内镜下逆行胰胆管造影加取石术诊治胆总管结石

目的:评价内镜下逆行胰胆管造影(ERCP)同时行乳头括约肌切开术(EST)对胆总管结石的诊断与治疗价值.方法:回顾性分析98例经B超检查诊断为胆总管结石的患者,先行ERCP检查,再行内镜下EST治疗胆总管结石.结果:98例中ERCP准确诊断胆总管结石96例,怀疑胆总管结石1例,未发现异常1例,其确诊率为97.9%,96例EST后采取网篮取石、球囊取石和机械碎石网篮取石成功,1例失败.结论:ERCP对胆总管结石诊断价值较高.EST是一种治疗胆总管结石安全、有效、简便的方法.     

内窥镜逆行胰胆管造影加乳头切开术在胆管梗阻性疾病中的诊疗价值

目的:评价内窥镜下逆行胰胆管造影(ERCP)对胆管梗阻性疾病的诊断以及内窥镜下乳头括约肌切开术(EST)治疗胆总管结石的价值。方法:回顾性分析82例经手术、病理证实的ERCP表现以及62例胆总管结石的EST取石治疗。结果:本组82例,78例ERCP显示异常,其中胆管结石65例,胆管癌7例,胆管炎症狭窄3例,胆总管囊肿、胆道蛔虫、外科手术后胆总管瘘各1例。4例ERCP未显示病变,ERCP对胆管梗阻性疾病诊断正确率为95.1%(78/82)。ERCP指导EST行网篮、球篮和机械碎石网篮取石,取石60例,2例失败,取石成功率为96.8%(58/60)。结论:ERCP对胆管梗阻性疾病有较高的诊断价值,同时在EST网篮碎石、取石中具有重要的基础作用,可指导网篮取石及观察疗效。     

ERCP诊治胆总管结石128例临床分析

目的探讨经内镜逆行胰胆管造影（ERCP）及其相关技术在治疗胆总管结石中的作用。方法对128例胆总管结石患者行ERCP检查和治疗,主要包括内镜下乳头括约肌切开（EST）后网篮取石、网篮机械碎石后网篮或/和球囊取出结石碎片、球囊取石并球囊清理胆道;内镜下鼻胆管引流（ENBD）或塑料支架置入引流等治疗。对诊断和治疗情况及并发症进行回顾性总结分析。结果 128例患者ERCP检查发现结石显影120例,敏感性为93.8%,较腹部超声（BUS）检出率（80.5%）明显增高（P〈0.05）。插管成功率96.1%,一次性取石干净89例;68例次行EST后取石网篮取石,26例行网篮碎石后取石,22例行EST后取石球囊取石,7例先行ENBD后择期取石。取石后行ENBD 14例次,行塑料支架植入引流术2例。平均住院（5.8±1.1）d,术后患者腹痛症状消失,经复查结石均取尽。ERCP患者术后出现并发症19例（15.4%）,其中并发高淀粉酶血症14例,并发急性胰腺炎2例,电解质紊乱2例,消化道出血1例,均经内科保守疗法治愈。随访发现结石复发1例,未发现死亡病例。结论 ERCP及其相关技术是胆总管结石安全、微创、经济的治疗方法。     

胆总管结石取石后复发结石的内镜再治疗

目的：观察内镜对胆总管结石取石后复发结石的治疗效果。方法：选择经上腹部CT或磁共振胰胆管成像（medical rehabititation center of pennsylvania,MRCP）证实、内镜下行胰胆管造影（endoscopic retrograde cholangiopancreatography,ERCP）术后胆总管再发结石48例,均经十二指肠乳头括约肌切开术（endoscopic sphincteropapillotomy,EST）,十二指肠乳头球囊扩张术（endoscopic papillo-sphincter balloon dilatation,EPBD）或EST＋EPBD后网篮或球囊取石。结果：48例中44例经内镜取石成功,手术时间为15-56min,平均29min。无一例并发症发生。结论：内镜治疗胆总管结石后可再发结石,经内镜再次取石是治疗EST术后胆总管结石复发的首选方法,安全有效。     

十二指肠镜治疗胆总管结石的疗效分析

目的探讨十二指肠镜治疗胆总管结石的疗效和安全性。方法对154例胆总管结石患者施行内镜下乳头括约肌切开术（EST）,直径〈10mm结石采用普通网篮或气囊取石;直径〉10mm结石采用碎石网篮碎石后,普通网篮或气囊取石。结果治疗成功142例,成功率92．2％。术后出现并发症15例,发生率9．7％。其中急性轻型胰腺炎11例,重型胰腺炎1例,急性胆管炎2例,乳头切开处出血1例。结论EST治疗胆总管结石安全有效,并发症较少,是目前治疗胆总管结石的有效方法之一。     

ERCP、EST联合LC治疗肝外胆管结石

目的：探讨内窥镜逆行胆胰管造影术（ERCP）、内窥镜下括约肌切开术（EST）、联合腹腔镜胆囊切除术（LC）治疗胆石症的疗效。方法：回顾性分析2006-03～2008-03开展的ERCP＋EST＋LC治疗胆囊结石合并胆总管结石136例。其中LC术前发现的胆总管结石134例,LC术后确诊的胆总管残留结石2例。ERCP术后约7 d行LC。结果：LC术前取石成功128例,其中107例采用取石网篮/气囊取出,21例采用碎石器/碎石网篮先碎石后取出。LC术前EST取石失败6例,行LC＋术中胆道镜取石成功1例,5例行开腹手术。LC术后发现胆总管残留结石2例,经EST切开取石成功。LC术全部成功,无手术并发症。全部病例术后行B超或MRCP检查,显示胆道内无残留结石。结论：按不同的病情合理选择、分次施行ERCP加EST加LC,使治疗所致的创伤最小,是目前治疗肝外胆管结石较为理想的选择。     

腹腔镜胆囊切除术后胆总管残石护理体会

目的总结腹腔镜胆囊切除(LC)、术后胆总管残留结石的护理措施。方法回顾性分析我院LC术后胆总管残留结石的临床资料。结果均由内镜逆行胰胆管造影术(ERCP)确诊,其中通过十二指肠镜乳头括约肌切开术(EST)取出结石5例,再次手术取石1例。结论通过应用ERCP和EST,不仅提高了LC术后胆总管结石的诊断水平,尤其为胆总管残留结石找到了微创、有效、安全的治疗途径,并为相关的护理提供了新思路。     

胆总管结石内镜和开腹手术治疗对比分析

目的:探讨内镜微创治疗胆总管结石的临床应用价值.方法:十二指肠镜(下以称内镜)治疗胆总管结石80例,与同期手术治疗77例.两组患者术前经B超、CT及核磁共振证实确有胆总管结石.内镜组行ERCP EST结石取出.开腹手术组根据病情行胆总管探查取石、T管引流或胆肠吻合术.结果:内镜治疗成功率96.25%,手术成功率91.68%(P＞0.05).两组术后住院日:内镜组:5.40±3.59d,开腹手术组:12.77±3.34d(P＜0.01).伴梗阻性黄疸消褪时间:内镜组:5.94±2.76d,开腹手术组:11.04±4.64d(P＜0.01).残余结石发生率:内镜组:3.75%,开腹手术组:7.79%(P＜0.01).结论:内镜治疗胆总管结石疗效优于开腹手术,有较好的临床应用价值.     

经皮经肝取石术治疗胆总管结石25例

目的 探讨经皮经肝胆结石取出术治疗胆总管结石的临床应用价值.方法 自2013年1月至2015年1月,25例胆总管结石患者采用经皮经肝途径取石.首先在超声或者X线透视引导下完成PTC并放置8F鞘;然后采用8～12 mm球囊扩张乳头,如结石直径超12 mm,加用网篮碎石;最后采用取石球囊通过交换导丝将结石经十二指肠乳头括约肌推至肠道内.结果 25例患者包括胃肠道术后(18例)、内镜治疗失败(3例)、不愿意接受内镜治疗(3例)、其他情况(1例).25例患者均成功取出结石.术后3例(12％)发生并发症,分别为发热2例、肝脓肿形成1例,随访6个月到3年,2例患者因原患肿瘤复发转移死亡,1例患者胆总管结石复发,无反流性胆管炎发生.结论 经皮经肝胆结石取出术治疗胆总管结石具有较高的手术成功率以及较低的并发症发生率,可以作为不适合内镜治疗或者内镜治疗失败的胆总管结石患者的治疗措施.     

“三镜”联合治疗胆囊合并胆总管结石230例临床分析

目的探讨经十二指肠镜胆管逆行造影／Oddis括约肌切开取石（ERCP／EST）＋腹腔镜胆囊切除（LC）＋腹腔镜胆总管探查取石（LCBDE）联合治疗胆囊结石合并胆总管结石的临床效果和应用价值。方法采用ERCP／EST＋LC＋LCBDE联合治疗胆囊结石合并胆总管结石230例,ERCP／EST术后0～5d行LC或LC＋LCBDE。结果成功完成“三镜”联合治疗219例,成功率95．2％;LC中转开腹11例,EST取石失败6例,其中5例行LCBDE、1例LC中转开腹＋胆道镜取治愈石,6例胆总管切开取石术后均行一期缝合。出现1例严重并发症,经处理后最终顺利出院。结论ERCP／EST＋LC＋LCBDE联合治疗胆囊结石合并胆总管结石能达到与开腹手术相同的效果,而且具有微创的特点。     

内镜括约肌切开术联合腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的临床研究

目的探讨内镜括约肌切开术（EST）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临床效果。方法回顾性分析2009年2月～2010年12月行手术治疗的70例胆囊结石合并胆总管结石患者的临床资料,38例行EST＋LC（微创组）,32例行开腹胆囊切除＋胆总管切开取石＋T管引流术（OCHTD）（开腹组）,记录手术情况、术后恢复情况、手术疗效及住院时间。结果微创组手术时间、术中出血量、肛门通气时间及术后住院时间显著低于开腹组,相比较有显著性差异（P〈0.05）。两组均手术成功,微创组术后未发现残余结石,开腹组残余结石率为21.9%,两组相比较有显著性差异（P〈0.05）。微创组并发症发生率显著低于开腹组（P〈0.05）。结论 EST＋LC优于传统开腹手术,其疗效确切、安全可靠,可作为治疗胆囊结石合并胆总管结石的主要方法。     

128层螺旋CT在外伤性肋骨骨折中的应用价值

目的探讨128层螺旋CT在外伤性肋骨骨折中的应用价值及限度。方法回顾分析50例疑似肋骨骨折患者128层螺旋CT扫描资料,利用容积再现volumerendering,VR）及薄层多平面重组（thin—sectionmulti．planarreconstruction,TSMPR）技术对肋骨骨折进行分析。结果50例患者中,VR发现肋骨骨折142处,TSMPR发现肋骨骨折151处,8例复查患者中,2例共发现3处原来未显示的肋骨骨折。VR显示骨折的空间解剖有优势。TSMPR显示肋骨骨折的细节效果好。结论128层螺旋CT的VR结合TSMPR是准确诊断肋骨骨折较可靠的方法,但各自均有一定的局限性,在工作中应予以重视。     

MR cholangiopancreatography: prospective comparison of a breath-hold 2D projection technique with diagnostic ERCP

The aim of this study was to compare prospectively a breath-hold projection magnetic resonance cholangiopancreatography (MRCP) technique with diagnostic endoscopic retrograde cholangiopancreatography (ERCP). Seventy-six patients with suspected strictures or choledocholithiasis were referred for MRCP and subsequent ERCP examination, which were performed within 4 h of each other. The MRCP technique was performed using fat-suppressed rapid acquisition with relaxation enhancement (RARE) projection images obtained in standardised planes with additional targeted projections as required by the supervising radiologist. Two radiologists (in consensus) assessed the MRCP results prospectively and independently for the presence of bile duct calculi, strictures, non-specific biliary dilatation and pancreatic duct dilatation, and recorded a single primary diagnosis. The ERCP was assessed prospectively and independently by a single endoscopist and used as a gold standard for comparison with MRCP. Diagnostic agreement was assessed by the Kappa statistic. The MRCP technique failed in two patients and ERCP in five. In the remaining 69 referrals ERCP demonstrated normal findings in 23 cases, strictures in 19 cases, choledocholithiasis in 9 cases, non-specific biliary dilatation in 14 cases and chronic pancreatitis in 4 cases. The MRCP technique correctly demonstrated 22 of 23 normal cases, 19 strictures with one false positive (sensitivity 100 %, specificity 98 %), all 9 cases of choledocholithiasis with two false positives (sensitivity 100 %, specificity 97 %), 12 of 14 cases of non-specific biliary dilatation and only 1 of 4 cases of chronic pancreatitis. There was overall good agreement for diagnosis based on a kappa value of 0.88. Breath-hold projection MRCP can provide non-invasively comparable diagnostic information to diagnostic ERCP for suspected choledocholithiasis and biliary strictures and may allow more selective use of therapeutic ERCP. Received: 20 May 1998; Revision received: 26 November 1998; Accepted: 7 January 1999     

Helical CT without contrast in choledocholithiasis diagnosis

The goal of this study was to determine the diagnostic value of the helical CT without contrast in suspected cases of choledocholithiasis, comparing this test with endoscopic retrograde cholangiopancreatography (ERCP). Forty patients with possible choledocholithiasis were studied prospectively. There were 23 women and 17 men, ranging in age from 24 to 91 years. Helical CT was performed immediately before ERCP (time interval between the two procedures was less than 1 h). A biliary area previously selected was studied with a technique of pitch 1 and slice thickness of 3.2 mm. Average time was 30 s. Reconstruction with different increments and windows were made. Stone presence was evaluated in bile duct and Vater's ampulla. Biliary dilation was evaluated too. Endoscopic retrograde cholangiopancreatography found stones in 19 patients and absence of stones in 20. One case was failed, but stones in bile duct were demonstrated during intraoperative cholangiography. Helical CT demonstrated stones in 15 of the 19 patients with positive ERCP. There were no false positives with CT. Patients without stones in ERCP were also negative in CT. The patient having the failed ERCP was considered positive in CT. The CT sensitivity was 80 % and specificity was 100 %, with an accuracy of 90 %. Helical CT without contrast has sensitivity and specificity good enough to be used as a screening technique in patients with suspected choledocholithiasis. Received: 15 February 2000/Revised: 3 July 2000/Accepted: 5 July 2000     

西门子128层螺旋CT诊断冠状动脉狭窄的研究

目的探讨西门子128层螺旋CT冠状动脉成像（CTA）对诊断冠状动脉狭窄的价值。方法收集来我院就诊的疑似冠状动脉狭窄患者36例,均进行128层螺旋CT冠状动脉造影检查和DSA选择性冠状动脉造影检查,观察两种检查方法中冠状动脉狭窄的影像学表现和诊断价值,并与64层以下冠状动脉CTA进行对照。结果 36例冠状动脉狭窄患者的两种检查结果,经统计学分析,西门子128层螺旋CT对冠状动脉狭窄的敏感性为98.08%、特异性为95.69%、准确性为96.43%。与64层以下螺旋CT比较,对患者心率、屏气等方面的要求更加宽松。结论西门子128层螺旋CT对冠状动脉狭窄的诊断价值高,方法简单、快速准确、无创伤,患者易接受,可作为疑似冠状动脉狭窄患者的首选检查手段。     

匙孔动态增强MRI对45例催乳激素分泌型垂体微腺瘤的诊断

目的:评价匙孔(keyhole)动态MRI对催乳激素(prolactin,PRL)分泌型垂体微腺瘤的诊断价值.材料和方法:回顾性分析45例经手术或临床证实的PRL分泌型垂体微腺瘤的动态增强MRI影像表现,由两位有经验的影像科医师阅片,不告知临床及实验室检查结果的情况下作诊断,垂体内见有粟粒、结节或片块状异常信号者作肯定微腺瘤诊断;垂体内信号不均匀者作可疑微腺瘤诊断;垂体内信号未见异常者不作微腺瘤诊断.结果:无临床及实验室检查参考时,可肯定垂体微腺瘤诊断者18例;可疑垂体微腺瘤诊断者26例;不作垂体微腺瘤诊断者1例.结合临床及实验室检查诊断正确率达97.8%.结论:keyhole动态MR对PRL分泌型垂体微腺瘤有较高的诊断价值,临床和实验室检查怀疑PRL分泌型垂体微腺瘤而MR平扫阴性的患者应常规作动态增强MR检查.     

128层螺旋CT数字减影血管成像对颅内动脉瘤的诊断价值

目的评价128层螺旋CT数字减影血管成像对颅内动脉瘤的诊断价值。方法60例临床怀疑颅内动脉瘤的患者分别进行128层螺旋CT数字减影血管成像（Digital subtraction angiography,DSACTA）和数字减影血管造影（DSA）,并对照手术或介入栓塞治疗结果评估其诊断价值。结果DSACTA共发现58例66个动脉瘤,其中52例为单个动脉瘤,4例为两个动脉瘤,2例多发动脉瘤。动脉瘤直径最小2mm,最大30mm。DSA检出60例68个动脉瘤,以DSA检出结果为金标准,128层螺旋CT数字减影血管成像,诊断符合率97．1％,2例2个小动脉瘤漏诊,漏诊率2．9％。结论DSACTA诊断颅内动脉瘤有较高准确性,可部分取代DSA造影检查。