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| 1 | Poorly expandable common bile duct with stones on endoscopic retrograde cholangiography显示文摘AIM:To describe characteristics of a poorly expandable(PE) common bile duct(CBD) with stones on endoscopic retrograde cholangiography.METHODS:A PE bile duct was characterized by a rigid and relatively narrowed distal CBD with retrograde dilatation of the non-PE segment.Between 2003 and 2006,endoscopic retrograde cholangiography(ERC) images and chart reviews of 1213 patients with newly diagnosed CBD stones were obtained from the computer database of Therapeutic Endoscopic Center in Chang Gung Memorial Hospital.Patients with characteristic PE bile duct on ERC were identified from the database.Data of the patients as well as the safety and technical success of therapeutic ERC were collected and analyzed retrospectively.RESULTS:A total of 30 patients with CBD stones and characteristic PE segments were enrolled in this study.The median patient age was 45 years(range,20 to 92 years);66.7% of the patients were men.The diameters of the widest non-PE CBD segment,the PE segment,and the largest stone were 14.3 ± 4.9 mm,5.8 ± 1.6 mm,and 11.2 ± 4.7 mm,respectively.The length of the PE segment was 39.7 ± 15.4 mm(range,12.3 mm to 70.9 mm).To remove the CBD stone(s) completely,mechanical lithotripsy was required in 25(83.3%) patients even though the stone size was not as large as were the difficult stones that have been described in the literature.The stone size and stone/PE segment diameter ratio were associated with the need for lithotripsy.Post-ERC complications occurred in 4 cases:pancreatitis in 1,cholangitis in 2,and an impacted Dormia basket with cholangitis in 1.Two(6.7%) of the 28 patients developed recurrent CBD stones at follow-up(50 ± 14 mo) and were successfully managed with therapeutic ERC.CONCLUSION:Patients with a PE duct frequently require mechanical lithotripsy for stones extraction.To retrieve stones successfully and avoid complications,these patients should be identified during ERC. | Chi-Liang Cheng Yung-Kuan Tsou Cheng-Hui Lin Jui-Hsiang Tang hien-Fu Hung Kai-Feng Sung Ching-Song Lee Nai-Jen Liu | 2012 | World Journal of Gastroenterology2012，18，19： | 7 |
| 2 | 老年胆总管巨大结石合并急性胆管炎85例的治疗分析显示文摘目的总结胆总管巨大结石合并急性胆管炎老年患者的诊疗体会。方法回顾性分析85例胆总管巨大结石合并急性胆管炎老年患者的临床资料,所有病例都进行抗感染、制酸、保肝、解痉等常规治疗,在此基础上25例行B超引导下经皮经肝胆道引流术(PTCD);50例患者行腹腔镜下胆总管切开取石术(LCBDE),其中6例中转开腹;35例患者直接行开腹胆总管切开取石术。结果 PTCD成功23例,2例置管失败。LCBDE术后出现胆瘘8例,肺部感染8例,心力衰竭5例,予以相应诊疗后治愈。开腹胆总管切开取石术后出现胆瘘4例,粘连性肠梗阻6例,切口感染6例,肺部感染8例,心力衰竭5例,均治愈。结论胆总管巨大结石合并急性胆管炎的老年患者情况复杂,病情发展快,对急性胆管炎的严重程度进行分级有利于病情评估,可根据患者麻醉ASA分级、病情分级多方面综合考虑,选择PTCD、LCBDE及开腹手术进行治疗。 | 王梽 郑清盛 王守铭 | 2018 | 福建医药杂志2018，40，2： | 3 |
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