对比分析。结果 ERCP诊断胆总管结石的敏感性为99%,显著高于MRCP的90%,差异有统计学意义（χ2=15.58,P〈0.01）;MRCP的敏感性亦明显高于B超（38.5%）,差异有统计学意义（χ2=115.4,P〈0.01）。B超、MRCP、ERCP诊断胆总管结石的特异性分别为92.8%、92.9%、100%,3种诊断方法比较差异无统计学意义。MRCP诊断胆总管结石的准确性为93.3%,显著高于B超（85.6%）,差异有统计学意义（χ2=4.37,P=0.037）,但与ERCP（93.4%）比较差异无统计学意义（χ2=0.03,P=0.95）。结论 B超对于胆总管结石的诊断具有一定的准确率,可作为最基本的检查手段,MRCP和ERCP对于胆总管结石的诊断具有较高的一致性,MRCP可部分替代诊断性ERCP,ERCP具备诊断及治疗双重效果,地位不可替代。     

内镜逆行胰胆管造影取石术与开腹手术治疗胆总管结石的疗效比较

目的 探讨内镜逆行胰胆管造影(ERCP)取石术治疗胆总管结石的有效性和安全性.方法 选取2012年1月至2013年3月本院就诊的胆总管结石患者100例,按随机数字表分为治疗组(n=50)和对照组(n=50),分别采用ERCP取石术和开腹手术进行治疗.比较两组患者的手术情况、手术费用和住院费用.术后2周,记录患者的临床疗效和术后并发症情况.术前和术后2周采用胃肠疾病生活质量指数(GIQLI)量表对患者的生活质量进行评价.结果 治疗组患者的手术时间、术中出血量、术后通气时间、切口疼痛时间及住院天数均少于对照组(均P＜0.05).而两组患者的住院费用、结石未净的发生率、血清总胆红素(TBIL)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)水平差异均无统计学意义(均P＞0.05).治疗组患者术后高淀粉酶血症的发生率高于对照组(P＜0.05).治疗2周后随访显示,治疗组患者的自觉症状、心理情绪和生活质量总评分均显著高于对照组(均P＜0.05).结论 ERCP取石术治疗胆总管结石的有效性和安全性较高.     

内镜下乳头小切开联合球囊扩张在胆总管结石治疗中的应用

目的观察内镜下十二指肠乳头括约肌切开术(EST)联合内镜乳头气囊扩张术(EPBD)治疗胆总管结石的手术效果。方法将年龄23~82岁的192例胆总管结石患者随机分为EST组和EST+EPBD组,各96例,比较2种手术的疗效。结果EST+EPBD组的平均手术时间、住院时间比较均显著少于EST组;一次性取石成功数及总成功取石成功数明显高于EST组。2组出血量、胰腺炎、胆道内钡剂反流、结石复发等多项并发症的比较,均有显著统计学意义差异(P0.05),EST+EPBD组术中术后并发症显著减少。结论内镜下乳头小切开联合球囊扩张可较大提高胆总管结石取石成功率,并减少术后并发症发生。     

EST联合LC与开腹手术治疗胆囊胆总管结石的临床对比分析

目的 比较EST联合LC与开腹胆囊切除、胆总管切开取石、T管引流术治疗胆囊结石合并胆总管结石的结果，评价EST联合LC治疗胆囊结石合并胆总管结石的价值。方法 回顾性分析77例胆囊结石合并胆总管结石的治疗方法和结果。其中23例行内镜十二指肠括约肌切开联合腹腔镜胆囊切除术（EST＋LC）。54例开腹胆囊切除、胆总管切开取石、T管引流术（OC＋OCHTD），比较二者的治疗成功率、术后并发症发生率、胃肠功能恢复时间、住院时间、住院费用等，进行统计学分析。井对出院后情况进行随访。结果 两组病例的治疗成功率、并发症发生率无显著性差异（P〉0．05），但EST＋LC组术后并发症严重程度较轻。EST＋LC组的胃肠功能恢复时间、住院时间较OC＋OCHTD组明显缩短（P〈0．05）。两组病例的住院治疗费用无显著性差异（P〉0．05）。术后42例病例获得随访，随访时间5～25个月（平均14．6个月），均无胆管结石复发或胆管炎发生。结论 EST联合LC是一种安全、有效、可行的的微创治疗方法，具有创伤小，术后恢复快，住院时间短的优点．     

十二指肠镜联合腹腔镜手术治疗老年胆囊结石合并胆总管结石124例

目的探讨十二指肠镜联合腹腔镜续贯治疗老年患者胆囊结石合并肝外胆管结石的疗效。方法回顾分析2010年1月至12月246例老年患者（年龄大于等于60岁）胆囊结石合并肝外胆管结石的临床资料,按手术方式的不同分为微创组和传统手术组。微创组（n=124）采用十二指肠镜下内镜乳头括约肌切开术（EST）取石再行腹腔镜胆囊切除术（LC）,传统手术组（n=122）采用传统开腹胆囊切除术胆总管切开取石T管引流术,对比两组住院时间、并发症和结肠功能恢复时间等。结果微创组与传统手术组比较,住院时间短、并发症低和术后结肠功能恢复时间短,差异均有明显的统计学意义（P〈0．01）;两组手术时间无统计学差异（P〉0．05）。结论十二指肠镜联合腹腔镜续贯治疗老年胆囊结石合并肝外胆管结石具有微创、安全、疗效良好等优点。     

无X线ERCP治疗妊娠期胆管结石术中护理

妊娠期胆胰疾病多由胆道梗阻引起,及早解除梗阻、通畅引流最为关键。妊娠期胆胰疾病中胆总管结石最常见,经内镜逆行胰胆管造影（endoscopic retrograde cholangiopancreatogra-phy, ERCP）是处理胆总管结石的首选方法。常规ERCP需要在X线辅助下完成,尽管大多数专家认为,单次ERCP所需X线照射剂量对孕妇和胎儿的影响不大,但X线照射的安全性仍受到广泛关注和担忧,因此,对妊娠期女性进行无X线ERCP有重要的实用价值。     

血淀粉酶在生长抑素与硫酸镁辅助ERCP治疗急性胰腺炎前后的表达变化及意义

目的 探讨血淀粉酶在生长抑素与硫酸镁辅助ERCP治疗急性胰腺炎(AP)前后的表达变化及意义.方法 选取2016年1月至2017年1月期间,本院经ERCP术诊治的急性胰腺炎患者120例随机分为3组,每组40例.对照组术前30min静脉滴注 0.9%氯化钠1000 mL;治疗一组,术中经十二指肠镜注入33%硫酸镁100mL至十二指肠,术后血淀粉酶升高给予0.9%氯化钠1000 mL+生长抑素6mg;治疗二组术前30 min静脉滴注 0.9%氯化钠1000 mL+生长抑素6mg,术中经十二指肠镜注入33%硫酸镁100mL至十二指肠.于术前2h,术后2、12、24 h检测3组患者血清淀粉酶水平,同时观察3组的疗效以及临床症状缓解情况.结果 患者术前血淀粉酶的水平、及患者主要临床症状无统计学差异(P>0.05).与对照组相比,两组治疗组术后血淀粉酶水平明显降低,临床症状明显缓解(P<0.05).与治疗一组相比,治疗二组的血淀粉酶水平显著降低,临床症状明显缓解(P<0.05).结论 生长抑素联合硫酸镁辅助ERCP治疗,能有效缓解急性胰腺炎(AP)的临床症状,并降低血淀粉酶的水平.不同时期给予生长抑素对患者的临床症状及血淀粉酶的水平有显著影响.     

内镜下奥狄括约肌切开预防急性胆源性胰腺炎复发的研究

目的探讨内镜下奥狄括约肌切开(endoscopicsphincterotomy,EST)预防急性胆源性胰腺炎复发的临床效果。方法对1999年1月～2001年7月连续入院并治愈的112例急性胆源性胰腺炎患者的临床资料进行分析、随访。所有患者入院前均无胆源性胰腺炎病史且未行胆囊切除术。根据患者住院期间是否行EST,将所有患者分为EST组和非EST组,比较两组胆源性胰腺炎复发率。结果平均随访18.5个月(6～30个月)。EST组38例,无胆源性胰腺炎复发(0/38);非EST组74例,14例胆源性胰腺炎复发(14/74),复发率为18.9%,两组有显著统计学意义(P<0.01)。在非EST组中,胆囊切除29例,2例胆源性胰腺炎复发(2/29),复发率为6.9%;未作胆囊切除45例,12例胆源性胰腺炎复发(12/45),复发率为26.7%,胆囊切除后胆源性胰腺炎复发率显著降低(P<0.05)。复发距患者出院时间为2周至2年不等。对2例胆囊切除术后复发的胆源性胰腺炎患者行ERCP,均发现有胆总管结石,行EST后,无胰腺炎发作。结论EST能有效预防胆源性胰腺炎复发,并具有创伤小、恢复快等优点,适合于高龄、一般情况差、不能耐受手术的患者;胆囊切除能显著降低胆源性胰腺炎复发率,胆总管结石是胆囊切除术后胆源性胰腺炎复发的主要原因。     

经内镜乳头括约肌大口切开治疗胆总管末端炎性狭窄

目的对80例胆总管末端炎性狭窄进行了内镜乳头括约肌切开(EST)治疗.方法40例行中小切开,EST术后行2年内的临床追踪观察.结果大口切开组2年后乳头形态呈裂孔状,中小切口组乳头形态为裂隙状;大口切开组症状复发者为5%,中小切开组为22.5%(P<0.05).两组近期并发症相同.结论内镜乳头括约肌大口切开治疗胆总管末端炎性疗效可靠.     

Complications of endoscopic retrograde cholangiopancreatography (ERCP) and their risk factors

PurposeDetermination of the type and frequency of complications developing after diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) as well as the risk factors predisposing to them.Material/MethodsThe retrospective study, including 734 ERCP performed in 550 patients, with 404 (55%) ES (endoscopic sphincterotomy) during a 4-year period.ResultsAmong 734 ERCP procedures, 76.4% (561) had both diagnostic and therapeutic purpose, 15.2% (112) were only diagnostic. Complications developed after 26 procedures (3.5%): acute pancreatitis (AP) in 8 patients (1.09%), cholangitis in 7 (0.95%) and delayed bleeding in 11 (1.5%) patients. After 49 (6.7%) ES immediate bleeding was observed. The risk factors for AP were: unintentional pancreatic duct contrasting, mechanical lithotripsy, the use of the “pre-cut” technique and bile duct dilatation. Cholangitis was more common in cases with difficult cannulation at older age and with lower baseline bilirubin level. The risk factors for delayed bleeding were: location of the ampulla of Vater in the diverticulum and the use of the “pre-cut” technique. Immediate bleeding was more frequent after revision of bile ducts with Dormia's basket or with balloon, after introduction of contrast medium to the pancreatic duct or in ductal cholelithiasis.ConclusionsERCP performed in the endoscopy unit of a specialist hospital department is a relatively safe procedure, with a low burden of complications as compared to the benefits it provides to appropriately qualified patients.     

The clustering patterns of metabolic risk factors and its association with sub-clinical atherosclerosis in Korean population

Background and aims: Metabolic syndrome (MetS) is considered to be an insulin-resistance syndrome, but recent evidence suggests that MetS has multiple physiological origins which may be related to atherosclerosis. This study investigated clustering patterns of metabolic risk factors and its association with sub-clinical atherosclerosis.

Subjects and methods: This study used factor analysis of 11 metabolic factors in 1374 individuals to define clustering patterns and determine their association with carotid intima-media thickness (CIMT). Eleven metabolic factors were used: body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), fasting blood insulin (FBI), serum triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), homeostasis model assessment-insulin resistance (HOMA-IR), high-sensitivity C-reactive protein (hsCRP) and adiponectin. Two regression analyses were done, the first using individual metabolic variables and the second using each factor from the factor analysis to evaluate their relationships with CIMT.

Results: Four clustering patterns, insulin-resistance factor (FBG, FBI, HOMA-IR), obesity-inflammatory factor (BMI, WC, hsCRP), blood pressure factor (SBP, DBP) and lipid metabolic factor (HDL-C, TG, adiponectin) were categorized. In a multivariate regression model after adjustment for age, sex, low-density lipoprotein cholesterol and smoking history (pack year), insulin resistance factor (B = 11.09, p = 0.026), obesity-inflammatory factor (B = 18.50, p < 0.001), blood pressure factor (B = 12.84, p = 0.010) and lipid metabolic factor (B = ? 11.55, p = 0.023) were found to be significantly associated with CIMT.

Conclusion: In conclusion, metabolic risk factors have four distinct clustering patterns that are independently associated with sub-clinical atherosclerosis.     

Bronchial hyperresponsiveness in young children with allergic rhinitis and its risk factors

BACKGROUND: Subjects with allergic rhinitis but no clinical evidence of asthma have greater bronchial hyperresponsiveness (BHR), and several factors have been implicated as its determinants. However, studies in young children are lacking. The aims of this study were to evaluate the prevalence of BHR in young children with allergic rhinitis and to investigate its risk factors. METHODS: Methacholine bronchial challenges were performed in 4- to 6-year-old nonasthmatic children with allergic rhinitis (n = 83) and in healthy nonatopic controls (n = 32), using a modified auscultation method. The end-point was defined as the appearance of wheezing and/or oxygen desaturation. Subjects were considered to have BHR when they had end-point concentrations of methacholine 相似文献