Objective To evaluate the clinical effectiveness of laparoscopic cholecystectomy and laparoscopic common bile duct exploration （LC＋LCBDE） and endoscopic retrograde cholangiopancreatography/endoscopic sphincterectomy with LC（ERCP/EST＋LC） in treatment for cholecystolithiasis with choledocholithiasis. Methods From January 2008 to July 2011， 127 patients suffered from cholecystolithiasis with choledocholithiasis underwent either LC＋LCBDE（85 cases， LC＋LCBDE group） or ERCP/EST＋LC（42 cases， ERCP/EST＋LC group） were collected retrospectively. The clearance rate of calculus， hospital stay， hospitalization expenses， and the rate of postoperative complications were compared between two groups. Results Eighty-five patients were performed successfully in the LC＋LCBDE group， out of which 54 patients had primary closure of common bile duct （LC＋LCBDE primary closure group）， whereas in 28 patients common bile ducts were closed over T tube （LC＋LCBDE＋T tube group）. Forty-two patients were performed successfully in the ERCP/EST＋LC group. There were no differences in the clearance rate of calculus〔100%（82/82） versus 97.37%（37/38）， P=0.317〕 and postoperative complications rate 〔（4.71% （4/85） versus 4.76%（2/42）， P=1.000〕 between the LC＋LCBDE group and ERCP/EST＋LC group. The median （quartile） hospital stay in the LC＋LCBDE group was shorter than that in the ERCP/EST＋LC group 〔12 （6） d versus 17（9） d， P＜0.001〕. In the LC＋LCBDE primary closure group， both median （quartile）?hospital stay and median（quartile） hospitalization expenses were less than those of ERCP/EST＋LC〔hospital stay：11（5） d versus 17（9） d， P＜0.001；hospitalization expenses：27 054（8 452） yuan versus 31 595（11 743） yuan， P=0.005〕 . Conclusions In the management of patients suffered from cholecystolithiasis with choledocholithiasis， both LC＋LCBDE and ERCP/EST＋LC are safe and effective. LC＋LCBDE， especially primary closure after LCBDE， is associated with significantly less costs as compared with ERCP/EST＋LC. Moreover， patients can be cured by LC＋LCBDE through one-stage treatment with the protection of the papilla function and no limits to the amount or size of the choledocholithiasis. The LC＋LCBDE is a preferable choice for the appropriate cases of cholecystolithiasis with choledocholithiasis.
Objective To analyze and explain how to treat 1 patient with post-ERCP hemobilia based on best clinical evidence. Methods We used EST and EPBD, ENBD, Hemobilia as key words to search MEDLINE （1978 ～ 2004） and CBMdisc（1978 ～ 2004） to find the best clinical evidence and evaluated the quality of evidence. Results According to the evidence, we found that endoscopic papillary balloon dilation （EPBD） or endoscopic nasobiliary drainage （ ENBD ） may be more effective and better tolerated in the treatment ofpost-ERCP hemobilia. Our patient did not receive sufficient medical treatment after hemobilia. He was not given a general assessment before surgery including liver function tests. As a result, the patient died of liver failure and its complications. Conclusions We should treat such patients promptly and efficiendy after hemobilia. We should also evaluate their general condition properly before the operation.
ObjectiveTo evaluate the efficiency of the spot-welding electrocoagulation with needle-knife to prevent bleeding after endoscopic sphincterotomy (EST). MethodsThe clinical data of 187 patients underwent EST from August 2009 to October 2009 were retrospectively analyzed, study group （n=102) were treated with spotwelding electrocoagulation with needleknife and 110 000 noradrenaline washing, control group (n=85) were treated with 110 000 noradrenaline washing alone. The bleeding and complications after EST were observed. ResultsThe differences of gender, age, primary diseases, cormorbidities, nutritional status, and immune function were not significant between two groups (Pgt;0.05). The bleeding after EST happened 4 cases (4.70%) in the control group and none in the study group. The bleeding rate of the study group was significantly lower than that of the control group (Plt;0.05). The bleeding cases in the control group were controlled successfully by spotwelding electrocoagulation with needleknife under endoscopy. Cholangitis occurred in 5 cases altogether, 1 case in each group deteriorated promptly and died of multiple organ failure syndrome, another 3 cases, 2 in the study group, 1 in the control group, were cured by PTCD and antibiotics. Biliary tract hemorrhage occurred one case in each group, which one died in the study group. Pancreatitis occurred 1 case in the study group and 2 cases in the control group, all of which were salvaged by conservative therapy. The incidences of complications were not significantly different between two groups (Pgt;0.05). ConclusionsThe spotwelding electrocoagulation with needleknife can significantly reduce the bleeding rate after EST. It is an effective, safe, and easy technique, especially to rural areas.
ObjectiveTo explore the efficacy and safety of endoscopic sphincterotomy (EST) in the treatment of sphincter of Oddi dysfunction (SOD).MethodsThe clinical data of 95 cases of SOD treated with EST in Affiliated Hospital of Guizhou Medical University and Tumor Hospital Affiliated to Guizhou Medical University from January 2014 to January 2019 were collected retrospectively, to evaluate and analyze the effect of clinical diagnosis and treatment of EST on SOD patients.ResultsAmong 95 SOD patients, 86 were biliary type SOD and 9 were pancreatic type SOD. All 95 patients underwent EST. The Verbal Rating Scales-5 (VRS-5) scores before EST were all 3 or 4 points, and the VRS-5 scores decreased after treatment in each type of SOD patients, the difference were all statistically significant (P<0.05). After treatment, levels of ALT, AST, ALP, TBiL, and DBiL in biliary type SOD Ⅰ and type Ⅱ were significantly lower than before (P<0.05); ALT, AST, ALP, GGT, and blood and urine amylase in patients with pancreatic type SOD after EST were significantly decreased than before (P<0.05), and the biochemical indicators of patients with SOD Ⅲ before and after treatment did not change significantly (P>0.05). After EST treatment, 70 (81.4%) of the 86 patients with bile type SOD showed significant effect, and 10 patients (11.6%) were effective, with an overall effective rate of 93.0% (80/86). Among the 16 patients with bile type SOD Ⅰ, 14 patients (87.5%) received significant effect, and 1 patient (6.3%) was effective, with an overall effective rate of 93.8% (15/16). That 51 patients with bile type SOD Ⅱ received EST, of which 43 patients (84.3%) were significantly effective and 6 patients (11.8%) were effective, with an overall response rate of 96.1% (49/51). Among the 19 patients with bile type SOD Ⅲ treated with EST, 13 patients (68.4%) were significantly effective and 3 patients (15.8%) were effective, with the overall effective rate was 84.2% (16/19). There was no statistically significant difference in the overall effective rate of patients with 3 types of biliary type SOD patients (P>0.05). Endoscopic treatment was effective in all 9 cases of pancreatic type SOD, with an overall effective rate of 100%. There were 5 patients (5.3%) of acute pancreatitis after EST, and no bleeding, perforation, cholangitis or other complications occurred. All patients were interviewed for 1 to 5 years postoperatively, the median follow-up duration was 2.33 year, during the follow-up period, nolong-term complications such as Oddi sphincter restenosis and cholangitis caused by intestinal bile reflux.ConclusionESTis a minimally invasive, safe, and effective treatment for SOD in patients with bile duct type and pancreatic duct type, and it is an important treatment for SOD.
目的:探讨腹腔镜胆囊切除术(LC)与内镜十二指肠乳头括约肌切开术(EST)联合应用治疗胆囊结石合并胆总管结石的临床效果。方法:回顾性分析我院开展的LC联合EST治疗胆囊结石合并胆总管结石76例,其中56例先行EST后行LC,20例先行LC后行ERCP/EST。结果:本组全部治愈,先行EST组56例,3例并发胰腺炎,3例出血,2例再发胆总管结石,先行LC组20例行EST11例,6例取石后未做括约肌切开,3例结石自行掉入肠道,1例出现胆道感染,1例胰腺炎,无出血及穿孔。结论:内镜治疗胆囊结石继发胆总管结石具有创伤小、效果好、并发症少、恢复快的的特点;先作EST可解除胆道梗阻、减轻炎症,并为LC创造条件,选择性先行LC后可减轻创伤,甚至不必做EST。
ObjectiveTo explore the clinical efficacy of percutaneous endoscopic interlaminar discectomy (PEID) and interlaminar fenestration discectomy in the treatment of lumbar (L) 5-Sacral (S) 1 lumbar disc herniation (LDH).MethodsLDH patients were retrospectively included from January 2016 to Januray 2018. And the patients were divided into the PEID group and the fenestration group according to their choice of different surgical methods. The operation time, intra-operative blood loss, and bed rest time in the two groups were recorded. The preoperative and postoperative [1 week, 1 month, 3 months, and last follow-up (>12 months)] Visual Analogue Score (VAS) of the lumbago and leg pain between the two groups were compared; the preoperative and postoperative [1 week, and last follow-up (>12 months)] Oswestry Disability Index (ODI) and also the postoperative [(>12 months)] therapeutic effect (modified MacNab) between the two groups were compared.ResultsA total of 66 patients were included, with 31 in the PEID group and 35 in the fenestration group. There was no significant difference in age, gender and course of disease between the two groups (P>0.05). There were leakage of cerebrospinal fluid and transient lumbago, leg pain and numbness, which were worse than those before operation in the PEID group (1 and 1 patient, respectively) and the fenestration group (2 and 3 patients, respectively). There were statistically significant differences between the PEID group and the fenestration group, in the operative time [(90.65±9.98) vs. (66.23±16.50) minutes], intra-operative blood loss [(51.77±18.64) vs. (184.29±78.38) mL], and bed time [(2.87±0.92) vs. (7.49±1.20) d] (t=−7.365, t’=−9.697, t=−17.374, P<0.001). There was no significant difference in the preoperative VAS score (lumbar-leg pain) and ODI index, and the ODI index at each postoperative time point, between the two groups (P>0.05). VAS score (lumbago) and VAS score (leg pain) in the PEID group at each postoperative time point were lower than those in the fenestration group (P<0.05); VAS scores (leg pain) at other time points were not statistically significant between the two groups (P > 0.05). VAS (lumbar-leg pain) score and ODI index at each postoperative time point were lower than those before the surgery. The was no statistically significant difference in the PEID group (90.32%) and fenestration group (85.71%) in the excellent rate (χ2=0.328, P=0.713).ConclusionsPEID has less surgical trauma, less bleeding, short bed rest, fast recovery, and better relief of postoperative lumbago symptoms. It is worthy of further promotion in clinical work.
Objective To explore the comprehensive treatment of synchronous double cancers of the esophagus and stomach. Methods The treatment procedures of 8 patients with synchronous double cancers of the esophagus andstomach admitted in the Department of Digestive Tumor Surgery of The Hospital of Traditional Chinese Medicine of Jiangsu Province between Oct. 2006 to Feb. 2013 were analyzed. Some experience of comprehensive treatment of synch-ronous double cancers of the esophagus and stomach was explored. Results Eight cases of synchronous double cancers of the esophagus and stomach were all diagnosed by endoscopic biopsy. According to the results of CT and endoscopic ultrasonography assessment， lesions which were staged earlier than T1a were cured by endoscopic mucosal resection（6 cases， including 4 cases of esophagus cancer and 2 cases of gastric cancer）， and resection operation （1 cases of esop-hagus cancer）. The lesions staged later than T2 were treated by preoperative neoadjuvant chemoradiation， surgery， and adjuvant chemoradiation after operation （8 cases， including 2 cases of esophagus cancer and 6 cases of gastric cancer）， and simple operation （1 case）. Eight patients had been followed-up for 10-76 months （averaged 41.3 months）. Six patients survived without recurrence and metastasis during the followed-up， 1 patient died in 7 months after operation， and 1 patient relapsed in 20 months after operation. Conclusions Individually designed comprehensive treatment using neo-chemotherapy， intervention chemotherapy， radio-chemotherapy， radical resction surgery， adjuvant chemotherapy， and endoscopic mucosal resection can treat synchronous double cancers of the esophagus and stomach effectively. Impr-actical pursuit for radical surgery will not result in good prognosis