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Concomitant adenosquamous carcinoma and cystadenocarcinoma of the extrahepatic bile duct:A case report 预览
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作者 Bing-Jie Lu Xue-Dong Cao +3 位作者 Nong Yuan Ning-Ning Liu Nisma L Azami Ming-Yu Sun 《世界临床病例杂志》 2019年第2期215-220,共6页
BACKGROUND Infiltrative adenosquamous carcinoma(ASC)of the extrahepatic bile duct is reported infrequently,which is an unusual variant of the ordinary adenocarcinoma.The simultaneous development of ASC and cystadenoca... BACKGROUND Infiltrative adenosquamous carcinoma(ASC)of the extrahepatic bile duct is reported infrequently,which is an unusual variant of the ordinary adenocarcinoma.The simultaneous development of ASC and cystadenocarcinoma in the extrahepatic biliary tree is rare.In addition,the accurate preoperative diagnosis of concomitant carcinoma in the multiple biliary trees at an early stage is often difficult.Thus,awareness of the risk of the multiplicity of biliary tumors is perhaps the most important factor in identifying these cases.CASE SUMMARY Here,we report a case of a 63-year-old female with jaundice,who was referred to Shuguang Hospital because of abdominal pain for 1 mo.An abdominal contrastenhanced computed tomography revealed a type I choledochal cyst and intraluminal masses suggestive of adenoma of the common bile duct.In addition,a preoperative diagnosis of a concomitant Klatskin tumor and type I choledochal cyst was made.The patient underwent anti-inflammatory therapy,followed by radical surgery due to hilar cholangiocarcinoma and resection of the choledochal cyst.Examination of the surgical specimen revealed a papillary tumor of the common bile duct,which arose from the malignant transformation of a preexisting cystadenoma.Histologic examination confirmed a special type of cholangiocarcinoma;the tumor in the hilar bile duct was an ASC,whereas the tumor in the common bile duct was a moderately differentiated cystadenocarcinoma.The patient showed rapid deterioration 8 mo after surgery.CONCLUSION Although concomitant ASC and cystadenocarcinoma of the extrahepatic bile duct is difficult to diagnose before surgery,and the prognosis is poor after surgery,surgical resection is still the preferred treatment. 展开更多
关键词 EXTRAHEPATIC BILE DUCT ADENOSQUAMOUS carcinoma Klatskin tumor Common BILE DUCT CYSTADENOCARCINOMA Case report
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Measuring nasolacrimal duct volume using computed tomography images in nasolacrimal duct obstruction patients in Korean
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作者 Jin-Hwan Park Jung-Ah Huh +2 位作者 Jun-Feng Piao Hwa Lee Se-Hyun Baek 《国际眼科杂志:英文版》 SCIE CAS 2019年第1期100-105,共6页
AIM: To investigate nasolacrimal duct(NLD) volume in Korean patients and to examine the correlation between NLD volume and obstruction. METHODS: Of patients who underwent orbital computed tomography from March 2013 to... AIM: To investigate nasolacrimal duct(NLD) volume in Korean patients and to examine the correlation between NLD volume and obstruction. METHODS: Of patients who underwent orbital computed tomography from March 2013 to January 2016, patients diagnosed with NLD obstruction were classified into the patient group and patients without obstruction were classified into the control group. The NLD volume was measured using the Image J program, which showed the NLD in axial,coronal, and sagittal images on computed tomography. RESULTS: The average value of men’s NLD volume,265.33±90.57 mm^3, was significantly larger than women’s,211.87±68.61 mm^3(P=0.009). In the patient group, the NLD volume of the obstructed eyes, 242.49±82.93 mm3,and the non-obstructed eyes, 225.20±73.20 mm3, were significantly higher than the control group, 217.61±82.04 mm^3(P<0.001, P<0.001). CONCLUSION: The NLD volume is larger in men than in women in Korean adults. If there is NLD obstruction in women, the NLD volume is larger and it is judged that inflammatory reaction caused a chronic change in the bone around the NLD and affect the measurement of NLD volume. 展开更多
关键词 COMPUTED tomography nasolacrimal DUCT OBSTRUCTION nasolacrimal DUCT VOLUME
Role of pancreatoscopy in management of pancreatic disease:A systematic review 预览
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作者 Tarun Kaura Field F Willingham Saurabh Chawla 《世界胃肠内镜杂志:英文版(电子版)》 2019年第2期155-167,共13页
BACKGROUND Per-oral pancreatoscopy(POP)plays a role in the diagnosis and therapy of pancreatic diseases.With recent technological advances,there has been renewed interest in this modality.AIM To evaluate the efficacy ... BACKGROUND Per-oral pancreatoscopy(POP)plays a role in the diagnosis and therapy of pancreatic diseases.With recent technological advances,there has been renewed interest in this modality.AIM To evaluate the efficacy and safety of POP in management of pancreatic stone disease and pancreatic ductal neoplasia.METHODS To determine the safety and efficacy of POP in the management of pancreatic diseases,a systematic search was conducted in MEDLINE,EMBASE and Ovid.Articles in languages other than English and case reports were excluded.All published case series were eligible.Data specific to POP were extracted from studies,which combined cholangiopancreatoscopy.Ten studies were included in the analysis of POP therapy for pancreatic stone disease,and 15 case series satisfied the criteria for inclusion for the role of POP in the management of pancreatic ductal neoplasia.The examined data were subcategorized according to adjunctive modalities,such as direct tissue sampling,cytology,the role of intraoperative POP,intraductal ultrasound(IDUS)and POP combined with image-enhancing technology.RESULTS The success rate for complete ductal stone clearance ranged from 37.5%-100%.Factors associated with failure included the presence of strictures,multiple stones and the inability to visualize the target area.Although direct visualization can identify malignant and premalignant conditions,there is significant overlap with benign diseases.Visually-directed biopsies provide a high degree of accuracy,and represent a unique approach for tissue acquisition in patients with ductal abnormalities.Addition of pancreatic fluid cytology increases diagnostic yield for indeterminate lesions.Protrusions larger than 3 mm noted on IDUS are significantly more likely to be associated with malignancy.The rate of adverse events associated with POP ranged from 0%-35%.CONCLUSION Current evidence supports wider adoption of pancreatoscopy,as it is safe and effective.Improved patient selection and utilization of novel technologies may further enhance its rol 展开更多
关键词 PANCREATOSCOPY Cholangiopancreatoscopy Chronic pancreatitis PANCREATIC DUCT stones INTRADUCTAL papillary MUCINOUS neoplasm PANCREATIC cancer PANCREATIC DUCT STRICTURE
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Big-data analysis:A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones 预览
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作者 Wei Zhang Bing-Yi Wang +5 位作者 Xiao-Yan Du Wei-Wei Fang Han Wu Lei Wang Yu-Zheng Zhuge Xiao-Ping Zou 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第8期1002-1011,共10页
BACKGROUND A clinical pathway(CP)is a standardized approach for disease management.However,big data-based evidence is rarely involved in CP for related common bile duct(CBD)stones,let alone outcome comparisons before ... BACKGROUND A clinical pathway(CP)is a standardized approach for disease management.However,big data-based evidence is rarely involved in CP for related common bile duct(CBD)stones,let alone outcome comparisons before and after CP implementation.AIM To investigate the value of CP implementation in patients with CBD stones undergoing endoscopic retrograde cholangiopancreatography(ERCP).METHODS This retrospective study was conducted at Nanjing Drum Tower Hospital in patients with CBD stones undergoing ERCP from January 2007 to December 2017.The data and outcomes were compared by using univariate and multivariable regression/linear models between the patients who received conventional care(non-pathway group,n=467)and CP care(pathway group,n=2196).RESULTS At baseline,the main differences observed between the two groups were the percentage of patients with multiple stones(P<0.001)and incidence of cholangitis complication(P<0.05).The percentage of antibiotic use and complications in the CP group were significantly less than those in the nonpathway group[adjusted odds ratio(OR)=0.72,95%confidence interval(CI):0.55-0.93,P=0.012,adjusted OR=0.44,95%CI:0.33-0.59,P<0.001,respectively].Patients spent lower costs on hospitalization,operation,nursing,medication,and medical consumable materials(P<0.001 for all),and even experienced shorter length of hospital stay(LOHS)(P<0.001)after the CP implementation.No significant differences in clinical outcomes,readmission rate,or secondary surgery rate were presented between the patients in the non-pathway and CP groups.CONCLUSION Implementing a CP for patients with CBD stones is a safe mode to reduce the LOHS,hospital costs,antibiotic use,and complication rate. 展开更多
关键词 Common BILE DUCT STONES Endoscopic RETROGRADE CHOLANGIOPANCREATOGRAPHY Clinical pathway Outcomes COSTS
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Cancer risk in primary sclerosing cholangitis:Epidemiology,prevention,and surveillance strategies 预览
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作者 Brian M Fung Keith D Lindor James H Tabibian 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第6期659-671,共13页
Primary sclerosing cholangitis(PSC)is a rare cholestatic liver disease characterized by progressive fibroinflammatory destruction of the intra-and/or extrahepatic biliary ducts.While its features and disease course ca... Primary sclerosing cholangitis(PSC)is a rare cholestatic liver disease characterized by progressive fibroinflammatory destruction of the intra-and/or extrahepatic biliary ducts.While its features and disease course can be variable,most patients with PSC have concurrent inflammatory bowel disease and will eventually develop liver cirrhosis and end-stage liver disease,with liver transplantation representing the only potentially curative option.Importantly,PSC is associated with a significantly increased risk of malignancy compared to the general population,mainly cholangiocarcinoma,gallbladder carcinoma,hepatocellular carcinoma,and colorectal cancer,with nearly 50%of deaths in patients with PSC being due to cancer.Therefore,robust surveillance strategies are needed,though uncertainty remains regarding how to best do so.In this review,we discuss the epidemiology,prevention,and surveillance of cancers in patients with PSC.Where evidence is limited,we present pragmatic approaches based on currently available data and expert opinion. 展开更多
关键词 BILE duct diseases CHOLANGIOCARCINOMA GALLBLADDER CARCINOMA Hepatocellular CARCINOMA Colorectal cancer CHEMOPROTECTION Inflammatory bowel disease
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暖通工程风管安装施工工艺探究 预览
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作者 詹明豪 《江西建材》 2019年第4期111-112,共2页
本文主要就暖通工程风管施工要点展开论述,并全面阐述了暖通工程风管制作与安装施工工艺。
关键词 暖通工程 风管 安装施工 施工工艺
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Safe laparoscopic cholecystectomy:Adoption of universal culture of safety in cholecystectomy 预览
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作者 Vishal Gupta Gaurav Jain 《世界胃肠外科杂志:英文版(电子版)》 2019年第2期62-84,共23页
The incidence of biliary injury after laparoscopic cholecystectomy(LC)has shown a declining trend though it may still be twice that as with open cholecystectomy.Major biliary or vasculobiliary injury is associated wit... The incidence of biliary injury after laparoscopic cholecystectomy(LC)has shown a declining trend though it may still be twice that as with open cholecystectomy.Major biliary or vasculobiliary injury is associated with significant morbidity.As prevention is the best strategy,the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC.Various aspects of safe cholecystectomy include:(1)thorough knowledge of relevant anatomy,various anatomical landmarks,and anatomical variations;(2)an understanding of the mechanisms involved in biliary/vascular injury,the most important being the misidentification injury;(3)identification of various preoperative and intraoperative predictors of difficult cholecystectomy;(4)proper gallbladder retraction;(5)safe use of various energy devices;(6)understanding the critical view of safety,including its doublet view and documentation;(7)awareness of various error traps(e.g.,fundus first technique);(8)use of various bailout strategies(e.g.,subtotal cholecystectomy)in difficult gallbladder cases;(9)use of intraoperative imaging techniques(e.g.,intraoperative cholangiogram)to ascertain correct anatomy;and(10)understanding the concept of time-out.Surgeons should be facile with these aspects of this culture of safety in cholecystectomy in an attempt to reduce the incidence of biliary/vascular injury during LC. 展开更多
关键词 BILE LEAK BILE duct injury CHOLECYSTECTOMY CHOLELITHIASIS CHOLECYSTITIS
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胆管内乳头状黏液性肿瘤的影像诊断
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作者 冯秋霞 张海龙 +2 位作者 刘畅 刘希胜 孙娜娜 《实用放射学杂志》 CAS 北大核心 2019年第5期842-843,847共3页
胆管内乳头状肿瘤(intraductal papillary neoplasms of the bile ducts,IPN-B)是一种胆管内的、具有纤维血管轴心的乳头状或绒毛状肿瘤,伴有胆管扩张[1]。可分为分泌黏液型和不分泌黏液型,其中分泌黏液的IPN-B又称为胆管内乳头状黏液... 胆管内乳头状肿瘤(intraductal papillary neoplasms of the bile ducts,IPN-B)是一种胆管内的、具有纤维血管轴心的乳头状或绒毛状肿瘤,伴有胆管扩张[1]。可分为分泌黏液型和不分泌黏液型,其中分泌黏液的IPN-B又称为胆管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasms of the bile duct,IPMN-B)[2],以往对该病认识不足,常与囊腺瘤等混淆[3],现回顾性分析15例IPMN-B的患者的资料及既往文献报道,总结IPMN-B的CT及MRI的影像学特点,提高该病的术前诊断水平。 展开更多
关键词 黏液性肿瘤 乳头状肿瘤 胆管内 影像诊断 neoplasms 影像学特点 胆管扩张 DUCT
Comprehensive and innovative techniques for laparoscopic choledocholithotomy: A surgical guide to successfully accomplish this advanced manipulation 预览
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作者 Tomohide Hori 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第13期1531-1549,共19页
Surgeries for benign diseases of the extrahepatic bile duct (EHBD) are classified as lithotomy (i.e., choledocholithotomy) or diversion (i.e., choledochojejunostomy). Because of technical challenges, laparoscopic appr... Surgeries for benign diseases of the extrahepatic bile duct (EHBD) are classified as lithotomy (i.e., choledocholithotomy) or diversion (i.e., choledochojejunostomy). Because of technical challenges, laparoscopic approaches for these surgeries have not gained worldwide popularity. The right upper quadrant of the abdomen is advantageous for laparoscopic procedures, and laparoscopic choledochojejunostomy is safe and feasible. Herein, we summarize tips and pitfalls in the actual procedures of choledocholithotomy. Laparoscopic choledocholithotomy with primary closure of the transductal incision and transcystic C-tube drainage has excellent clinical outcomes;however, emergent biliary drainage without endoscopic sphincterotomy and preoperative removal of anesthetic risk factors are required. Elastic suture should never be ligated directly on the cystic duct. Interrupted suture placement is the first choice for hemostasis near the EHBD. To prevent progressive laceration of the EHBD, full-layer interrupted sutures are placed at the upper and lower edges of the transductal incision. Cholangioscopy has only two-way operation;using dedicated forceps to atraumatically grasp the cholangioscope is important for smart maneuvering. The duration of intraoperative stone clearance accounts for most of the operative time. Moreover, dedicated forceps are an important instrument for atraumatic grasping of the cholangioscope. Damage to the cholangioscope requires expensive repair. Laparoscopic approach for choledocholithotomy involves technical difficulties. I hope this document with the visual explanation and literature review will be informative for skillful surgeons. 展开更多
关键词 LAPAROSCOPIC SURGERY Choledocholithotomy BILE DUCT LAPAROSCOPY General SURGERY
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Co-occurrence of IPMN and malignant IPNB complicated by a pancreatobiliary fistula:A case report and review of the literature 预览
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作者 Xu Ren Chun-Lan Zhu +3 位作者 Xu-Fu Qin Hong Jiang Tian Xia Yong-Ping Qu 《世界临床病例杂志》 2019年第1期102-108,共7页
BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB)is pathologically similar to intraductal papillary mucinous neoplasm(IPMN).However,there are several significant differences between them.The rate of IPM... BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB)is pathologically similar to intraductal papillary mucinous neoplasm(IPMN).However,there are several significant differences between them.The rate of IPMN associated with extrapancreatic malignancies has been reported to range from 10%-40%,and it may occasionally be complicated with the presence of fistulas.IPMN associated with malignant IPNB is extremely rare and only nine cases have been reported in the literature.CASE SUMMARY We report a 52-year-old man who presented with recurrent cholangitis for nine months.Computed tomography and magnetic resonance cholangiopancreatography showed the common bile duct stricture with dilated pancreatobiliary duct without other abnormal findings.The underlying pathogenesis could not be identified based on the radiologic images.Endoscopic retrograde cholangiopancreatography revealed a pancreatobiliary fistula with dilated main pancreatic duct,biliary stricture with dilated biliary tree,and mucus discharge from the enlarged orifice of the major papilla.The patient underwent SpyGlass cholangiopancreatoscopy due to a suspected mucin-producing biliary neoplasm and indeterminate main pancreatic duct dilatation.Multiple papillary growing neoplasms with vascular images,with the extent of lesions spreading in the biliopancreatic ductal lumens,were identified by SpyGlass.In addition,the presence of a pancreatobiliary fistula was also identified.The patient was diagnosed as having benign IPMN and malignant IPNB with focal invasion by postoperative pathology.Furthermore,varying histological subtypes were present in both IPMN and IPNB.Pylorus-preserving pancreaticoduodenectomy was performed on the patient with excellent results during the 52 month followup period.CONCLUSION We deemed that pancreatography and SpyGlass allowed for an efficient diagnosis of IPMN with pancreatobiliary fistula,whereas the etiology could not be identified by radiologic imaging. 展开更多
关键词 INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM of the pancreas INTRADUCTAL PAPILLARY NEOPLASM of the bile duct Extrapancreatic malignancies CO-OCCURRENCE Pancreatobiliary fistula SpyGlass cholangiopancreatoscopy Endoscopic retrograde cholangiopancreatography Case report
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Role of endoscopy in the management of primary sclerosing cholangitis 预览
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作者 Neil Bharat Marya James H Tabibian 《世界胃肠内镜杂志:英文版(电子版)》 2019年第2期84-94,共11页
Primary sclerosing cholangitis(PSC)is a rare but prominent fibroinflammatory cholangiopathy which can affect individuals of essentially any age.It carries a median survival of 15-20 years,regardless of age at diagnosi... Primary sclerosing cholangitis(PSC)is a rare but prominent fibroinflammatory cholangiopathy which can affect individuals of essentially any age.It carries a median survival of 15-20 years,regardless of age at diagnosis,and is a foremost risk factor for cholangiocarcinoma.Given the chronic and progressive nature of PSC,its inherent risk for biliary tract and other complications,and the paucity of effective pharmacotherapies,endoscopy plays a major role in the care of many patients with this disorder.In this review,we discuss the endoscopic management of PSC,including established and evolving approaches to the diagnosis and treatment of its benign as well as malignant sequelae.Owing to the rarity of PSC and dearth of high-quality evidence,we propose pragmatic approaches based on both currently available data and expert opinion. 展开更多
关键词 BILE duct diseases CHOLANGIOCARCINOMA Inflammatory bowel disease Endoscopic RETROGRADE CHOLANGIOPANCREATOGRAPHY Biopsy Primary SCLEROSING CHOLANGITIS
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Radiation therapy for extrahepatic bile duct cancer: Current evidences and future perspectives 预览
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作者 Taeryool Koo Hae Jin Park Kyubo Kim 《世界临床病例杂志》 2019年第11期1242-1252,共11页
Extrahepatic bile duct cancer (EBDC) is a rare malignancy that involves neoplastic changes extending from both hepatic ducts to the common bile duct. The treatment of choice is surgical resection, but the predominant ... Extrahepatic bile duct cancer (EBDC) is a rare malignancy that involves neoplastic changes extending from both hepatic ducts to the common bile duct. The treatment of choice is surgical resection, but the predominant pattern of initial treatment failure is locoregional recurrence. Accordingly, adjuvant radiotherapy has been administered after surgical resection based on these rationales. At this time, there is minimal evidence supporting adjuvant radiotherapy, because there have been no phase III trials evaluating its benefit. Relatively small retrospective studies have tried to compare outcomes associated with EBDC treated with or without radiotherapy. We aimed to review studies investigating adjuvant radiotherapy for resected EBDC. Because less than onethird of EBDC cases are amenable to curative resection at diagnosis, other locoregional treatment modalities need to be considered, including radiotherapy. The next aim of this review was to summarize reports of definitive radiotherapy for unresectable EBDC. Patients with advanced EBDC often experience biliary obstruction, which can lead to jaundice and progress to death. Biliary stent insertion is an important palliative procedure, but stents are prone to occlusion after subsequent ingrowth of the EBDC. Radiotherapy can be effective for maintaining the patency of inserted stents. We also reviewed the benefit of palliative radiotherapy combined with the biliary stent insertion. Lastly, we discuss the existing gaps in the evidence supporting radiotherapy in the management of EBDC. 展开更多
关键词 EXTRAHEPATIC BILE duct cancer Patterns of failure ADJUVANT RADIOTHERAPY Definitive RADIOTHERAPY PALLIATIVE RADIOTHERAPY BILIARY stent
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Safety and efficacy of percutaneous transhepatic balloon dilation in removing common bile duct stones: A systematic review 预览
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作者 Yu-Liang Li Dong Li +3 位作者 Bin Liu Wu-Jie Wang Wei Wang Yong-Zheng Wang 《世界荟萃分析杂志》 2019年第4期162-169,共8页
BACKGROUND Endoscopic sphincterotomy (EST) is widely regarded as the first choice in the management of common bile duct (CBD) stones. However, for some patients, this treatment is not possible. The percutaneous transh... BACKGROUND Endoscopic sphincterotomy (EST) is widely regarded as the first choice in the management of common bile duct (CBD) stones. However, for some patients, this treatment is not possible. The percutaneous transhepatic balloon dilation (PTBD) technique has been suggested as an alternative but has yet to gain wide acceptance. AIM To review cases of PTBD for removing CBD stones and explore the safety and efficacy of this treatment. METHODS We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched EMBASE, PubMed, and Web of Science for cases of PTBD that underwent CBD stone removal from 1981 to January 2019. We analyzed all relevant articles available in full text. We extracted data on patient’s age, gender, overall technique success rate, reasons for technique failure, and the presence and type of major and minor complications. We analyzed the data and reported the results in a table and text. Altogether, we retrieved 12 case series and 6 case reports, for a total of 1347 patients. Thirty cases were excluded due to a lack of patient data. RESULTS The overall technique success rate for removing a CBD stone was 98.5%(1327/1347) and 98.1%(109/111) for removing concurrent CBD and gallbladder stones. Based on available data (n = 1312), mean age of all patients (687 males and 625 females) was 68.9 years. The total number of procedures in the remaining 1317 patients (after exclusion) was 3237 (average 2.4 procedures per patient). The total number of failures for eliminating a CBD stone was 20, and the reasons for failure included: Stone impaction (n = 10), intrahepatic bile duct stricture (n = 5),large stone (n = 2), severe CBD dilation (n = 1), multiple stones (n = 1), and duodenal perforation (n = 1). Various major complications related to the procedure were reported, but the incidence rate was low (1.4%). No pancreatitis or procedure related mortality was reported. Minor complications including transient hyperamylasemia, nausea, vomiting 展开更多
关键词 Common bile duct stone PERCUTANEOUS TRANSHEPATIC approach Balloon DILATION INTERVENTIONAL procedures PAPILLA Endoscopic SPHINCTEROTOMY
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Causes associated with recurrent choledocholithiasis following therapeutic endoscopic retrograde cholangiopancreatography: A large sample sized retrospective study 预览
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作者 Feng Deng Mi Zhou +4 位作者 Ping-Ping Liu Jun-Bo Hong Guo-Hua Li Xiao- Jiang Zhou You-Xiang Chen 《世界临床病例杂志》 2019年第9期1028-1037,共10页
BACKGROUND Recurrence of primary choledocholithiasis commonly occurs after complete removal of stones by therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The potential causes of the recurrence of cho... BACKGROUND Recurrence of primary choledocholithiasis commonly occurs after complete removal of stones by therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The potential causes of the recurrence of choledocholithiasis after ERCP are unclear. AIM To analyze the potential causes of the recurrence of choledocholithiasis after ERCP. METHODS The ERCP database of our medical center for the period between January 2007 and January 2016 was retrospectively reviewed, and information regarding eligible patients who had choledocholithiasis recurrence was collected. A 1:1 case-control study was performed for this investigation. Data including general characteristics of the patients, past medical history, ERCP-related factors, common bile duct (CBD)-related factors, laboratory indicators, and treatment was analyzed by univariate and multivariate logistic regression analysis and Kaplan Meier analysisly. RESULTS First recurrence of choledocholithiasis occurred in 477 patients;among these patients, the second and several instance (≥ 3 times) recurrence rates were 19.5% and 44.07%, respectively. The average time to first choledocholithiasis recurrence was 21.65 mo. A total of 477 patients who did not have recurrence were selected as a control group. Multivariate logistic regression analysis showed that age > 65 years (odds ratio [OR]= 1.556;P = 0.018), combined history of choledocholithotomy (OR = 2.458;P < 0.01), endoscopic papillary balloon dilation (OR = 5.679;P = 0.000), endoscopic sphincterotomy (OR = 3.463;P = 0.000), CBD stent implantation (OR = 5.780;P = 0.000), multiple ERCP procedures (≥2;OR = 2.75;P = 0.000), stones in the intrahepatic bile duct (OR = 2.308;P = 0.000), periampullary diverticula (OR = 1.627;P < 0.01), choledocholithiasis diameter ≥ 10 mm (OR = 1.599;P < 0.01), bile duct-duodenal fistula (OR = 2.69;P < 0.05), combined biliary tract infections (OR = 1.057;P < 0.01), and no preoperative antibiotic use (OR = 0.528;P < 0.01) were independent risk factors for the recurrence of choledochol 展开更多
关键词 CHOLEDOCHOLITHIASIS Endoscopic RETROGRADE CHOLANGIOPANCREATOGRAPHY Recurrence Common BILE duct
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Management of the late effects of disconnected pancreatic duct syndrome: A case report 预览
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作者 Reiko Yamada Yuhei Umeda +8 位作者 Yasunori Shiono Hiroaki Okuse Naoki Kuroda Junya Tsuboi Hiroyuki Inoue Yasuhiko Hamada Kyosuke Tanaka Noriyuki Horiki Yoshiyuki Takei 《世界临床病例杂志》 2019年第9期1053-1059,共7页
BACKGROUND There have been few reports about the late effects of disconnected pancreatic duct syndrome (DPDS). Although few reports have described the recurrence interval of pancreatitis, it might be rare for recurren... BACKGROUND There have been few reports about the late effects of disconnected pancreatic duct syndrome (DPDS). Although few reports have described the recurrence interval of pancreatitis, it might be rare for recurrence to occur more than 5 years later. Herein, we describe a case of recurrence in an 81-year-old man after the treatment of walled-off necrosis (WON) with pancreatic transection 7 years ago. CASE SUMMARY An 81-year-old man visited our hospital with chief complaints of fever and abdominal pain 7 years after the onset of WON due to severe necrotic pancreatitis. His medical history included an abdominal aortic aneurysm (AAA), hypertension, dyslipidemia, and chronic kidney disease. Computed tomography (CT) scan showed that the pancreatic fluid collection (PFC) had spread to the aorta with inflammation surrounding it, and CT findings suggested that bleeding occurred from the vasodilation due to splenic vein occlusion. First, we attempted to perform transpapillary drainage because of venous dilation around the residual stomach and the PFC. However, pancreatic duct drainage failed because of complete main pancreatic duct disruption. Second, we performed endoscopic ultrasound-guided drainage. After transmural drainage, the inflammation improved and stenting for the AAA was performed successfully. The inflammation was resolved, and he has been free from infection for more than 2 years after the procedure. CONCLUSION This case highlights the importance of continued follow-up of patients for recurrence after the treatment of WON with pancreatic transection. 展开更多
关键词 Case report ENDOSCOPY NECROSIS PANCREAS Walled-off NECROSIS Disconnected PANCREATIC DUCT SYNDROME
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胆管内乳头状肿瘤2例并文献复习
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作者 覃滢 肖运平 邓奎品 《实用放射学杂志》 CAS 北大核心 2019年第3期509-510,共2页
胆管内乳头状肿瘤(intraductal papillary neoplasm of thebile duct,IPNB)是一组缺乏卵巢样间质的胆管上皮性肿瘤,包括胆管乳头状瘤(病)、胆管内生长型肝内胆管癌、胆管乳头状癌等[1-2]。该病少见,易误诊。本文报道2例IPNB并回顾分析... 胆管内乳头状肿瘤(intraductal papillary neoplasm of thebile duct,IPNB)是一组缺乏卵巢样间质的胆管上皮性肿瘤,包括胆管乳头状瘤(病)、胆管内生长型肝内胆管癌、胆管乳头状癌等[1-2]。该病少见,易误诊。本文报道2例IPNB并回顾分析其特点,以提高对其认识。 展开更多
关键词 乳头状肿瘤 胆管内 文献复习 neoplasm 胆管乳头状瘤 上皮性肿瘤 肝内胆管癌 duct
Outcomes of endoscopic sphincterotomy vs open choledochotomy for common bile duct stones 预览
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作者 Xiao-Dong Zhou Qiao-Feng Chen +7 位作者 Yuan-Yuan Zhang Ming-Ju Yu Chang Zhong Zhi-Jian Liu Guo-Hua Li Xiao-Jiang Zhou Jun-Bo Hong You-Xiang Chen 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第4期485-497,共13页
BACKGROUND Endoscopic sphincterotomy(EST)for the management of common bile duct stones(CBDS)is used increasingly widely because it is a minimally invasive procedure.However,some clinical practitioners argued that EST ... BACKGROUND Endoscopic sphincterotomy(EST)for the management of common bile duct stones(CBDS)is used increasingly widely because it is a minimally invasive procedure.However,some clinical practitioners argued that EST may be complicated by post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP)and accompanied by a higher recurrence of CBDS than open choledochotomy(OCT).Whether any differences in outcomes exist between these two approaches for treating CBDS has not been thoroughly elucidated to date.AIM To compare the outcomes of EST vs OCT for the management of CBDS and to clarify the risk factors associated with stone recurrence.METHODS Patients who underwent EST or OCT for CBDS between January 2010 and December 2012 were enrolled in this retrospective study.Follow-up data were obtained through telephone or by searching the medical records.Statistical analysis was carried out for 302 patients who had a follow-up period of at least 5 years or had a recurrence.Propensity score matching(1:1)was performed to adjust for clinical differences.A logistic regression model was used to identify potential risk factors for recurrence,and a receiver operating characteristic(ROC)curve was generated for qualifying independent risk factors.RESULTS In total,302 patients undergoing successful EST(n=168)or OCT(n=134)were enrolled in the study and were followed for a median of 6.3 years.After propensity score matching,176 patients remained,and all covariates were balanced.EST was associated with significantly shorter time to relieving biliary obstruction,anesthetic duration,procedure time,and hospital stay than OCT(P<0.001).The number of complete stone clearance sessions increased significantly in the EST group(P=0.009).The overall incidence of complications and mortality did not differ significantly between the two groups.Recurrent CBDS occurred in 18.8%(33/176)of the patients overall,but no difference was found between the EST(20.5%,18/88)and OCT(17.0%,15/88)groups.Factors associated with CBDS recurrence included 展开更多
关键词 Common BILE DUCT stone CHOLEDOCHOTOMY Endoscopic SPHINCTEROTOMY Outcome RECURRENCE Risk factor
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日光温室正压式湿帘风机系统设计及其降温效果
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作者 刘云骥 徐继彤 +2 位作者 庞松若 孙周平 李天来 《中国农业大学学报》 CAS CSCD 北大核心 2019年第5期130-139,共10页
针对传统湿帘风机系统存在温湿度不均匀,无法调控冷空气温度;对温室密闭性要求较高,不适用于节能型日光温室等问题,借鉴国外半封闭温室降温方式,对日光温室正压式湿帘风机降温系统结构参数优化与应用效果进行研究。结果表明:最优的湿帘... 针对传统湿帘风机系统存在温湿度不均匀,无法调控冷空气温度;对温室密闭性要求较高,不适用于节能型日光温室等问题,借鉴国外半封闭温室降温方式,对日光温室正压式湿帘风机降温系统结构参数优化与应用效果进行研究。结果表明:最优的湿帘风机系统结构参数为,湿帘厚度150 mm,单位面积水流速4 L/(min·m^2),直径50 cm、均匀打孔、孔距20 cm、孔径1 cm、反光膜材料的通风筒;与对照温室相对,此系统最高可降温10℃,室内温度基本全天均低于室外,在距地面1.5 m水平面上各处的温差在2℃以内,湿度差在7%以内,垂直方向上距地面3 m以下的温差在3℃以内。此降温系统能够有效的降低夏季日光温室的温度,且温室各处的温湿度比较均匀,可以为我国节能型日光温室提供有效的夏季降温措施。 展开更多
关键词 日光温室 降温效果 湿帘风机 风筒 冷却效率 温湿度
TIME-PERIODIC ISENTROPIC SUPERSONIC EULER FLOWS IN ONE-DIMENSIONAL DUCTS DRIVING BY PERIODIC BOUNDARY CONDITIONS 预览
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作者 袁海荣 《数学物理学报:B辑英文版》 SCIE CSCD 2019年第2期403-412,共10页
We show existence of time-periodic supersonic solutions in a finite interval, after certain start-up time depending on the length of the interval, to the one space-dimensional isentropic compressible Euler equations, ... We show existence of time-periodic supersonic solutions in a finite interval, after certain start-up time depending on the length of the interval, to the one space-dimensional isentropic compressible Euler equations, subjected to periodic boundary conditions. Both classical solutions and weak entropy solutions, as well as high-frequency limiting behavior are considered. The proofs depend on the theory of Cauchy problems of genuinely nonlinear hyperbolic systems of conservation laws. 展开更多
关键词 SUPERSONIC flow ISENTROPIC COMPRESSIBLE EULER equations duct time-periodic solution initial-boundary-value problem
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Endoscopic ultrasound-guided vs endoscopic retrograde cholangiopancreatography biliary drainage for obstructed distal malignant biliary strictures: A systematic review and meta-analysis 预览
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作者 Fernanda P Logiudice Wanderlei M Bernardo +9 位作者 Facundo Galetti Vitor M Sagae Carolina O Matsubayashi Antonio C Madruga Neto Vitor O Brunaldi Diogo T H de Moura Tomazo Franzini Spencer Cheng Sergio E Matuguma Eduardo G H de Moura 《世界胃肠内镜杂志:英文版(电子版)》 2019年第4期281-291,共11页
BACKGROUND For palliation of malignant biliary obstruction (MBO), the gold-standard method of biliary drainage is endoscopic retrograde cholangiopancreatography (ERCP) with the placement of metallic stents. Endoscopic... BACKGROUND For palliation of malignant biliary obstruction (MBO), the gold-standard method of biliary drainage is endoscopic retrograde cholangiopancreatography (ERCP) with the placement of metallic stents. Endoscopic ultrasound (EUS)-guided drainage is an alternative that is typically reserved for cases of ERCP failure. Recently, however, there have been robust randomized clinical trials (RCTs) comparing EUS-guided drainage and ERCP as primary approaches to MBO. AIM To compare EUS guidance and ERCP in terms of their effectiveness and safety in palliative biliary drainage for MBO. METHODS This was a systematic review and meta-analysis, in which we searched the MEDLINE, Excerpta Medica, and Cochrane Central Register of Controlled Trials databases. Only RCTs comparing EUS and ERCP for primary drainage of MBO were eligible. All of the studies selected provided data regarding the rates of technical and clinical success, as well as the duration of the procedure, adverse events, and stent patency. We assessed the risk of biases using the Jadad score and the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation criteria. RESULTS The database searches yielded 5920 records, from which we selected 3 RCTs involving a total of 222 patients (112 submitted to EUS and 110 submitted to ERCP). In the EUS and ERCP groups, the rate of technical success was 91.96% and 91.81%, respectively, with a risk difference (RD) of 0.00%(95%CI:-0.07, 0.07;P = 0.97;I2 = 0%). The clinical success was 84.81% and 85.53% in the EUS and ERCP groups, respectively, with an RD of ?0.01%(95%CI:-0.12, 0.10;P = 0.90;I2 = 0%). The mean difference (MD) for the duration of the procedure was -0.12%(95%CI:-8.20, 7.97;P = 0.98;I2 = 84%). In the EUS and ERCP groups, there were 14 and 25 adverse events, respectively, with an RD of -0.06%(95%CI:-0.23, 0.12;P = 0.54;I2 = 77%). The MD for stent patency was 9.32%(95%CI:-4.53, 23.18;P = 0.19;I2 = 44%). The stent dysfunction rate was significantly lower in the EUS group (MD =-0. 展开更多
关键词 Common bile duct neoplasms ENDOSCOPIC retrograde cholangiopancreatography ENDOSONOGRAPHY Ultrasonography Interventional/methods ENDOSCOPIC ultrasound Systematic review META-ANALYSIS
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