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| 1 | 胆总管结石经内镜逆行胰胆管造影术取石迟发出血的危险因素分析及防治显示文摘目的探讨经内镜逆行胰胆管造影术(ERCP)取石并发上消化道出血的危险因素及防治方法。方法回顾性分析2014年1月至2014年12月在皖南医学院附属弋矶山医院接受ERCP患者的临床资料,收集可能与ERCP取石术迟发出血有关的危险因素进行单因素和多因素分析,寻找ERCP取石术迟发出血的独立危险因素。结果符合入组标准者383例,男157例、女226例,年龄最小19岁,最大88岁。并发消化道出血患者41例(10.7%),术中出血27例(7.0%),术后出血14例(3.7%);其中轻度出血28例,中度出血9例(4例为贲门黏膜撕裂),重度出血4例。患者均痊愈出院,无一例外科治疗及死亡。单因素分析发现阿司匹林/氢氯吡格雷片服药史、胆管炎、巨大憩室及憩室内乳头为ERCP取石术迟发出血的危险因素(P〈0.05)。多因素分析显示胆管炎(OR=4.125,95%CI:1.306~13.031,P〈0.05)、阿司匹林/氢氯吡格雷片服药史(OR=10.220,95%C1:2.997~34.853,P〈0.01)及憩室内乳头(OR=14.064,95%CI:t.888—104.762,P〈0.05)为ERCP取石术迟发出血的独立危险因素。结论胆管炎、阿司匹林/氢氯吡格雷片服药史及憩室内乳头使ERCP取石患者并发上消化道迟发出血的风险增加。如发生出血,积极止血,尤其内镜下止血至关重要。 | 汪润芝 邓涛 | 2015 | 中华消化内镜杂志2015，32，7： | 22 |
| 2 | Predictors of re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy bleeding显示文摘AIM: To predict the re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy(ES) bleeding.METHODS: Over a 15-year period, data from 161 patients with delayed post-ES bleeding were retrospectively collected from a single medical center. To identify risk factors for re-bleeding after initial successful endoscopic hemostasis, parameters before, during and after the procedure of endoscopic retrograde cholangiopancreatography were analyzed. These included age, gender, blood biochemistry, comorbidities, endoscopic diagnosis, presence of periampullary diverticulum, occurrence of immediate postES bleeding, use of needle knife precut sphincterotomy, severity of delayed bleeding, endoscopic features on delayed bleeding, and type of endoscopic therapy.RESULTS: A total of 35 patients(21.7%) had rebleeding after initial successful endoscopic hemostasis for delayed post-ES bleeding. Univariate analysis revealed that malignant biliary stricture, serum bilirubin level of greater than 10 mg/d L, initial bleeding severity, and bleeding diathesis were significant predictors of rebleeding. By multivariate analysis, serum bilirubin level of greater than 10 mg/d L and initial bleeding severity remained significant predictors. Re-bleeding was controlled by endoscopic therapy in a single(n = 23) or multiple(range, 2-7; n = 6) sessions in 29 of the 35 patients(82.9%). Four patients required transarterial embolization and one went for surgery. These five patients had severe bleeding when delayed post-ES bleeding occurred. One patient with decompensated liver cirrhosis died from re-bleeding.CONCLUSION: Re-bleeding occurs in approximately one-fifth of patients after initial successful endoscopic hemostasis for delayed post-ES bleeding. Severity of initial bleeding and serum bilirubin level of greater than 10 mg/d L are predictors of re-bleeding. | Mu-Hsien Lee Yung-Kuan Tsou Cheng-Hui Lin Ching-Song Lee Nai-Jen Liu Kai-Feng Sung Hao-Tsai Cheng | 2016 | World Journal of Gastroenterology2016，22，11： | 11 |
| 3 | 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 |
| 4 | 全覆膜金属支架治疗内镜乳头括约肌切开术后出血的疗效显示文摘EST是ERCP检查中常用的诊断与治疗操作,EST术后乳头切缘出血发生率为2%~9%[1-2].内镜下止血是其首选治疗方案.如内镜下治疗不能控制出血,则需行动脉栓塞和外科开腹手术治疗,增加了患者创伤和经济负担.目前临床上常用的内镜下控制EST术后出血的方法是金属夹夹闭出血灶和黏膜下注射肾上腺素[3-4].但这两种治疗方法均难以控制EST术后活动性出血,因此,临床上需要更简便有效的内镜下止血措施.近年来,笔者应用全覆膜自膨式金属支架(full covered self-expandable metal stents,FCSEMS)控制EST术后出血,取得了一定的效果.本研究回顾性分析2012年1月至2013年2月成都军区总医院应用FCSEMS治疗4例EST术后出血患者的临床资料,探讨EST术后出血治疗的新方法. | 庞勇 张炳印 汤礼军 田伏洲 白文涛 刘丹青 黄尚卿 高茜 | 2014 | 中华消化外科杂志2014，13，7： | 3 |
| 5 | Ankaferd hemostat in the management of gastrointestinal hemorrhages显示文摘Gastrointestinal (GI) bleeding refers to any hemorrhage ascribed to the pathologies of the gastrointestinal tract,extending from the mouth to the anal canal.Despite the recent improvements in the endoscopic,hemostatic and adjuvant pharmacologic techniques,the reported mortality is still around 5%-10% for peptic ulcer bleeding and about 15%-20% for variceal hemorrhages.Although endoscopic management reduces the rates of re-bleeding,surgery,and mortality in active bleeding;early recurrence ratios still occur in around 20% of the cases even with effective initial hemostatic measures.In this quest for an alternative pro-hemostatic agent for the management of GI bleedings,Ankaferd blood stopper (ABS) offers a successful candidate,specifically for 'difficult-to-manage' situations as evidenced by data presented in several studies.ABS is a standardized mixture of the plants Thymus vulgaris,Glycyrrhiza glabra,Vitis vinifera,Alpinia officinarum,and Urtica dioica.It is effective in both bleeding individuals with normal hemostatic parameters and in patients with deficient primary and/or secondary hemostasis.ABS also modulates the cellular apoptotic responses to hemorrhagic stress,as well as hemostatic hemodynamic activity.Through its effects on the endothelium,blood cells,angiogenesis,cellular proliferation,vascular dynamics,and wound healing,ABS is now becoming an effective alternative hemostatic medicine for gastrointestinal bleedings that are resistant to conventional anti-hemorrhagic measurements.The aim of this review is to outline current literature experience suggesting the place of ABS in the management of GI bleeding,and potential future controlled trials in this complicated field. | Yavuz Beyazit Murat Kekilli Ibrahim C Haznedaroglu Ertugrul Kayacetin Metin Basaranoglu | 2011 | World Journal of Gastroenterology2011，17，35： | 1 |
| 6 | 金属支架置入术后迟发性十二指肠乳头出血(附1例报告)显示文摘全覆膜自膨式可回收金属支架(full-covered self-expanding removable metal stents,FCSERMS)除治疗传统意义上的胆管良、恶性狭窄外[1-2],也可用于内镜乳头括约肌切开术后难以控制的出血[3-4]。本文报道1例病人FCSERMS术后6个月发生十二指肠乳头迟发性出血的诊治。病例:男,84岁,因内镜下胆道金属支架引流术后6个月,经皮经肝胆管穿刺置管引流术(percutaneous transhepatic cholangial drainage,PTCD)后3个月,呕血及便血1 d入院。6个月前因胆总管结石及胆管狭窄行内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancretography,ERCP)治疗,顺利取出结石后放置FCSERMS(见图1)。 | 张诚 杨玉龙 胡海 赵刚 | 2019 | 外科理论与实践2019，24，4： | 0 |
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