19例胰管结石手术经验探析

目的：探讨胰管结石诊断和手术治疗方法的选择。方法回顾性分析重庆荣昌县中医院2006年1月－2014年9月收治的19例胰管结石患者的临床资料。所有患者均通过影像学检查（B 超、CT 及磁共振胰胆管造影）得到诊断。19例患者均伴有慢性胰腺炎,3例伴有糖尿病,2例伴有黄疸,1例伴有胆道出血,1例伴有胰头癌。结果19例患者均采取手术治疗,其中胰管切开取石、胰管空肠吻合5例,胰十二指肠切除9例,单纯行胰体尾部切除术3例,保留十二指肠的胰头切除2例。结论外科手术是治疗胰管结石最常用,也是重要和最终手段。应根据患者的的实际情况进行充分分析选择,制订个性化的手术方案,从而保证手术的成功率,改善患者的生存质量。     

胰管结石的诊断及手术治疗（附25例分析）

对25例胰管结石患者的临床资料作回顾性分析。25例中表现为持续性左上腹痛23例,右上腹痛2例,伴左腰背部放射痛20例;均行B超检查,确诊22例;16例行腹部CT检查,确诊12例;12例行磁共振胰胆管造影（MRCP）检查,确诊12例。均行手术治疗,结石全部取出。认为B超、CT及MRCP检查有助于胰管结石的诊断,本病手术治疗效果满意。     

胰管结石28例外科治疗

胰管结石临床上比较少见,正常人群发病率〈1％,其形成和发展与慢性胰腺炎（CP）互为因果。据统计,90％以上的酒精性CP合并胰管结石,20％～50％的CP在发病2年后形成胰管结石。结石所导致的胰管阻塞是临床出现腹痛、反复急性胰腺炎（AP）发作、胰腺内外分泌功能减退的重要原因。我院自2000年1月至2007年12月以来共收治胰管结石患者28例,均行手术治疗,取得较好疗效,现报告如下。     

ERCP治疗胰管结石的临床分析

目的 分析经内镜逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)治疗胰管结石的适应证、临床效果及并发症。方法 选择2016年1月至2022年1月在郑州大学第一附属医院内镜中心诊治的35例胰管结石患者,分析取石成功率、并发症,随访术后6个月临床症状缓解情况。结果 35例患者共进行ERCP 53例次,取净结石21例,取石成功率60.0%。术中乳头出血1例,术后高淀粉酶血症6例,急性胰腺炎2例,术后6个月随访患者腹痛、脂肪泻等症状缓解,体质量增加。结论 ERCP治疗胰管结石是安全有效的,能减轻患者痛苦,改善临床症状。     

胰管结石一例

患者 ,男 ,5 7岁。上腹部疼痛 1月伴腰背部及左肩放射痛 ,需用杜冷丁方能缓解 ,恶心、呕吐 ,偶有腹泻。于 2 0 0 1年9月 13日入院。查体 :T36 .7℃ ,皮肤、巩膜无黄染 ,全腹软 ,未扪及包块 ,上腹部深压痛、无反跳痛及肌紧张 ,肝脾不肿大 ,移动性浊音阴性 ,肠鸣音正常。实验室检查 :肝功及血淀粉酶正常 ,ESR 13m m/ h,CA19- 9、CEA、AFP阴性 ,血糖7.9m mol/ L。影像学检查 :腹部 X片示 L1平面钙化影 ,B超及 CT均提示胰管扩张及结石 ,ERCP发现胰管结石。诊断为慢性胰腺炎、胰管结石。经术前准备后于 2 0 0 1年 9月 18日在全麻下行胰…     

胰管结石的手术治疗

目的 探讨胰管结石的手术治疗方法。方法23例慢性胰腺炎伴胰管结石患者,14例行胰管切开取石、胰管空肠侧侧Roux-en—Y吻合术（2例有黄疸者加做胆管内引流术）,4例行胰体尾切除术（其中2例加做胰肠’吻合术）,1例行胰管成型取石术。4例因胰头肿大行胰十二指肠切除术（2例术后证实为胰头癌）。其中16例术中应用激光碎石。结果术中见23例主胰管直径0．8～2．0cm,多发结石17例、单发结石6例。手术均成功,行激光碎石者碎石率100％。无手术并发症。术后随访,20例术前有上腹痛者,17例术后腹痛消失,3例减轻;9例合并糖尿病者,4例血糖恢复正常,2例胰岛素用量减少,3例糖尿病未得到控制;术后第3年出现糖尿病1例;5例合并脂肪泻者,2例脂肪泻消失,1例减轻,2例无明显变化。2例合并胰头癌患者分别于术后1a2个月、1a8个月死亡。结论手术治疗胰管结石疗效较好,但应合理选择适应证和手术方式。     

胰管结石的手术治疗

胰管结石是慢性胰腺炎的并发症,临床上比较少见,正常人群发病率不超过1%,胰管阻塞是引起腹痛、消化道功能紊乱等症状的主要原因[1]。胰管结石伴慢性胰腺炎通常采用胰管切开取石、胰管空肠吻合术,但远期效果不佳,逆行反复慢性感染和癌变发生率高。全胰结石更加少见,治疗较困难。     

胰管结石的诊断和治疗(附35例临床分析)

目的探讨胰管结石的诊断和治疗方法。方法回顾性分析过去10余年问治疗的35例胰管结石患者的临床资料。结果全部35例中33例出现持续性左上腹痛伴左腰背部放射痛,上腹部压痛25例。35例均行B型超声检查,诊断阳性率为88.57%(31/35);23例行腹部CT检查,诊断阳性率为78.26%(18/23);19例行逆行胰胆管造影检查,诊断阳性率为100%(19/19);19例行磁共振胰胆管成像检查,诊断阳性率为94.73%(18/19)。患者分别采用手术治疗和内镜治疗。手术治疗16例,采用的术式包括胰管切开取石、胰管空肠Roux-en-Y侧侧吻合术(11例)或胰管空肠侧侧吻合、空肠空肠侧侧吻合术(3例)或胰十二指肠切除术(Child法2例),均将结石取出;内镜治疗胰管结石19例,结石均在3枚或3枚以下、局限在胰头或胰体部、直径小于1cm,取石网篮和气囊取出结石11例,放置胰管支架8例。全组无死亡病例,治疗后3周内症状都不同程度地得到缓解,随诊28例,随诊率为80%,随诊时间为1～43个月。结论胰管结石一旦诊断,均应给予积极的治疗。首选内镜治疗,内镜治疗有着严格的适应证;不适合内镜治疗并且无手术禁忌证的患者均应采取手术治疗。     

胰管空肠Roux—en—Y吻合术治疗胰管结石

胰管结石临床较为少见,发病率不超过1%。近年来,随着医学影像学的发展,胰管结石的病例明显增多,我院1990 年1月至2004年6月共收治胰管结石患者9例,行胰管切开取石、胰管空肠Roux-ez-Y吻合术8例。现报告如下。资料与方法一、一般资料本组8例中男6例,女2例。年龄14-66岁,平均年龄为42.6岁。病程1-6年。上腹部疼痛8例,脂肪泻和消瘦5例, 黄疸1例,糖尿病4例,反复消化道出血1例,上腹部压痛8 例,上腹部包块1例。     

胰管结石治疗方案的选择分析与比较

目的 收集并对比分析内镜逆行胰胆管造影(ERCP)、腹腔镜术和开腹手术三种方案治疗胰管结石(PDS)患者的临床资料及治疗效果,总结PDS治疗方案选择的经验,进一步研究探讨可行的使患者获益最大化、最优化的治疗方案。方法 回顾性分析2014年6月—2018年12月海军军医大学附属公利医院治疗的131例PDS患者的临床资料。根据手术情况分为3组：ERCP组69例,腔镜组32例,开腹组30例。监测3组患者手术前后相关指标的变化;进一步对比分析腔镜组和开腹组的手术疗效。正态分布的计量资料两组间比较采用独立样本t检验;多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验或SNK-q检验。偏态分布的计量资料两组间比较采用Mann-Whitney U检验,多组间比较采用Kruskal-Wallis H检验。手术前后相关指标差异比较采用重复测量资料的方差分析和Friedman检验。计数资料组间比较采用χ²检验。结果 131例PDS患者中Ⅰ型40例、Ⅱ型76例、Ⅲ型15例。腔镜组与开腹组主要手术方式的病例数比较差异无统计学意义(χ²=1.93,P>...     

经内镜乳头括约肌切开术治疗胆总管结石108例临床分析

目的 :探讨经内镜乳头括约肌切开术 (EST)治疗胆总管结石的临床效果。方法 :EST治疗胆总管结石 1 0 8例。其中结石直径 <0 .5cm 1 2例 ,0 .6～ 1 .0cm 38例 ,1 .1～ 1 .5cm 30例 ,1 .6～ 2 .0cm 1 3例 ,2 .1～ 2 .5cm 9例 ,>2 .5cm 6例。单颗结石 68例 ,2颗结石2 7例 ,3颗以上结石 1 3例 ,最多的 1例结石 1 4颗。结果 :EST取石成功 1 0 5例 ,成功率 97.2 % ,失败 3例。采用取石网篮、取石球囊和机械碎石网篮取石。EST术后并发症 6例 ,发生率 5 .6 %。其中切口出血 3例 ,急性胰腺炎 2例 ,重症胆管炎 1例。随访 88例 ,时间 1个月～ 2年 ,全身状况良好 ,B超或CT检查无再发结石。结论 :经内镜乳头括约肌切开术是一种治疗胆总管结石安全、有效的治疗方法     

Effects of Acute Pancreatic Duct Obstruction on Pancreatic Perfusion: Implication of Acute Pancreatic Duct Decompression

Background: Acute pancreatitis can result in pancreatic ischaemia and necrosis. Pancreatic duct (PD) obstruction may be the first step causing ischaemia in acute pancreatitis. Nitric oxide donors can attenuate acute pancreatitis through improvement in compromised pancreatic perfusion (PP). In this study, we determined if (1) PD obstruction altered PP and (2) PD decompression or L-arginine administration reversed this change. Methods: Fifteen Australian possums were randomly assigned to two groups: Animals in group A ( n = 6) were subjected to 30 min of PD obstruction and 60 min of PD decompression. Animals in group B ( n = 9) were subjected to 120 min PD ligation and 60 min PD decompression. A subset group B ( n = 6) were subjected to intravenous L-arginine (100 μg/kg) at the end of 120 min of ligation and at the end of PD decompression. The PP (Laser Doppler fluxmetry), PD pressure and blood pressure were continuously monitored. Results: PD pressure increased from 2.9 ± 2.5 to 18.1 ± 4.9 mmHg following PD ligation. PP was reduced to 67.1% ± 4.5% ( P < 0.01) and 46.2% ± 7.5% ( P < 0.001) of baseline following 30 and 120 min of PD ligation, respectively. Following 60 min of PD decompression, PP was restored to 89.1% ± 13.4% ( P < 0.02) of the baseline in the 30-min group. However, following 120 min PD ligation, PP remained depressed. L-arginine administration after 120 min of PD ligation transiently increased PP from 46.2% ± 7.5% to 81.1% ± 8.6% ( P < 0.03) of baseline. This effect was reproduced if L-arginine was administered at the end of decompression ( P < 0.05). Conclusion: In patients with acute pancreatitis due to obstructive causes, early decompression of the PD may prevent early pancreatic ischaemia.     

核磁共振胰胆管造影与内镜下逆行胰胆管造影在胰胆疾病诊断方面的对比研究

目的：探索核磁共振胰胆管造影（ＭＲＣＰ）检查在临床应用中的价值。方法：对１１０例胰胆管疾病患者选择性地行ＭＲＣＰ检查,并与内镜下逆行胰胆管造影（ＥＲＣＰ）检查作比较,结合内镜下治疗以及外科手术,以明确两者之间的相关性。ＥＲＣＰ和手术结果作为金标准。结果：１１０例患者ＭＲＣＰ图像质量均较高,对胆管扩张诊断的敏感性为８５．０６％（７８／８７）,对胆管下段狭窄伴扩张诊断的敏感性为９０％（１８／２０）。Ｍ     

Pancreatogram of Unfused Pancreatic Duct Systems

Abstract: The aim of this study was to indirectly evaluate functional aspects of the accessory papilla, by measuring the diameter of the dorsal duct in non-fusion (pancreas divisum). In 56 patients with definite non-fusion, the diameter of the duct on ERCP was measured with a caliper rule, in the ventral duct (V1, V2), in the head of the dorsal duct (Dh1, Dh2), the body (Dbl, Db2), and the tail (Dt1, Dt2). The controls were 61 consecutive patients with a normally fused pancreatic duct system. The mean value ± SD were V1:2.0±1.1, V2:1.7±0.8, Dh1:2.5±0.6, Dh2:2.6±0.8, Dbl:2.7±0.8, Db2: 2.1 ±0.5, Dt1: 1.7±0.5, Dt2: 0.9±0.2 in the non-fusion group. The values in the control group were 3.4±0.9, 3.0±0.8, 1.0±0.3, 1.3±0.4, 2.6±0.6, 2.3±0.6, 1.6 ± 0.3, 0.9 ± 0.2, respectively. Results showed that the diameter of the pancreatic duct was significantly related to the age of the patient in the body and tail of the non-fusion group but not in the controls (p<0.05). The diameter of the ventral duct in the control group was related to the age but not in the non-fusion group (p<0.0001). In non-fusion group, mean values of V1 and V2 was smaller (p<0.02), and Dh1 and Dh2 were larger (p<0.05) than those in the controls. While there were no significant differences in the mean values of Db1, Db2, Dt1, and Dt2 in both groups. These results may indicate a more prominent influences of age to the caliber changes of pancretic duct when non-fusion existed.     

进展期胰腺癌的外科治疗——附514例分析

目的：探讨对进展期胰腺癌积极进行外科切除治疗的价值及提高胰腺癌患生存率的相关因素。方法：回顾性分析华山医院1970－2001年收治的514例行手术治疗的胰腺癌患,其中117例行Whipple手术或区域性胰十二指肠切除术,分析不同阶段、不同治疗技术条件下,患的生存率及其相关因素。结果：70年代、80年代和90年代胰头癌的切除率分别为9．5％、16．6％和31．0％。90年代后期采用三步法（减黄→介入→手术）,使手术切除率进一步提高,达37．1％。三个年代的1年生存率分别为50．0％、57．1％和84．1％,3年生存率分别为25．0％、28．5％和39．7％,5年生存率分别为0、9．5％和10．2％。手术切除率和生存率均有明显升高,与诊断技术的进步和手术方法、技巧的改进及综合治疗的运用有关。结论：对进展期胰腺癌积极进行手术治疗,能改善患生活质量,提高生存率。     

23例腹腔镜结直肠癌手术临床分析

目的探讨腹腔镜结直肠癌根治术临床疗效。方法回顾性分析我院2009年8月～2012年4月所实施的23例腹腔镜结直肠癌根治术患者的临床资料。结果全组手术均在腹腔镜下完成。行腹腔镜下Dixon术10例,Miles术8例,乙状结肠癌根治术2例,左半结肠癌根治术1例,右半结肠癌根治术2例。手术时间为110～255 min(平均180 min),术中平均失血25 ml。无围手术期死亡者。术后胃肠道功能恢复时间1～2 d。术后至今均获随防,随坊时间为6～24个月。1例术后第8个月出现腹腔广泛转移,其余患者均为无瘤生存。结论腹腔镜结直肠癌根治术具有微创、安全、恢复快等优势,可以替代传统的开腹手术。     

Response to Neoadjuvant Therapy and Prognosis in Patients with Resectable Pancreatic Cancer: A Propensity Score Matching Analysis

Background/AimsControversy regarding the effectiveness of neoadjuvant therapy for resectable pancreatic ductal adenocarcinoma (PDAC) still exists. Here, we aimed to identify the potential benefits of neoadjuvant therapy followed by surgery for resectable PDAC.MethodsWe reviewed radiologically resectable PDAC patients who received resection with curative intent at a tertiary hospital in South Korea between January 2012 and August 2019. A total of 202 patients underwent curative resection for resectable PDAC 167 underwent surgical resection first during this period, and 35 received neoadjuvant chemotherapy/chemoradiation therapy followed by surgery. Resectable PDAC patients were subdivided, and 13 propensity score matching (PSM) was performed to reduce selection bias.ResultsCompared with the group that received surgery first, the group that received neoadjuvant treatment followed by surgery had significantly smaller tumors (22.0 mm vs 27.0 mm, p=0.004), a smaller proportion of patients with postoperative pathologic T stage (p=0.026), a smaller proportion of patients with lymphovascular invasion (20.0% vs 40.7%, p=0.022), and a larger proportion of patients with negative resection margins (74.3% vs 51.5%, p=0.049). After PSM, the group that received neoadjuvant therapy had a significantly longer progression-free survival than those in the group that underwent surgery first (29.6 months vs 15.1 months, p=0.002). Overall survival was not significantly different between the two groups after PSM analysis.ConclusionsWe observed significantly better surgical outcomes and progression-free survival with the addition of neoadjuvant therapy to the management of resectable PDAC. However, despite PSM, there was still selection bias due to the use of different regimens between the groups receiving surgery first and neoadjuvant therapy. Large homogeneous samples are needed in the future prospective studies.     

甲状腺功能亢进症156例外科治疗临床分析

目的探讨甲状腺功能亢进症外科手术治疗效果。方法回顾性分析156例甲亢患者临床资料。结果本组无手术死亡病例,发生甲状腺危象1例,无术后出血,窒息及呼吸困难,喉返神经损伤3例,低钙性抽搐4例,给予相应治疗措施后恢复,术后甲亢复发3例。结论外科手术可有效治疗甲亢,术前准备充分,手术操作细致,术后处理妥当可提高疗效,减少并发症。     

胰腺癌患者胰液中端粒酶活性表达及临床意义

采用 DCR- ELISA和 PCR- SSCP两种方法检测胰腺癌患者胰液中端粒酶的活性。结果 31例胰腺癌患者中 ,19例端粒酶活性阳性 ;3例胰腺良性肿瘤患者中 ,1例端粒酶活性阳性 ;6例非胰腺疾病患者的端粒酶活性均为阴性。另外检测了 4例胰腺癌患者癌细胞株的端粒酶活性 ,结果均呈阳性。结果显示 ,胰腺癌患者胰液中端粒酶活性呈高表达 ,与胰腺良性肿瘤及非胰腺疾病相比差异有显著性 ( P<0 .0 5)。提示胰液中端粒酶活性检测可作为胰腺癌诊断和鉴别诊断的重要依据     

Immediate or Interval Endoscopic Papillary Large-balloon Dilation after Limited Endoscopic Sphincterotomy for Bile Duct Stone Removal

Objective Endoscopic papillary large-balloon dilation (EPLBD) with limited endoscopic sphincterotomy (EST) is widely used for removing multiple large common bile duct (CBD) stones. However, the safety and effectiveness of immediate EPLBD after limited EST and EPLBD at an interval after limited EST is unclear. Thus, this multicenter retrospective study was conducted to examine this matter. Methods Propensity score-matching was performed to adjust the baseline characteristics between the immediate and interval EPLBD groups. We compared the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) complications and the early outcomes of ERCP between the 2 matched groups, which comprised 66 patients each. Results The complete stone clearance rate in each study group was 100%. The overall incidence of post-ERCP complications in the propensity score-matched interval and immediate EPLBD groups was 3/33 (9.1%) and 1/33 (3.0%), respectively (p=0.61). The immediate EPLBD group had significantly fewer mean ERCP sessions for complete stone removal and a significantly lower rate of endoscopic mechanical lithotripsy (EML) usage than the interval EPLBD group [1.6 vs. 2.4 sessions, p<0.001; and 4/33 (12.1%) vs. 12/33 (36.4%), p=0.042, respectively]. Conclusion The incidence of post-ERCP complications in the immediate EPLBD group was not significantly different from that in the interval EPLBD group. Compared with interval EPLBD, immediate EPLBD may result in a reduced number of ERCP sessions for complete stone clearance and reduce the rate of EML usage.