儿童胰胆疾病内镜逆行胰胆管造影诊治分析

目的探讨内镜逆行胰胆管造影(ERCP)在儿童胰胆疾病中的诊断和治疗作用。方法回顾分析2008年3月至8月上海交通大学医学院附属瑞金医院ERCP诊治的10例儿童胰胆疾病临床资料及图像。结果10例患儿ERCP诊治全部成功,无急性胰腺炎及出血、穿孔等并发症。结论ERCP对诊治儿童胰胆疾病是一种安全、有效的手段。     

经内镜逆行胰胆管造影术治疗肝硬化合并胆胰疾病的价值

目的评价肝硬化合并胆胰疾病患者行经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)治疗的疗效和安全性。方法回顾性分析西京消化病医院2008年11月至2017年12月期间因肝硬化合并胆胰疾病行ERCP的初治患者99例的病例资料,分析ERCP成功率及并发症发生情况。结果99例肝硬化患者以乙肝病毒感染(40.4%,40/99)和病因不明(30.3%,30/99)为主,终末期肝病模型评分(15.4±5.3)分;胆胰疾病以胆总管结石和胆管狭窄为主,分别占49.5%(49/99)和33.3%(33/99)。ERCP治疗成功率为100.0%(99/99)。术后总体并发症发生率为14.1%(14/99),其中肝硬化相关并发症发生率为3.0%(3/99);ERCP相关并发症发生率为11.1%(11/99),包括胆道感染(9.1%,9/99)和迟发性出血(2.0%,2/99)。无ERCP术后胰腺炎、穿孔及ERCP相关死亡。结论肝硬化合并胆胰疾病患者行ERCP治疗是安全有效的。     

ERCP与MRCP对胆胰疾病诊断的比较分析

在胰胆疾病的诊断中，影像学检查越来越起重要的作用。近年来，除了十二指肠逆行胰胆管造影(ERCP)，磁共振胰胆管造影(MRCP)作为胰胆系疾病的无创伤性诊断新技术，已被广泛应用于临床。早期研究显示，MRCP在胰胆管扩张方面有较高的准确性，但在胆总管结石与肿瘤的诊断方面尚有争论。本文就ERCP和MRCP对胆胰疾病的诊断价值做一比较分析。     

治疗性内镜下逆行胰胆管造影技术治疗胆总管结石216例临床分析

随着内镜下逆行胰胆管造影（ERCP）技术的不断提高,治疗性ERCP技术,如内镜下乳头切开术、针状电刀乳头预切开术、内镜下十二指肠鼻胆管引流术（ENBD）、内镜下乳头括约肌气囊扩张术（EPBD）和机械碎石术（ML）等在胆总管结石患者的治疗中得到广泛应用。我们对我院运用ERCP技术治疗的216例胆总管结石患者的临床资料进行回顾性分析。     

经内镜逆行胰胆管造影诊治胆胰疾病1147例分析

内镜下逆行胰胆管造影术(ERCP)是胰胆管疾病重要的诊断和治疗方法。随着该技术的不断发展,临床应用范围逐渐扩大,单纯诊断性ERCP逐渐被治疗性ERCP所取代[1,2]。本文对6年来我们研究所1147例ERCP进行了分析。 一、资料和方法 1.一般资料:自1996年1月至2002年1月,我所采用内镜进行ERCP诊治1147例患者,男591例,女556例,年     

胆胰疾病磁共振误诊及与ERCP结果比较分析

磁共振胰胆管显影术（MRCP）作为一种无创性诊断技术，其临床应用日趋增多，而经内镜逆行胰胆管造影（ERCP）作为胆胰系疾病的诊断金标准已在临床应用多年。为了评价MRCP和ERCP对胆胰系疾病的诊断价值，我们分析了56例胆胰疾病病例磁共振胰胆管造影（MRCP）误诊情况及与ERCP结果进行比较，报道如下。     

ERCP和EST诊治胆胰系疾病研究进展

十二指肠镜逆行胰胆管造影(ERCP)及十二指肠乳头壶腹括约肌切开术(EST),适用于十二指肠乳头、壶腹、肝内外胆管、胆囊及胰腺疾病的诊断与治疗。其最大的优点是使患者免受开腹手术之苦,创伤较小。下面就近年来的应用进展概述如下。     

超声内镜在可疑胆胰疾病ERCP术前的初步应用

目的 超声内镜(EUS)在可疑胆胰病变患者行内镜逆行胰胆管造影(ERCP)术前的临床应用价值.方法 对15例急性胰腺炎、梗阻性黄疸、胆总管扩张或反复腹痛等病史的患者,经腹部B超、CT和/或MRCP检查可疑胆胰病变,术前行EUS检查诊断,并经ERCP确认.结果 15例患者确诊胆总管结石并行EST取石术9例,确诊壶腹部肿瘤2例,胆管内乳头状瘤2例,十二指肠乳头炎性狭窄1例,胰管结石1例.结论 EUS对可疑胆胰病变有很高的诊断价值,特别能提高胆总管结石确诊率,高于MRCP检查,并能指导ERCP,提高治疗效果,减少风险.     

经内镜逆行胰胆管造影诊治胆胰疾病的护理体会

内镜下逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatograply，ERCP)是胰胆管疾病重要的诊断和治疗方法，我院自1999年10月至2003年6月行诊断性和治疗性ERCP共326例次，同时实施针对性的护理，取得满意效果。     

磁共振胰胆管造影术与直接造影术对照诊断胰胆系疾病

明确磁共振胰胆管造影术与直接造影术,如经内镜逆行性胰胆管造影术,经皮经肝胆管造影术相比,对胰胆系疾病的诊断价值。方法对３１例疑有胰胆系疾病的患者在,ＭＲＣＰ后４小时内行ＥＲＣＰ,其中１例患者因ＥＲＣＰ未成功而改行ＰＴＣ。ＭＲＣＰ应用呼吸触发,非屏气,脂肪抑制、重Ｔ２加权及超快回波技术进行扫描,然后采用量大强度投影技术进行处理,获得胰胆系结构图像。ＥＲＣＰ采用常规方法进行,最后将ＭＲＣＰ的冠状斜位像     

Oldest biliary endoprosthesis in situ

The advantages of endoscopic retrograde cholangiopancreatography over open surgery have made it the predominant method of treating patients with choledocholithiasis. After sphincterotomy, however, 10%-15% of common bile duct stones cannot be removed with a basket or balloon. The methods for managing “irretrievable stones” include surgery, mechanical lithotripsy, intraductal or extracorporeal shock wave lithotripsy and biliary stenting. The case presented was a referred 82-year-old Caucasian woman with a 7-year-old plastic biliary endoprosthesis in situ. To the best of our knowledge the examined endoprosthesis is the oldest endoprosthesis in situ reported in the literature. Endoscopic biliary endoprosthesis placement remains a simple and safe procedure for patients with stones that are difficult to manage by conventional endoscopic methods and for patients who are unfit for surgery or who are high surgical risks. To date no consensus has been reached regarding how long a biliary prosthesis should remain in situ. Long-term biliary stenting may have a role in selected elderly patients if stones extraction has failed because the procedure may prevent stones impaction and cholangitis.     

Restoration of common bile duct diameter within 2 weeks after endoscopic stone retraction is a preventive factor for stone recurrence

Background: Little information is available about the relationship between restoration of common bile duct(CBD) diameter after endoscopic stone retraction and recurrence of CBD stones in elderly patients.The present study was to determine whether restoration of CBD diameter is a preventive factor for CBD stone recurrence in elderly patients who underwent endoscopic retrograde cholangiopancreatography(ERCP).Methods: From January 2006 to December 2010, 238 patients underwent the first and the second session of ERCP for the removal of CBD stones. Among them, 173 were over 65 years old. These patients were divided into recurrent group and non-recurrent group. Restoration of CBD diameter and patients' characteristics were compared.Results: There was no statistical difference in patients' characteristics, associated diseases, or ERCP-related complications between the two groups. Reduction of CBD diameter was significantly larger in the nonrecurrent group(2.7 ± 1.7 mm) compared to that in the recurrent group(1.4 ± 2.3 mm, P = 0.002). The proportion of patients with restoration of CBD diameter were significantly lower in the recurrent group(6/42, 14.3%) compared with that in the non-recurrent group(67/131, 51.1%)(P 0.01).Conclusions: There is an inverse relationship between restoration of CBD diameter and CBD stone recurrence. Therefore, patients without restoration of CBD diameter within 2 weeks after endoscopic stone removal should be monitored more frequently.     

Pancreatitis complicating mucin-hypersecreting common bile duct adenoma

Villous adenomas of the bile ducts are extremely uncommon. We describe a 58-year-old man presenting with clinical signs and laboratory findings of acute pancreatitis and obstructive jaundice. Preoperative investigation demonstrated a dilated papillary orifice with mucus exiting (fish-mouth sign) and a filling defect in the distal common bile duct. He underwent a modified Whipple operation and histological examination of the surgical specimen showed villous adenoma with rich secretion of mucus.     

Efficacy of intraductal ultrasonography in the diagnosis of non-opaque choledocholith

AIM: To evaluate the efficacy of intraductal ultrasonography (IDUS) in the diagnosis of non-opaque, common bile duct stones.METHODS: A total of 183 patients (102 males, mean age 73 years; 81 females, mean age 70 years) with suspected common bile duct stones diagnosed through abdominal computed tomography (CT), magnetic resonance imaging (MRI), and abdominal Type-B ultrasound were included in the study. The diagnosis was confirmed through endoscopic retrograde cholangiopancreatography (ERCP) followed by IDUS.RESULTS: A total of 183 patients with suspected common bile duct (CBD) stones were included in the study as follows: 36 patients with high-density CBD stones, 68 patients with sand-like stones, 44 patients with low-density stones, 21 patients with ampullary cancer, and 14 patients with pancreatic cancer. Conventional imaging revealed 124 cases of choledochectasia, and only 36 cases of suspected CBD stones; ERCP revealed 145 cases of CBD stones with three missed diagnoses. IDUS revealed 148 cases of CBD stones, 21 cases of ampullary tumors, and 14 cases of pancreatic cancer.CONCLUSION: IDUS was more effective in the diagnosis of bile duct stones than ERCP, upper abdominal CT or upper abdominal MRI.     

Endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: From guidelines to clinical practice

AIM: To study the practical applicability of the American Society for Gastrointestinal Endoscopy guidelines in suspected cases of choledocholithiasis.METHODS: This was a retrospective single center study, covering a 4-year period, from January 2010 to December 2013. All patients who underwent endoscopic retrograde cholangiopancreatography(ERCP) for suspected choledocholithiasis were included. Based on the presence or absence of predictors of choledocholithiasis(clinical ascending cholangitis, common bile duct(CBD) stones on ultrasonography(US), total bilirubin > 4 mg/d L, dilated CBD on US, total bilirubin 1.8-4 mg/d L, abnormal liver function test, age > 55 years and gallstone pancreatitis), patients were stratified in low, intermediate or high risk for choledocholithiasis. For each predictor and risk group we used the χ2 to evaluate the statistical associations with the presence of choledocolithiasis at ERCP. Statistical analysis was performed using SPSS version 21.0. A P value of less than 0.05 was considered statistically significant. RESULTS: A total of 268 ERCPs were performed for suspected choledocholithiasis. Except for gallstone pancreatitis(P = 0.063), all other predictors of cho-ledocholitiasis(clinical ascending cholangitis, P = 0.001; CBD stones on US, P ≤ 0.001; total bilirubin > 4 mg/dL, P = 0.035; total bilirubin 1.8-4 mg/dL, P = 0.001; dilated CBD on US, P ≤ 0.001; abnormal liver function test, P = 0.012; age > 55 years, P = 0.002) showed a statistically significant association with the presence of choledocholithiasis at ERCP. Approximately four fifths of patients in the high risk group(79.8%, 154/193 patients) had confirmed choledocholithiasis on ERCP, vs 34.2%(25/73 patients) and 0(0/2 patients) in the intermediate and low risk groups, respectively. The definition of "high risk group" had a sensitivity of 86%, positive predictive value 79.8% and specificity 56.2% for the presence of choledocholithiasis at ERCP. CONCLUSION: The guidelines should be considered to optimize patients’ selection for ERCP. For high risk patients specificity is still low, meaning that some patients perform ERCP unnecessarily.