术前胆道引流对胰十二指肠切除术后影响的Meta分析

目的旨在评估术前胆道引流(PBD)对胰十二指肠切除术(PD)后的并发症及短期病死率的影响。方法检索Pub Med、Embase、Cochrane等数据库以及美国主要消化有关杂志在2010年1月1日-2017年1月1日发表的PBD对PD影响的最新研究。采用Rev Man5.3软件对手术后总并发症发生率、术后感染发生率、术后吻合口瘘发生率、术后短期病死率进行统计学分析。结果最终纳入8篇文献共2687例患者,分为PBD组(PD术前经PBD处理)和n-PBD组(PD术前未经处理)。在短期病死率方面,PBD组与n-PBD组无明显统计学差异[比值比(OR)=1.19,95%可信区间(CI):0.79~1.80,P=0.41];术后总并发症发生率和术后感染发生率方面,PBD组比n-PBD组明显增高(OR=1.95,95%CI:1.24~3.06,P=0.004;OR=2.37,95%CI:1.45~3.87,P=0.000 5);术后吻合口瘘的发生率两组间无明显统计学差异(OR=1.43,95%CI:0.95~2.14,P=0.09)。结论术前减黄无法对患者术后预后带来益处,会增加术后总发症及术后感染发生率。因此,不推荐PBD作为PD的常规术前处理。     

老年帕金森病患者血尿酸水平及其与认知功能的关系

目的 探讨老年帕金森病(PD)患者血尿酸水平与认知功能的关系,并对相关因素进行分析.方法 回顾性分析60例老年PD患者的病历资料,选择性别、年龄相匹配的60例健康体检者作为对照,记录性别、年龄、病程、Hoehn&Yahr分期(H-Y分期)、尿酸、简易智能量表(MMSE)评分,并进行比较和相关性分析.结果 老年PD组血浆尿酸水平[(262±53)μmol/L]明显低于对照组[(332±45)μmol/L],差异有统计学意义(t=-6.724,P＜0.001).PD组男性血浆尿酸水平[(271±48)μmol/L]均值略高于女性水平[(254±39)μmol/L],但差异无统计学意义(t=3.282,P=0.058).PD组男性血浆尿酸水平明显低于对照组男性尿酸水平[(353±62)μmol/L],差异有统计学意义(t=-5.625,P＜0.001).PD组女性血浆尿酸水平低于对照组女性尿酸水平[(294±59)/μmol/L],差异有统计学意义(t=-4.721,P=0.012).老年PD各亚组间血尿酸水平无显著差异,但与对照组比较差异均有统计学意义(F=22,039,P＜0,01).老年PD组血尿酸水平与病程长短无明显相关性(r=0.961,P＞0,05).老年PD患者存在认知功能障碍,其MMSE评分与H-Y分期(r=-0.577,P=0.019)、年龄(r=-0.333,P=0.034)呈负相关,与血尿酸水平呈正相关(r=0.789,P=0.000),与病程(r=-0.333,P=0.027)、体质指数(BMI)(t=-0.410,P=0.115)无相关性.结论 老年PD患者血尿酸水平降低,低尿酸水平可能与老年PD患者的认知功能障碍有关.

Abstract：

Objective To explore the relationship between uric acid (UA) level and cognitive function in elderly patients with Parkinson,s disease (PD) and analyze the cognition related factors.Methods The clinical data of 60 elderly PD cases in our hospital from 2001 to 2009 were retrospectively analyzed. The 60 healthy people receiving medical examination in our hospital and matched by gender and age, were as control group. The information including gender, age, illness duration, Hoehn & Yahr stage (H-Y stage), serum UA level and Mini-Mental State Examination (MMSE) scale were recorded. Results The serum UA level was significantly lower in PD group than in control group [(262±53) μmol/L vs. (332±45) μmol/L, t=-6.724, P＜0.001]. In PD group, the serum UA level was slightly higher in males than in females [(271 ±48) μmol/L vs.(254±39) μmol/L, t=3. 282, P=0. 058]. The serum UA level was significantly lower in male PD patients than in male controls [(353± 62) μmol/L, t=- 5. 625, P＜0. 001], and was lower in female PD patients than in female controls [( 294 ± 59) μmol/L, t = - 4. 721, P = 0. 012]. There were no significant differences in serum UA level among different H-Y stage subgroups (P＞0. 05), but the serum UA level was lower in different H-Y stage subgroups than in control group (F=22. 039, P＜0. 01 ). There was no correlation between the UA level and the illness duration (r=0. 961, P＞0.05).The MMSE score had significant difference between elderly PD group and control group (t= -3. 168,P＜0. 001). In PD patients, the MMSE score was positively correlated with serum UA level (r=0. 789, P= 0. 000), and was negatively correlated with H-Y stage (r= - 0. 577, P = 0. 019 ), age (r= -0. 333, P=0. 034), but was not correlated with illness duration (r= -0. 333, P=0. 207) and BMI (t=- 0. 410, P= 0. 115). Conclusions The level of serum UA is lower in elderly patients with PD than in normal controls. There is correlation between the serum UA level and cognitive impairment. Lower serum UA level predicts worse cognitive scores.     

TIPS联合GCVE术对食管胃底曲张静脉破裂出血患者Child-Pugh评分的影响

目的比较经颈静脉肝内门体静脉分流术(TIPS)与TIPS联合胃冠状静脉栓塞术(GCVE)对肝硬化患者Child-Pugh评分的影响。方法收集2014年3月至2017年3月我院34例TIPS肝硬化患者和24例TIPS联合GCVE肝硬化患者,收集术前和术后的Alb、TBil、PT、腹水及肝性脑病等数据,获得Child-Pugh,采用t检验或卡方检验进行统计分析。结果 TIPS组的Child-Pugh评分在术后第1、3个月与术前相比,差异有统计学意义(P0.05),在术后6、12个月与术前相比差异无统计学意义(P0.05),而TIPS联合GCVE组术后的1、3、6、12月的Child-Pugh评分与术前相比均差异无统计学意义(P0.05)。TIPS组的术后Child-Pugh评分为8.56±1.82、8.01±1.68、7.58±1.32、7.29±1.45,显著差于TIPS联合GCVE组的(7.53±1.91)、(7.16±1.34)、(6.69±1.57)、(6.08±1.21),(P0.05)。TIPS组术后总胆红素逐渐升高,在第1、3、6月分别为(38.1±10.5)μmol/L、(49.4±10.8)μmol/L和(52.3±11.7)μmol/L,显著高于术前的(26.7±8.6)μmol/L(分别为t=4.898,P0.01;t=9.587,P0.01;t=10.28,P0.01),术后第12月TBil为(30.8±10.9)μmol/L与术前相比差异无统计学意义(t=1.722,P=0.089),而TIPS联合GCVE的TBil在术后第3、6、12月显著低于TIPS组(分别为t=6.187,P0.01;t=7.006,P0.01;t=3.958,P0.01)。TIPS组术后凝血酶原时间(PT)逐渐升高,与术前相比均差异有统计学意义(均P0.01),TIPS联合GCVE在术后第3、6、12月的PT显著优于TIPS组(分别为t=2.082,P=0.042;t=3.137,P0.01;t=2.04,P=0.046)。结论 TIPS联合GCVE对肝硬化患者术后Child-Pugh评分较单纯TIPS组恢复快。     

前列地尔联合中心静脉导管腹腔引流治疗顽固性腹水

目的观察前列地尔联合中心静脉导管腹腔引流治疗顽固性腹水的疗效。方法入组患者随机分为两组。对照组(30例)在内科保肝、利尿等综合治疗基础上腹腔置管放液,首次放腹水少于800 ml,以后每天1 500~2 000 ml,同时每天静滴人血白蛋白10 g,疗程21天。治疗组(30例)在对照组治疗基础上加用前列地尔10μg/d静脉点滴,疗程21天。结果所有患者治疗后腹胀较前缓解,尿量增多。治疗组患者总有效率(80%)优于对照组(40%),差异有统计学意义(χ2=10.0,P=0.001)。治疗组治疗前后谷丙转氨酶(ALT)分别为(145.00±14.25)U/L及(83.49±12.44)U/L(t=44.166,P=0.000),总胆红素(TBil)分别为(76.20±5.85)μmol/L及(38.49±3.11)μmol/L(t=29.048,P=0.000),血清肌酐(SCr)分别为(124.83±7.29)μmol/L及(83.98±7.58)μmol/L(t=29.019,P=0.000),差异均有统计学意义。对照组治疗前后ALT、TBil、SCr相比较,差异均有统计学意义,分别为t=19.819,P=0.000;t=10.820,P=0.000;t=12.534,P=0.000。治疗后两组ALT、TBil、SCr相比较,差异均有统计学意义,分别为t=4.564,P=0.000;t=7.073,P=0.000;t=14.127,P=0.000。结论前列地尔联合中心静脉导管腹腔引流治疗顽固性腹水有一定疗效。     

自制简易胆道支架修复兔胆道缺损的动物实验研究

目的探讨支架法修复胆道缺损的可行性和安全性。方法采用医用静脉采血针制造简易胆道支架。将30只兔随机分为A组和B组,每组15只。在A组动物,切除胆总管0.5 cm;B组切除1.0 cm。应用自制简易胆道支架与缺损的胆总管断端进行捆绑,恢复其连续性。于术后1、3、6月各处死5只家兔,观察两组动物术后的生存情况、术前术后肝功能变化,肝脏、新生胆管组织和新生胆管组织病理学改变。结果两组均顺利完成手术,无术后黄疸发生。术后A组1只兔因胆漏死亡;B组1只因应激性溃疡死亡。A组动物术前ALT为(56.36±6.35)IU/L,术后1、3、6月分别为[(59.63±5.02)IU/L、(54.63±8.26)IU/L、(59.85±7.43)IU/L,P0.05];AST为(54.13±7.63)IU/L,术后1、3、6月分别为[(57.42±8.31)IU/L、(55.42±5.21)IU/L、(53.62±5.61)IU/L,P0.05];ALP为(207.35±63.47)IU/L,术后1、3、6月分别为[(218.42±73.23)IU/L、(195.31±46.73)IU/L、(189.31±37.64)IU/L,P0.05];TBIL为(0.15±0.08)μmol/L,术后1、3、6月分别为[(0.17±0.04)μmol/L、(0.14±0.05)μmol/L、(0.16±0.07)μmol/L,P0.05]。B组动物术前ALT为(60.26±3.65)IU/L,术后1、3、6月分别为[(69.21±5.13)IU/L、(63.79±8.35)IU/L、(59.97±6.47)IU/L,P0.05];AST为(51.33±6.43)IU/L,术后1、3、6月分别为[(55.43±7.26)IU/L、(61.62±5.73)I U/L、(52.32±5.31)IU/L,P0.05];ALP为(217.25±53.72)IU/L,术后1、3、6月分别为[(228.62±71.32)IU/L、(200.35±46.83)IU/L、(209.83±36.41)IU/L,P0.05];TBIL为(0.14±0.05)μmol/L,术后1、3、6月分别为[(0.16±0.04)μmol/L、(0.12±0.02)μmol/L、(0.13±0.06)μmol/L,P0.05];术后两组动物肝组织病理学与术前比较无显著变化;术后1月,两组支架已覆盖充血水肿的新生胆管组织;术后3月两组新生的胆管组织已无水肿存在;术后6月两组新生胆管组织在外观上与正常胆管组织无差异。结论本实验表明在血供丰富、缺损1.0 cm以内的胆总管具有很强的再生和形成新生胆管的能力。支架法修复1.0 cm以内的胆道缺损安全可行。     

胆道支架置入术联合125I粒子条胆道腔内照射治疗恶性梗阻性黄疸患者临床研究

目的 探讨胆道支架置入联合¹²⁵ I 粒子条胆道内照射治疗恶性梗阻性黄疸(MOJ)患者的临床疗效。方法 2015年6月～2017年10月我院收治的96例MOJ患者,55例行经皮经肝胆管引流( PTCD) 后行胆道支架植入术治疗(对照组),41例接受PTCD术后行胆道支架植入术联合¹²⁵ I 粒子条胆道腔内照射治疗(观察组)。结果 96例患者手术均获得成功,术后两组患者均无明显出血、腹膜炎、胆道穿孔、肠炎、胆道感染、白细胞明显降低、恶心、呕吐等并发症发生;在术后1个月,观察组和对照组血清TBIL分别为(32.6±19.2)μmol/L对(107.8±20.2)μmol/L,血清DBIL分别为(23.4± 12.4)μmol/L对(97.4±12.5)μmol/L,血清ALT分别为(30.4±16.5)U/L对(85.9±19.8)U/L,血清AST分别为(30.7±13.2)U/L对(71.4±18.9)U/L,血清CA199分别为(30.7±13.2)U/L对(71.4±18.9)U/L,差异均具有统计学意义(P＜0.05);术后,观察组胆道通畅时间为(6.4±3.8)个月,显著长于对照组【(2.9±1.8)月,P＜0.05】;观察组总有效率为53.7%,显著高于对照组的30.9%(P＜0.05);观察组患者中位生存时间为10.7 个月,显著长于对照组患者的6.2 个月(P＜0. 05) 。结论 采取胆道支架联合胆道腔内¹²⁵ I 粒子条植入照射治疗恶性梗阻性黄疸患者能抑制肿瘤生长,延长支架开放时间,延长患者生存时间,适合姑息性治疗。     

同型半胱氨酸与帕金森病的临床相关性研究

目的对比帕金森病(PD)患者与健康人群血浆同型半胱氨酸(Hcy)浓度,观察血浆Hcy水平与PD的临床相关性。方法选取2010年1月~2014年12月在江苏盛泽医院住院的PD(PD组)患者56例,健康体检者67例为对照组。采用ELISA法检测血浆Hcy水平。结果 PD组血浆Hcy水平明显高于对照组,差异有统计学意义[(16.45±8.56)μmol/L vs(13.63±5.12)μmol/L,P=0.026]。PD组中男性患者血浆Hcy水平显著高于女性患者,差异具有统计学意义[(19.56±10.29)μmol/L vs(14.11±6.20)μmol/L,P=0.017]。PD患者的血浆Hcy水平与年龄、病程及Hoehn-Yahr分期无关(P=0.959、P=0.539、P=0.214),而与性别呈负相关(r=-0.317,P=0.017)。结论 PD患者的血浆Hcy水平较健康人群升高,男性PD患者血浆Hcy水平明显高于女性患者,血浆Hcy水平升高可能是PD的独立危险因素。     

门冬氨酸鸟氨酸联合利福昔明治疗肝性脑病的临床疗效

目的:研究门冬氨酸鸟氨酸联合利福昔明治疗肝硬化相关性显性肝性脑病的临床疗效.方法:选取河南省人民医院及郑州市第二人民医院2014-02/2015-02诊治的80例合并肝硬化的肝性脑病患者,随机分为门冬氨酸鸟氨酸组(对照A组)、利福昔明治疗组(对照B组)和门冬氨酸鸟氨酸联合利福昔明治疗组(治疗组),治疗7 d后,分别检测各组治疗前后血氨浓度、谷丙转氨酶(alanine aminotransferase,ALT)、血清总胆红素(total bilirubin,TBIL)水平进行评价和比较.结果:7 d治疗后,对照组A、对照组B患者血氨浓度、ALT浓度及TBIL浓度与治疗组对比差异均有统计学意义(血氨:68.14μmol/L±11.13μmol/L,85.22μmol/L±11.19μmol/L vs 45.16μmol/L±11.18μmol/L,t=3.014,P0.05;t=2.011,P0.01;ALT:89.21 U/L±11.14 U/L,78.16 U/L±13.02 U/L vs 56.26 U/L±14.04 U/L,t=2.106,P0.05;t=2.057,P0.05;TBIL:40.06μmol/L±8.05μmol/L,43.22μmol/L±8.122μmol/L vs 34.09μmol/L±6.18μmol/L,t=1.085,P0.05;t=1.024,P0.01).且治疗组总有效率及显效率(85.00%,55.00%)明显高于对照组(52.50%,35.00%)(P0.05).结论:门冬氨酸鸟氨酸联合利福昔明可以显著改善临床症状并提高临床疗效.     

不同性别老年冠状动脉真性分叉病变患者的临床特征及介入治疗预后分析

目的探讨老年患者冠状动脉真性分叉病变的临床特征及经皮冠状动脉介入治疗(PCI)术后预后是否存在性别差异。方法回顾性分析2013年12月至2015年12月徐州医科大学附属医院心血管内科成功接受PCI的冠状动脉真性分叉病变的老年患者病例资料。总共169例,根据性别分为女性组(71例)和男性组(98例),分析两组患者的临床资料及冠状动脉分叉病变特征,比较两组患者PCI术后预后。结果女性组吸烟比例(2.8%比49.0%,P0.001)显著低于男性组,但高脂血症比例[56.3%比38.8%,P=0.024]显著高于男性组,差异均有统计学意义;高血压病、糖尿病比例略高于男性组,但差异均无统计学意义(均P0.05)。女性组患者入院时总胆固醇[(5.41±1.17)mmol/L比(4.42±1.00)mmol/L,P0.001]、三酰甘油[(1.96±1.14)mmol/L比(1.54±0.73)mmol/L,P0.001]、低密度脂蛋白胆固醇[(3.19±1.00)mmol/L比(2.57±0.74)mmol/L,P0.001]、高密度脂蛋白胆固醇[(1.41±0.29)mmol/L比(1.23±0.24)mmol/L,P0.001]均显著高于男性组,差异均有统计学意义;尿素氮[(5.25±1.96)mmol/L比(5.98±1.64)mmol/L,P=0.009]、肌酸酐[(56.03±14.71)μmol/L比(73.26±23.79)μmol/L,P0.001]、尿酸[(279.62±86.18)μmol/L比(307.33±71.59)μmol/L,P=0.024]、胱抑素C[(0.87±0.15)mg/L比(0.97±0.22)mg/L,P=0.002]、总胆红素[(12.31±3.85)μmol/L比(13.93±5.10)μmol/L,P=0.026]均显著低于男性组,差异亦均有统计学意义。随访中位数时间为17个月,女性组总体主要不良心脑血管事件发生率显著高于男性组(25.4%比11.2%,P=0.016),差异有统计学意义。结论冠状动脉真性分叉病变老年患者远期预后存在性别差异,女性组不良事件较男性组发生率明显升高。     

胆管内外引流治疗内镜难治性恶性胆道梗阻的对比研究

目的　比较经皮经肝穿刺胆管金属支架内引流术与导管外引流术治疗内镜难治性恶性胆道梗阻的疗效及并发症。方法　回顾性分析 1999年 9月至 2 0 0 2年 8月上海长海医院对内镜难治性恶性胆道梗阻患者施行经皮经肝穿刺胆管引流术的资料 ,比较两种引流术前后和引流术间肝功能的差异及并发症。共 2 7例患者 (2 9例次 )入选。其中 ,内引流组 13例 (13例次 ) ,男 9例 ,女 4例 ,平均年龄 6 2 5岁 ;外引流组 15例 (16例次 ) ,男 9例 ,女 6例 ,平均年龄 6 0 8岁。结果　术前 2～ 4d及术后5～ 7d血清总胆红素 (TB)在内引流组分别为 (2 79 19± 10 8 15 ) μmol/L和 (15 8 0 2± 99 97) μmol/L ,外引流组为 (2 6 1 0 9± 10 6 4 8) μmol/L和 (172 81± 10 6 4 8) μmol/L。血清直接胆红素 (DB)内引流组为(2 2 6 83± 84 0 3) μmol/L和 (132 5 7± 80 16 ) μmol/L ,外引流组为 (2 0 8 0 3± 95 0 3) μmol/L和 (14 2 6 1±83 74 ) μmol/L。术前两组间TB和DB差异无显著性 (P >0 0 5 ) ;术后两组TB和DB均较术前显著降低 (P <0 0 1) ;术后TB和DB降低幅值在内引流组显著高于外引流组 (P <0 0 5 )。内引流组 1例出现胆漏和肠梗阻 ,1例出血 ;外引流组 2例导管移位和脱落 ,1例导管堵塞 ,1例出血 ,1例胆漏     

Effect of preoperative biliary drainage on surgical results after pancreaticoduodenectomy in patients with distal common bile duct cancer：Focused on the rate of decrease in serum bilirubin

AIM： To examine if the rate of decrease in serum bilirubin after preoperative biliary drainagecan be used as a predicting factor for surgical complications and postoperative recovery after pancreaticoduodenectomy in patients with distal common bile duct cancer.METHODS： A retrospective study was performed in 49 consecutive patients who underwent pancrea-ticoduodenectomy for distal common bile duct cancer. Potential risk factors were compared between the complicated and uncomplicated groups. Also, the rates of decrease in serum bilirubin were compared pre- and postoperatively. RESULTS： Preoperative biliary drainage （PBD） was performed in 40 patients （81.6%）. Postoperative morbidity and mortality rates were 46.9% （23/49） and 6.1% （3/49）, respectively. The presence or absence of PBD was not different between the complicated and uncomplicated groups. In patients with PBD, neither the absolute level nor the rate of decrease in serum bilirubin was significantly different. Patients with rapid decrease preoperatively showed faster decrease during the first postoperative week （5.5 ± 4.4 μmol/L vs -1.7 ± 9.9 μmol/L, P = 0.004）.CONCLUSION： PBD does not affect the surgical outcome of pancreaticoduodenectomy in patients with distal common bile duct cancer. There is a certain group of patients with a compromised hepatic excretory function, which is represented by the slow rate of decrease in serum bilirubin after PBD.     

The Effects of Different Preoperative Biliary Drainage Methods on Complications Following Pancreaticoduodenectomy

The objective of this study was to investigate the effects of different preoperative biliary drainage (PBD) methods on complications in jaundiced patients following pancreaticoduodenectomy. We retrospectively analyzed 270 extrahepatic bile duct cancer patients who underwent pancreaticoduodenectomy. A total of 170 patients without PBD treatment were defined as the non-PBD group. According to different PBD methods, 45, 18, and 37 patients were classified into the percutaneous transhepatic biliary drainage (PTBD), endoscopic nasobiliary drainage (ENBD), and endoscopic retrograde biliary stent (ERBS) groups, respectively. Clinical characteristics and complications were compared among the 4 groups.Preoperative cholangitis occurred in 14 (8.2%) and 8 (21.6%) patients in the non-PBD and ERBS group, respectively (P = 0.04). Compared with the non-PBD group, delayed gastric emptying (DGE) and wound infection occurred significantly more often in the ERBS group. The incidence of severe complications was significantly lower in the PTBD group than the non-PBD group (P = 0.03). Postoperative hospital stay and complication rates were significantly higher in the ERBS group than the PTBD group. There were no significant differences in complications between ENBD and other groups.In conclusion, PTBD can improve surgical outcomes by reducing severe complication rate in jaundiced patients following pancreaticoduodenectomy. ERBS increased the rates of DGE and wound infection due to high incidence of cholangitis before operative intervention and should be avoided. ENBD carried no special effect on complications and needs further analysis.     

使用增剪侧孔的PTCD引流管治疗高位胆道梗阻

目的探讨使用增剪侧孔的PTCD引流管治疗高位胆道梗阻的方法与疗效。方法 36例高位恶性梗阻性黄疸患者,其中肝门部胆管癌32例,肝转移癌4例。经皮穿刺一侧肝内胆管,增剪侧孔的PTCD外引流管通过闭塞段,猪尾型头端置于接近闭塞部的肝总管或胆总管,侧孔位于梗阻近段,实现全肝（Bismuth-CorletteⅠ、Ⅱ型梗阻）或一侧肝脏（Ⅲ、Ⅳ型梗阻）无肠液返流的内外引流。Ⅳ型梗阻病变累及肝段胆管时,引流管侧孔置于穿刺道所在肝管,头端通过闭塞段置于另一闭塞的肝段肝管,增强引流效果。结果 31例成功施行跨越闭塞段后置管,完成内外引流27例和多闭塞段的单引流管外引流4例,技术成功率86%。5例因导丝未能通过闭塞段,用常规方法行一侧肝叶或肝段胆管外引流。术后1周左右总胆红素平均值由术前（189±53）μmol/L降至（135±34）μmol/L,平均下降幅度（33±13）%;临床症状改善。结论应用增剪侧孔的引流管治疗高位胆道梗阻灵活、方便,近期疗效肯定,可选择做为临床常用方法。     

Ampullary carcinoma： Effect of preoperative biliary drainage on surgical outcome

AIM： To evaluate the influence of preoperative biliary drainage on morbidity and mortality after surgical resection for ampullary carcinoma.
METHODS： We analyzed retrospectively data for 82 patients who underwent potentially curative surgery for ampullary carcinoma between September 1993 and July 2007 at the Singapore General Hospital, a tertiary referral hospital. Diagnosis of ampullary carcinoma was confirmed histologically. Thirty-five patients underwent preoperative biliary drainage （PBD group）, and 47 were not drained （non-PBD group）. The mode of biliary drainage was endoscopic retrograde cholanoiopancreatography （n = 33） or percutaneous biliary drainage （n = 2）. The following parameters were analyzed： wound infection, intra-abdominal abscess, intra-abdominal or gastrointestinal bleeding, septicemia, biliary or pancreatic leakage, pancreatitis, gastroparesis, and re-operation rate. Mortality was assessed at 30 d （hospital mortality） and also longterm. The statistical endpoint of this study was patient survival after surgery.
RESULTS： The groups were well matched for demographic criteria, clinical presentation and operative characteristics, except for lower hemoglobin in the non- PBD group （10.9 ± 1.6 vs 11.8 ± 1.6 in the PBD group）.Of the parameters assessing postoperative morbidity, incidence of wound infection was significantly less in the PBD than the non-PBD group [1 （2.9%） vs 12 （25.5%）]. However, the rest of the parameters did not differ significantly between the groups, i.e. sepsis [10 （28.6%） vs 14 （29.8%）], intra-abdominal bleeding [1 （2.9%） vs 5 （10.6%）], intra-abdominal abscess [1 （2.9%） vs 8 （17%）], gastrointestinal bleeding [3 （8.6%） vs 5 （10.6%）], pancreatic leakage [2 （5.7%） vs 3 （6.4%）], biliary leakage [2 （5.7%） vs 3 （6.4%）], pancreatitis [2 （5.7%） vs 2 （4.3%）], gastroparesis [6 （17.1%） vs 10 （21.3%）], need for blood transfusion [10 （28.6%） vs 17 （36.2%）] and re-operation rate [1 （2.9%） vs 5 （10.6%）]. There was no early mortality in either group. Median survival was 44 mo （95% CI： 34.2-53.8） in the PBD group and 41 mo （95% CI： 27.7-54.3; P = 0.86） in the non-PBD group.
CONCLUSION： Biliary drainage before surgery for ampullary cancer significantly reduced postoperative wound infection. Overall mortality was not influenced by preoperative drainage.     

超声内镜引导下胆汁引流治疗ERCP治疗失败的恶性梗阻性黄疸患者疗效初步研究

目的 探讨采用超声内镜引导下胆汁引流术(EUS-BD)和经皮肝胆管引流术(PTBD)再治疗经内镜逆行胰胆管造影术(ERCP)治疗失败的恶性梗阻性黄疸患者的有效性及安全性。方法 2013年1月～2018年12月我院收治的经ERCP治疗失败的恶性梗阻性黄疸患者75例,术前经B超、CT或MRCP等影像学检查证实存在恶性胆管梗阻,其中胰腺癌15例、壶腹部癌12例、胆管癌27例、胆囊癌9例、胃肠道恶性肿瘤侵犯11例和非霍奇金淋巴瘤1例。其中40例接受EUS-BD治疗,35例接受PTBD治疗。结果 在40例EUS-BD治疗患者中,采用超声内镜引导下对接技术完成治疗16例(40.0%),在超声内镜引导下顺行技术完成治疗24例(60.0%),其中37例(92.5%)操作成功,在35例PTBD治疗患者中,28例(80.0%)操作成功,EUS-BD治疗患者操作时间为治疗后,EUS-BD治疗患者血清总胆红素水平为(138.7±50.2)μmol/L,显著低于PTBD治疗患者的(162.4±60.2)μmol/L,而血清白蛋白水平为(34.8±3.7)g/L,显著高于PTBD治疗患者的(32.1±4.6)g/L,P<0.05];EUS-BD治疗患者术后并发症发生率为7.5%(3/40),其中胆道出血2例(5.0%),急性胆管炎1例(2.5%),PTBD治疗患者术后并发症发生率为22.9%(8/35,P<0.05),其中胆道出血3例(8.6%),肝包膜下出血1例(2.9%),胆汁性腹膜炎1例(2.9%),胆漏1例(2.9%),胆道感染2例(5.7%)。结论 在ERCP治疗失败的恶性胆道梗阻患者,可选择EUS-BD或PTBD进行补救治疗,或许可消退黄疸,暂时减轻病情。     

超声与X线引导内镜胆道引流术的临床研究

目的 比较分析超声与X线引导内镜胆道引流术的置管成功率、疗效及手术并发症.方法 比较62例超声引导内镜胆道引流术(超声引导组)和54例X线引导内镜胆道引流术(X线引导组)患者手术前后血清胆红素、胆总管内径和临床症状的变化情况.结果 超声引导组62例中54例置管成功,手术前与术后1周患者血清直接胆红素分别为(205.41±115.27)μmol/L及(106.47±82.16)μmol/L(P<0.05),胆总管内径分别为(12.6±7.1)mm及(8.5±3.1)mm(P<0.05).X线引导组54例中51例置管成功,手术前与术后1周患者血清直接胆红素分别为(211.14±106.25)μmol/L及(110.89±59.47)μmol/L(P<0.05),胆总管内径分别为(13.1±7.0)mm及(8.8±3.2)mm(P<0.05).超声引导组术后无腹痛、发热、淀粉酶升高等早期并发症,X线引导组术后有3例(5.9%)出现上述并发症.结论 X线仍然是内镜胆道引流术最有效的引导方法.超声引导可避免X线辐射、造影剂过敏等不利因素,且具有实时显示、移动方便,可进行床边急诊、内镜下诊治等优点,可替代X线用于引导所有胆道结石以及狭窄不甚严重的肿瘤患者行鼻胆管引流术和胆道塑料支架引流术.     

经皮肝穿刺胆道取石治疗胆总管结石患者影响引流持续时间的因素分析*

目的 探讨影响经皮肝穿刺胆道引流(PTBD)治疗胆总管结石(CBDS)患者引流持续时间的因素。方法 2019年4月～2021年3月我院收治的112例CBDS患者均接受PTBD治疗。收集临床资料,以PTBD平均引流时间加标准差之和为截断点,将患者分为PTBD 持续时间延长组和正常组,应用多因素Logistic回归分析影响引流延长的因素。结果 在112例CBDS患者中,109例(97.3%)患者成功取出结石,其中81例胆道引流时间短于17天,另28例超过17天;PTBD持续时间延长组血清总胆红素【(38.1±7.3)μmol/L对(24.2±6.2)μmol/L】、淀粉酶【(403.7±15.6)U/L对(92.7±13.2)U/L】 、ALP【(302.3±52.1)U/L对(180.7±50.2)U/L】、GGT【(176.6±16.7)U/L对(93.3±15.6)U/L】、C反应蛋白【(75.1±12.2)mg/L对(56.9±10.3)mg/L】和结石直径【(16.9±2.5)mm对(11.3±2.1)mm】等均显著高于PTBD持续时间正常组,差异有统计学意义(P＜0.05);多因素Logistic回归分析显示血清总胆红素(OR:4.092,95%CI:1.684～9.944)和淀粉酶水平(OR:3.277,95%CI:1.348～7.965)及结石直径(OR:3.651,95%CI:1.502～8.873)是影响CBDS患者PTBD持续时间的独立因素(P＜0.05)。结论 采用PTBD治疗CBDS患者成功率高,了解一些容易导致引流时间延长的因素有助于做好术前准备和术后管理。     

改良鼻胆管与普通鼻胆管引流在经胆囊入路治疗细径胆总管结石患者疗效研究

目的 探讨使用内镜下改良的鼻胆管引流(ENBD)在经胆囊入路治疗细径胆总管结石(CBDS)患者的疗效.方法 2015年12月～2018年6月我科诊治的54例细径CBDS患者(对照组),采用腹腔镜胆囊切除术(LC)后,在腹腔镜下经胆囊管行胆总管探查术,再在十二指肠镜协助下经腹顺行安置常规鼻胆管引流;2018年7月～202...     

Biliary drainage tube evaluation after common bile duct exploration for choledocholithiasis

BACKGROUND/AIMS: We studied the postoperative evaluation of transcystic duct tube drainage (C-tube), T-tube drainage (T-tube), and retrograde transhepatic biliary drainage after common bile duct exploration for patients with choledocholithiasis. METHODOLOGY: We analyzed the preoperative clinical features of patients, intraoperative findings, postoperative status and management, daily output of bile, liver function, postoperative infections, and postoperative complications for patients who underwent common bile duct exploration including 16 C-tube, 17 T-tube, and 8 retrograde transhepatic biliary drainage cases. RESULTS: There were no significant differences in the preoperative clinical features, intraoperative findings, or the daily output of bile from the tube. The removal day of the biliary drainage tube and postoperative hospital stay were shorter in the C-tube group than in the T-tube and retrograde transhepatic biliary drainage groups. Aspartate amino-transferase level and body temperature in the C-tube group on day 7 were lower than those in the T-tube group, and the total bilirubin level in the C-tube group on day 14 was lower than in the T-tube and retrograde transhepatic biliary drainage groups. Moreover, postoperative complications occurred significantly less frequently in the C-tube group (25.0%) than in the T-tube group (76.5%). CONCLUSIONS: C-tube drainage is thought to be most useful after common bile duct exploration for patients with choledocholithiasis.     

Effect of Preoperative Biliary Drainage on Complications Following Pancreatoduodenectomy: A Meta-Analysis

Preoperative biliary drainage (PBD) prior to pancreatoduodenectomy (PD) is still controversial; therefore, the aim of this study was to examine the impact of PBD on complications following PD.A meta-analysis was carried out for all relevant randomized controlled trials (RCTs), prospective and retrospective studies published from inception to March 2015 that compared PBD and non-PBD (immediate surgery) for the development of postoperative complications in PD patients. Pooled odds ratio (OR) and 95% confidence interval (CI) were estimated using fixed-effect analyses, or random-effects analyses if there was statistically significant heterogeneity (P < 0.05).Eight RCTs, 13 prospective studies, 20 retrospective studies, and 3 Chinese local retrospective studies with 6286 patients were included in this study. In a pooled analysis, there were no significant differences between PBD and non-PBD group in the risks of mortality, morbidity, intra-abdominal abscess, sepsis, hemorrhage, pancreatic leakage, and biliary leakage. However, subgroup analysis of RCTs yielded a trend toward reduced risk of morbidity in PBD group (OR 0.48, CI 0.24 to 0.97; P = 0.04). Compared with non-PBD, PBD was associated with significant increase in the risk of infectious complication (OR 1.52, CI 1.07 to 2.17; P = 0.02), wound infection (OR 2.09, CI 1.39 to 3.13; P = 0.0004), and delayed gastric emptying (DGE) (OR 1.37, CI 1.08 to 1.73; P = 0.009).This meta-analysis suggests that biliary drainage before PD increased postoperative infectious complication, wound infection, and DGE. In light of the results of the study, PBD probably should not be routinely carried out in PD patients.