内镜下乳头括约肌切开的护理

目的探讨乳头括约肌切开术的护理。方法将十二指肠镜插入十二指肠降部找到乳头,在X线透视下插入切开刀、导丝,推注造影剂,选择好合适位置后行乳头括约肌切开。结果53例病人治疗中采用了此技术,52例达到治疗目的,1例术后穿孔。结论此技术具有创伤小、康复快的优点,术中配合作用重要,可使病人有满意的疗效。     

ERCP在胆管结石诊断和治疗中的应用

目的评价内镜下逆行胰胆管造影(ERCP)对胆管系统结石诊断和治疗的价值。方法对106例ERCP资料作回顾性分析,并将超声(US)、计算机断层扫描(CT)与ERCP的资料进行比较。结果胆囊结石的诊断US优于CT和EPCP,胆总管结石的诊断ERCP优于CT、US。本组病例中ERCP检查的胆管结石患者在明确诊断的同时通过内镜下乳头切开取石和/或鼻胆管引流解除梗阻。其中结石最小直径0.1cm,最大直径5cm,单发19例,多发37例。胆系结石主要位于胆总管和胆囊内,ERCP主要表现为胆总管内的充盈缺损,胆管扩张,下端梗阻时,可出现杯口状的充盈缺损,其上方胆管口径扩张。结论ERCP作为一种微创的诊断兼治疗的手段,对胆管结石有重要的临床应用价值。     

食管内镜下黏膜下剥离术的围手术期护理

目的通过对食管内镜下黏膜下剥离术（ESD）围手术期患者护理经验的回顾,总结针对此类患者的护理体会。方法采用术前指导、术中配合、术后护理的护理程序对接受ESD治疗的33例患者的围手术期护理进行总结。结果本组33例患者从术前平稳过渡到接受手术,患者术后均恢复良好,无护理并发症发生。结论食管ESD可提高病变黏膜完整切除率,但风险大,因此作为一项新技术,做好患者围手术期护理是至关重要的,它可减轻患者术前焦虑,帮助患者顺利度过手术的不同时期。     

经内镜乳头括约肌切开术治疗总胆管结石的临床应用

目的：探讨内镜服头括约肌切开术（EST）对总胆管结石的治疗价值。方法：对近20年来该科应用EST治疗总胆管结石病例进行分析研究,结果：466例EST病例中治疗成功457例,成功率98％,结石未能排出4例,乳头切开后因合并症急诊开腹手术5例,出血,急性化脓性胆管炎,急性胰腺炎等合并症14例,合并症发生率3％,结论：EST治疗总胆管结石,不麻醉,不开腹,安全,有效,是目前治疗总胆管结石,不麻醉,不开腹,安全,有效,是目前治疗总胆管结石的理想方法,如有条件,当应首选。     

急诊治疗性逆行胆胰管造影对重症急性胆源性胰腺炎的疗效

目的探讨应用急诊治疗性逆行胆胰管造影(endoscopic retrograde cholangio pancerea-tography,ERCP)对重症急性胆源性胰腺炎的诊治与临床疗效。方法将2002年2月至2006年7月的264例胆源性SAP(severe acute pancreatitis;SAP),随机分为急诊ERCP治疗组(140例)及药物治疗组(124例);两组患者接受相同内科基础治疗,急诊ERCP治疗组在此基础上,急诊施行十二指肠乳头括约肌切开(EST)及鼻胆管引流(ENBD)或鼻胰管引流(ENPD);对疑有胆总管结石梗阻者、在EST后经内镜取石。记录两组血淀粉酶恢复与腹痛缓解时间、中转手术率、并发症发生率和平均住院天数及费用,评定入院1d、3d、6d患者的APACHEⅡ评分。结果急诊治疗性ERCP成功137例、取石成功率约为74·5%,留置ENBD或ENPD的成功率为97·8%,急诊ERCP治疗组的血淀粉酶恢复正常与腹痛缓解时间较短、患者入院后APACHEⅡ评分亦较药物治疗组下降快;急诊ERCP治疗组的并发症率为5·7%、转手术率是3·6%、病死率1·4%,均低于药物治疗组(其并发症率29·8%,转手术率15·4%,病死率7·3%),P<0·05,平均住院日和费用也低于药物治疗组。结论以胆源性为主因的SAP,施行急诊ERCP介入治疗是救治SAP有效的微创诊治措施,急诊ERCP介入治疗在临床疗效、住院时间及费用等均优于单纯内科药物治疗。     

The role and value of endorectal ultrasonography in diagnosing T1 rectal tumors

Rectal carcinoma in 50% to 60% of cases is localized in the rectum and, if diagnosed early can be locally excised. The authors evaluated the diagnostic accuracy of the preoperative endorectal ultrasonography (ERUS) in the staging of rectal tumors and the usefulness of the method to assess patients' suitability for local excision. In the retrospective analysis, we analyzed 29 patients with rectal cancer. The depth of invasion into the rectal wall was assessed by ERUS and all patients were qualified for tumor excision with transanal endoscopic microsurgery (TEM). We analyzed overall accuracy of ERUS and the effectiveness of treatment. In the analyzed group, diagnostic accuracy of ERUS in assessing T1 carcinomas was 89.2%, sensitivity 92.3% and specificity 50%. Local excision with TEM was deemed to be curative in 86.2% patients with rectal tumors detected by ERUS. ERUS is an accurate method of preoperative assessment of T1 and T2 carcinomas and its diagnostic accuracy is sufficient to qualify patients for anal-saving operations.     

A European survey of perendoscopic treatment of biliary complications in patients with alveolar echinococcosis

Background: Biliary complications represent a turning point in the course of Alveolar Echinococcosis (AE). We conducted a European survey to collect data on the current usage and results of perendoscopic interventions (PEIs) for their treatment.

Methods: Patient’s characteristics and follow-up until January 31st, 2015 were recorded using an online questionnaire.

Results: From 18 centers 129 PEIs were analyzed in 38 patients; 139 plastic stents were inserted during 85 PEIs; median time between stent placements was significantly longer when 3 stents or more were placed. Initial symptoms disappeared in 95% and long-term bile duct patency was obtained in 73% of cases. Cholangitis was a more frequent complication of the PEIs (10%) than in other indications; intensive lavage of the bile ducts may prevent this complication.

Conclusion: European centers use perendoscopic biliary drainage as an efficient and safe alternative to surgery to treat AE biliary complications. Insertion of multiple plastic stents delays stent occlusion and leads to effective and prolonged bile duct patency.     

针状切开刀在治疗性ERCP插管困难病例中的应用

目的探讨用针状切开刀为主的乳头括约肌预切开术（PST）在治疗性逆行胰胆管造影术（ERCP）插管困难病例中的应用,并对其在治疗性ERCP中的作用和安全性作回顾性评价。方法954例常规ERCP病例中,70例患者在实施ERCP治疗操作中,当常规方法不能使胆系显影或胆道深部插管困难时,即用标准切开刀（经胰管）和针状切开刀行乳头预切开,观察预切开的效果和近期并发症。结果常规ERCP诊治成功884例92．6％,失败70例中用各种针状预切开术,成功率达88．5％,使用各种针状预切开术后使ERCP成功率提升6．6个百分点,使成功率由92．6％提升达到99．2％。两者差别显著（P〈0．001）。常规ERCP的并发症为8．69％,无内镜相关死亡。新式预切开术组并发症为10％,且与常规ERCP组相比并发症无差异。（P〉0．05）。结论本文介绍的针状切为主的乳头括约肌预切开术及粘膜桥切断技术和开口上移技术在治疗性ERCP遇到深插管困难情况下是一种行之有效的操作技术,可明显提高成功率,且并发症少。     

甘油果糖肾上腺素注射液用于内镜下黏膜切除术

目的：探讨在内镜下黏膜切除术（EMR）中应用甘油果糖0．05％肾上腺素美蓝注射液黏膜下注射的疗效。方法：注射针经内镜于黏膜下层分点注射甘油果糖0．05％肾上腺素美蓝注射液,≤1crn的病灶注射1～3mL;〉1cm的病灶周围注射3～5mL,以病灶明显隆起、黏膜与黏膜下肌层分离为限。圈套器经内镜套取病灶并电凝切除。对较大病灶不能整块套取切除者,采用分次套取摘除。结果：用甘油果糖肾上腺素注射液行EMR术共147例,其中术q-钛夹止血6例（4％）,无穿孔及大出血。结论：甘油果糖肾上腺素注射液可以明显缩短EMR术时间,并发症发生率较低,可提高EMR疗效和安全性。