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Objective To evaluate the safety and efficacy of endoscopic intraductal radiofrequency ablation combined with biliary metal stent and biliary metal stent only for the treatment of biliary malignant tumor.Methods Data of 48 patients with biliary malignant tumor were reviewed.All patients were examined by ERCP for the range of obstruction.Twenty-four patients received combined therapy (combination group),while 24 others received stent placement only (control group).In the combination group,stenotic segments were treated with intraductal radiofrequency ablation,then metal stents were placed into the biliary duct.In the control group,only metal stents were placed.Changes of serum total bilirubin (TB),surgical complications,days of stent patency and median survival time were studied.Results In the combination group,TB level [median (min-max)] was 238.15 μmol/L (22.10-410.70 μmol/L) before treatment and it decreased to 113.40 μmol/L (9.80-243.70 μmol/L) after,while in the control group it was 239.70 μmol/L(112.30-558.50 μmol/L) before and 121.10 μmol/L (52.10-329.30 μmol/L) after respectively,significantly different in both groups (P＜0.05).The time of stent patency was 156 days (44-530 days) in the combination group and 110 days (14-462 days) in the control group (P＜0.05).The median survival time was 173 days (44-550 days) and 133 days (14-490 days) respectively(P＜0.05).Conclusion The combination therapy of endoscopic intraductal radiofrequency ablation with biliary stent is safe and feasible for biliary malignant tumor.It can prolong the duration of stent patency and median survival time as well as improve postoperative survival quality.
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Objective To discuss the clinical application of percutaneous transhepatic removal of gall-stone technique in treating common bile duct (CBD) stones.Methods Between January 2013 and January 2015,a total of 25 patients with CBD stones underwent lithotomy procedure via percutaneous transhepatic route.First,under ultrasound or fluoroscopy guidance percutaneous transhepatic cholangiography (PTC) was performed with subsequent placement of an 8 F rsheath;then,a balloon of 8-12 mm diameter was employed to dilate the papilla;mechanical lithotripsy was adopted when the stone size exceeded 12 mm;finally,through guide-wire exchange technique the stone-retrieval balloon was used to push the stones into the intestinal tract through the sphincter of duodenal papilla.Results The reasons to receive percutaneous transhepatic removal of gall-stone technique in the 25 patients included previous gastrointestinal surgery (n=18),endoscopic treatment failure (n=3),unwilling to receive endoscopic treatment (n=3),and other reasons (n=1).Successful removal of stones was accomplished in all 25 patients.After the treatment,complications occurred in 3 patients (12％),including fever (n=2) and liver abscess formation (n=1).The patients were followed up for 0.5-3 years;two patients died of tumor recurrence and metastasis,and one patient developed recurrence of common bile duct stones.No reflux cholangitis occurred.Conclusion For the treatment of CBD stones,percutaneous transhepatic removal of gall-stone technique carries higher technical success rate with lower incidence of complications,therefore,this technique can be used for the patients who are not suitable for endoscopic treatment or in whom endoscopic treatment failed.
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Objective:To compare the clinical effect of domestic and imported omeprazole injection in the treatment of peptic ulcer bleeding.Methods:According to the random sequence generated by the computer,118 patients who were treated in digestive department of our hospital from April 2013 to May 2015 were randomly divided into 2 groups,59 cases in each group.The control group was given treatment of imported drug losec,while the study group was given treatment of domestic drug aoxikang,and two groups were treated continuously for 7 days.The incidences of gastrointestinal reactions,dizziness and palpitations,the average treatment time,and clinical therapeutic effects were compared,in addition,the costs of treatment in the two groups were analyzed.Results:There were no significant differences in the incidences of gastrointestinal reactions,dizziness and palpitations and the average treatment time between the study group and the control group (P＞0.05).There was no significant difference between the two groups in the treatment effect after rank sum test (P＞0.05).The total effective rates (96.61％ vs 94.91％) were equivalent,the differences were not statistically significant (P＞0.05),but the costs of using domestic drugs were lower than that of imported drugs.Conclusion:The clinical curative effects of domestic aoxikang and imported losec in treatment of peptic ulcer bleeding have no significant difference,which can have a good therapeutic effect,but the economy of aoxikang is more better.
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Objective To investigate the impact of pancreatic duct stenting as a preventive measure for post-ERCP pancreatitis in patients with repeatedly non-selective pancreatic duct cannulation.Methods Clinical data of 64 patients with biliary tract disease from January 2008 to December 2015 was prospective analyzed. All the patients were randomly divided into observation group and control group. Patients in observation group received pancreatic stent placement, while patients in control group was not received pancreatic stent placement and nasal duct. Postoperative monitoring items included abdominal pain, blood amylase. Then record and compare the incidence of acute pancreatitis, pancreatitis severity rating, abdominal pain score, Ranson score, amylase recovery time between the two groups.Results Observation group had ifve cases of PEP, the rate was 15.6 %, including mild four cases (12.5 %), medium one case (3.1 %); the control group had 13 cases of PEP, the rate was 40.6 %, including mild six cases (18.8 %), medium four cases (12.5 %), severe three cases (9.4 %). PEP observation group was signiifcantly lower than the control group (P < 0.05). Mild, medium and severe PEP were lower than the control group, in which the severe PEP was signiifcantly lower than the control group (P < 0.05). Ranson score of the observation group was (1.2 ± 0.4), significantly lower than the control group (2.5 ± 1.2) (P < 0.05); the observation group amylase average recovery time was (3.0 ± 0.6) d, it is also signiifcantly lower than the control group (5.8 ± 1.4) d (P < 0.01). No bleeding and perforation complications occurred.Conclusion Pancreatic stenting can effectively prevent the incidence of PEP, reduce postoperative pain, improve patient recovery.
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Objective To evaluate the safety and efficacy of pancreatic duct precutting by arciform knife combined with needle knife in difficult cannulation of ERCP.Methods The clinical data of 38 patients who were treated with pancreatic duct precutting by arciform knife combined with needle knife in our hospital from June 2005 to May 2012 were retrospectively reviewed.Results The success rate of ERCP was 86.8％ (33/38) without any complications of bleeding or perforation,while 4 cases were presented with hyperamylasemia after ERCP,4 with pancreatitis and 1 with cholangitis who all got recovered after 5 days with conservative treatment.Conclusion The application of pancreatic duct precutting by arciform knife combined with needle knife can improve the success rate of ERCP and is a kind of effective operation technique.