Intraductal biliary and pancreatic endoscopy： An expanding scope of possibility

Intraductal endoscopy describes the use of an endoscope to directly visualize the biliary and pancreatic ducts. For many years, technological challenges have made performing these procedures difficult. The “mother-baby” system and other various miniscopes have been developed, but routine use has been hampered due to complex setup, scope fragility and the time consuming, technically demanding nature of the procedure. Recently, the SpyGlass peroral cholangiopancreatoscopy system has shown early success at providing diagnostic information and therapeutic options. The clinical utility of intraductal endoscopy is broad. It allows better differentiation between benign and malignant processes by allowing direct visualization and targeted sampling of tissue. Therapeutic interventions, such as electrohydraulic lithotripsy （EHL）, laser lithotripsy, photodynamic therapy, and argon plasma coagulation （APC）, may also be performed as part of intraductal endoscopy. Intraductal endoscopy significantly increases the diagnostic and therapeutic yield of standard endoscopic retrograde cholangiography （ERCP）, and as technology progresses, it is likely that its utilization will only increase. In this review of intraductal endoscopy, we describe in detail the various endoscopic platforms and their diagnostic and clinical applications.     

两种微创方案治疗胆囊结石并胆总管结石的疗效对比

目的 比较腹腔镜胆囊切除术（LC）+胆道镜胆总管探查取石术（LCBDE）与LC+内镜下十二指肠乳头括约肌切开取石术（EST）治疗胆囊结石并胆总管结石的临床疗效。方法 收集我院2013年1月~2017年12月收治的胆囊结石合并胆总管结石患者104例作为研究对象,按照手术方法分为LC+LCBDE组和LC+EST组,各52例。比较两组患者手术时间、术中出血量、住院时间、并发症发生率以及Oddis括约肌损伤发生率。结果 LC+LCBDE组患者的手术时间（131.52±25.71）min、住院时间（8.13±2.35）d、并发症发生率（15.38%）、Oddis括约肌损伤发生率（3.85%）均低于LC+EST组的（167.12±35.24）min、（10.37±3.25）d、48.07%、25.00%,差异均有统计学意义（P＜0.05）;两组术中出血量比较,差异无统计学意义（P＞0.05）。结论 LC+LCBDE和LC+EST均是治疗胆囊结石并胆总管结石的有效微创手段,LC+LCBDE方案具有手术时间短、住院时间短、并发症发生率低的优点,同时能保护Oddis括约肌的正常功能,具有一定的优越性。     

小切口手术联合胆道镜治疗胆石症

目的总结小切口手术联合胆道镜治疗胆石症的经验。方法回顾分析1995年1月至2004年4月以小切口联合胆道镜手术治疗1367例胆石症的临床资料。胆道镜处理有3种途径:经胆囊管途径(297例),经胆总管切开途径(327例)和经术后T管窦道途径(305例)。结果1367例中在小切口(3~5cm)下完成手术者1320例,47例(3.4%)因出血、粘连、解剖变异或胆道损伤等各种原因将切口延长至5cm以上始完成手术。743例为单纯胆囊切除。624例联合胆道镜处理,其中150例未发现胆总管结石,474例发现胆总管结石,467例经术中术后胆道镜取尽,7例胆总管结石紧嵌于胆总管末端,术后以EST(4例)和气压弹道碎石后取尽(3例)。发生术后并发症31例。结论小切口联合胆道镜手术是一种相对微创的直视下治疗胆石症的便捷方法。     

腹腔镜联合胆道镜微创治疗胆道结石210例分析

目的：总结腹腔镜联合胆道镜微创治疗胆道结石的手术技巧和临床应用。方法：回顾分析总结腹腔镜联合胆道镜微创治疗胆道结石210例患者的临床资料。结果：210例患者中,胆囊合并胆总管结石171例,单纯性胆总管结石26例,胆总管结石合并肝吸虫病8例,胆总管结石合并左肝右肝管结石5例。患者平均手术时间为69min,平均术后住院日为5.4d。结论：腹腔镜联合胆道镜微创治疗胆道结石手术创伤小,时间短,疗效好,安全可靠。     

腹腔镜下经纤维胆道镜治疗肝内外胆管结石的体会(附730例报告)

目的:探讨腹腔镜联合纤维胆道镜及液电碎石术治疗肝内、外胆管结石的临床应用价值。方法:回顾分析730例腹腔镜胆道手术中经胆囊管残端、胆总管切开及术后经"T"管窦道行纤维胆道镜下取石、液电脉冲碎石的临床资料。结果:346例一次性取净胆总管内结石,占47.4%;31例一次性取净左、右肝内胆管结石,占19.5%。术后经"T"管窦道纤维胆道镜取石、液电碎石治疗后全部治愈。术后胆漏3例,出血17例,无死亡病例及中转开腹。结论:腹腔镜联合纤维胆道镜、液电碎石术治疗肝内、外胆管结石符合微创、安全、可靠、有效的原则,腹腔镜下纤维胆道镜操作技术是治疗肝内、外胆管结石的关键。     

腹腔镜联合纤维胆道镜治疗胆囊胆总管结石

目的探讨腹腔镜联合胆道镜治疗胆囊结石胆总管结石的效果。方法将2005年6月—2009年6月收治的168例胆囊结石合并胆总管结石患者,随机抽取90例行腹腔镜胆囊切除+胆总管切开+胆道镜探查、取石T管引流术(联合腹腔镜组),另78例行开腹胆囊切除+胆总管切开取石T管引流术(对照组),对比分析两组的临床效果。结果开腹组并发症发生率高于联合组(P0.05),联合组住院时间、胃肠功能恢复时间均短于对照组(P0.05),两组手术时间、住院费用差异无统计学意义(P0.05)。结论与传统开腹手术相比,用腹腔镜联合胆道镜治疗胆囊胆总管结石具有创伤小、恢复快、住院时间短等优点,优于传统开腹手术。     

Percutaneous endoscopic laser lithotripsy of retained stones in the left hepatic duct

Summary A 35-year-old woman with a retained stone in a branch of the left hepatic duct was referred to us. The stone was discovered on the postoperative T-tube cholangiogram. A flexible ureteroscope was introduced into the duct, under fluoroscopic and direct endoscopic vision and the pulsed dye laser was used successfully to disintegrate the calculus. The postoperative course was uneventful. We suggest that in certain selected cases, the pulsed dye laser might be useful in disintegrating stones sited in difficult positions.     

腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的效果

目的 探讨腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的临床效果。方法 回顾性分析咸阳市中心医院2012年1月至2015年12月收治的68例胆囊结石合并胆总管结石并接受手术治疗的患者临床资料,根据手术方式,将患者分为腹腔镜微创手术组（腹腔镜组）38例,传统开腹手术组（开腹组）30例。比较两组患者的术中出血量、手术时间、术后排气时间、住院时间、术后并发症以及术后第2天的白细胞（WBC）、中性粒细胞百分比（NEUT%）及C反应蛋白（CRP）。结果 腹腔镜组术中出血量、术后排气时间、住院天数、术后伤口疼痛、切口感染例数均少于开腹组,差异有统计学意义（P<0.05）;两组患者在手术时间、术后胆漏、胆管残余结石方面比较差异无统计学意义（P>0.05）;术后第2天,腹腔镜组患者NEUT%、CRP低于开腹组患者,差异有统计学意义（P<0.05）。结论 腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石具有创伤小、痛苦小、术后恢复快等优点,疗效确切,适合临床推广。     

Interobserver agreement for evaluation of imaging with single operator choledochoscopy: What are we looking at?

BackgroundSingle operator choledochoscopy is a platform used to assist in the confirmation of diagnosis of biliary lesions. However, there are little data regarding the interobserver agreement of imaging interpretation. Our objective was to assess the interobserver agreement in single operator choledochoscopy interpretation.Methods38 De-identified SPY Choledochoscopy video clips were sent to 7 interventional endoscopists. They were asked to score the videos on presence of four criteria selected by the investigators: growth, stricture, hyperplasia, and ulceration. Observers also chose a final diagnosis from the categories of cancer, hyperplasia, inflammation, or normal. Kappa scores were calculated for the scoring of the four criteria and for the selection of the final diagnosis.ResultsThe overall interobserver agreement was fair in scoring for the presence of a growth (K = 0.28, SE 0.035) and stricture (K = 0.32, SE 0.035). Scoring for ulceration was slight to fair (K = 0.17, SE 0.035). There was only slight agreement for the presence of hyperplasia (K = 0.11, SE 0.035); and presumed final diagnosis based on imaging (K = 0.18, SE 0.022).ConclusionThe results of this study support the need for an effort to identify and validate cholangioscopy imaging criteria for biliary pathology. This may assist in improving the reliability of the diagnostic value of cholangioscopy as its use becomes more widespread.     

腹腔镜联合胆道镜治疗胆道结石的临床效果分析

目的：分析探究对胆道结石患者采用胆道镜联合腹腔镜进行治疗的临床效果。方法选取2012年5月—2014年5月在该院确诊为胆道结石的100例患者进行研究,将患者平均分为对照组与试验组,每组50例患者,对照组给予开腹手术进行治疗,试验组给予胆道镜联合腹腔镜进行治疗,对比分析临床治疗效果情况。结果对手术后的效果比较,试验组总有效率（92.00%）明显好于对照组的总有效率（68.00%）,差异有统计学意义（P＜0.05）。结论腹腔镜联合胆道镜治疗胆道结石的临床效果显著,一定程度的缓解了患者的临床症状,促进了患者治疗后身体及心理的康复,安全可靠,值得推广应用。