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Objective To compare the effect of percutaneous intraluminal radiofrequency ablation ( RFA ) combined with biliary stenting and that of percutaneous transhepatic puncture combined with biliary stenting .Methods A total of 56 patients with unresectable malignant obstructive jaundice were reviewed retrospectively .Among them, 25 patients had received percutaneous intraluminal RFA combined with biliary stenting ( RFA group) while another 31 patients had been simultaneously selected for the simple biliary stent implantation ( stent group ) .The changes of the serum total bilirubin ( TB) and direct bilirubin ( DB) before and after 7-14 days of treatment , surgical complications , stent median patency and the median survival were observed.Follow-up information was obtained through telephone reviews or check-up records. Results The technical success rate was 100%.No procedure-related peritonitis or perforation occurred .There were respectively 3 cases with cholangeitis in RFA group and 3 in stent group.All the cases was controlled by effective clinical treatment.There was obvious statistically significant difference after treatment in TB and DB in the two groups (P<0.01, P<0.01).TB and DB fell by (149.05 ±110.71) and (96.93 ±69.12)μmol/L after 7-14 days in RFA group vs (151.40 ±94.47) and (94.21 ±67.36)μmol/L in stent group.The changes of the two groups were of no statistical significances .The stent patenmedian time was 122 ( 9 -550 ) and 157 ( 16 -510 ) d, while the median survival was 125(9-550) and 163 ( 16 -520 ) d.The difference was of no statistical significance .Conclusion Percutaneous intraluminal RFA combined with biliary stenting and percutaneous transhepatic puncture combined with biliary stenting are both safe and feasible therapeutic options for unresectable malignant obstructive jaundice .There is no statistically significant diffference between the two groups in the recent and long-term curative effects .
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Objective To evaluate the effect and feasibility of balloon dilatation for treatment of anastomotic stricture after biliary-intestinal anastomosis with percutaneous transhepatic cholangial drainage( PTCD) .Methods A total of 23 pa-tients with anastomotic stricture after biliary-intestinal anastomosis who had undergone PTCD+balloon dilatation were ana-lyzed retrospectively between Mar 2009 to Dec 2011.The patency of bile duct, jaundice index and liver function were recor-ded.Results PTCD+balloon dilatation was completed successfully in all cases, and a metallic stent was implanted in one case.Anastomotic stricture, postoperative jaundice index and liver function were improved significantly after operation.No serious complications occurred.Conclusion PTCD+balloon dilatation has good curative effect on anastomotic stricture. The complication rate is low.It is a safe, feasible and effective minimally invasive treatment.
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Objective To observe the basic rhythm of myoelectrie activities of sphcter of Oddi (SO)and explore its biological significance.Methods Healthy adult rabbits(n=32)were randomized into 4 groups with 8 in each.The first group was for recording of myoelectric activities of SO after keeping fast for 18 hours.The second group was manipulated to observe the myoelectric activities of SO after food infusion through the stoma in stomach.The myoelectric activities of SO in the third group were monitored after the classical Nardi test was performed on these rabbits.The fourth group was used to observe the myoelectric activities of SO after the cholinergic receptors had been blocked.Using the double claw metal electrodes which were put into SO and duodenum through the plasma membrance,the myoelectric signal were recorded with RM6240 multi-channel physiologic recording and signal processing system and non-stop recording was conducted for 120-150 mins.Results 1)Spike Potentials of SO with the frequency was observed in rabbits that had been fasting.2)Myoelectronic activity of SO was observed in rabbits infused with 50 ml milk through stoma.3)After the administration of 1 mg morphine and 1 mg neostigmine i.v,the myoelectric activities of SO were noted as long-lasting persistent MASO.4)Administration of anisodamine 1 mg(i.v.)in the empty abdomen group dismissed SPSO and MASO.This state lasted for 120 min before SPSO gradually reconverted to the state of empty abdomen.Conclusion There are four patterns of myoelectric activities of SO,i.e,tensional waves under empty abdomen indicating a state in which the SO kept a basic tension level.Peristaltic waves under intake of food.Spastic waves under the stimulation of drugs and relaxant waves under the post-ganglionic block of cholinergic receptors were observed in the present study.Correspondingly,their mechanic locomotion is inferred as the basic tensional state to faciliate the deposition and condensation of bile,the peristalsis for the entry of bile into duodenum,the spasmus so that the bile can not be released into duodenum under pathological situation or the effect of drugs.the long lasting relaxant state after effective inhibition of post-ganglionic cholinergic receptors,respectively.The above results indicate that there are more than two states that is ON or OFF in SO and the concepts of contract and peristalsis of SO should be distinguished.
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Objective To evaluate the effect of laparoscopic adjustable gastric banding(LAGB) in patients with obesity and obesity-related comorbidities.Methods From Oct.2006 to Dec.2007,50 morbidly obese patients including 11 cases with type 2 diabetes,3 with hypertension,15 with hyperlipidemia,28 with fatty liver,1 with obstructive sleep-apnea syndrome and 2 cases with gallstones underwent LAGB.The mean follow-up period for these patients was 11.2 months.ranging from 6 to 18 months.The weight loss,obesity-related comorbidities,outcomes and complications were evaluated.Results Mean BMI decreased significantly from preoperative(39±6)kg/m2 to postoperative(31±4)kg/m2,(28±7)kg/m2 and(27±7)kg/m2 respectively at 9,12 and 18 months(P＜0.05).The mean excess weight loss at 9,12 and 18 months postoperatively was 30%±11%、42%±13%and 45%±13% respectively.At 12 and 18 months,respectively,20%and 44%of patients had＞50%excess weight loss.The obesity-related comorbidities resolved or improved in 66%～100%of the patients at 12 and 18 months postoperatively.Complications occurred in 4 cases,among them 3 cases were cured conservatively and in 1 case reoperation was performed. Conclusions Based on short-term follow-up results,LAGB is a safe,effective and feasible technique in the treatment of patients with morbid obesity and obesity-related comorbidities.
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Objective To investigate the effects of hypercholesteremia on the motor function of sphincter of Oddi (SO). Methods Thirty-two rabbits were divided into control group and experimental groups. In the control group, the rabbits were fed with normal diet. In the experimental groups, the rabbits were fed with normal diet + cholesterol for 4, 6 and 10 weeks. Myoelectric activity and pressures of SO were detected. All data were analyzed by t test. Results The serum total cholesterol and low density lipoprotein cholesterol were at a high level in rabbits which were fed with normal diet + cholesterol for 10 weeks (t=9.63, 11.38, P <0.05); basal pressure, pike pressure and amplitude of SO were significantly elevated (t=5.23, 6.34, 3.24, P < 0.05) ; the spike potential of SO changed to myoelectronic activity, with prolonged time period of myoelectronic activity, while the discharge rate was decreased (t=13.68, 10.18, P < 0.05). Conclusion Hypercholesteremia may change the motor function of SO and enhance its peristalsis to speed up the excretion of bile.
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Objective To investigate the short-term outcome of laparoscopic adjustable gastric banding (LAGB) for morbid obesity complicated with type 2 diabetes. Methods Eight morbidly obese patients with type 2 diabetes underwent LAGB from October 2006 to August 2007. The weight parameters, fasting (FBG) and 2-hour blood glucose (2hBG), medication for diabetes were assessed 1,3, 6 and 9 months after surgery. Results All of the patients lost weight, with a mean body mass index decreased from (38.7±7.5) kg/m2 before LAGB to (30.5±4.3) kg/m2 9 months after LAGB. The FBG and 2hBG were decreased significantly at month 6 and 9 after LAGB, with normal FBG and 2hBG in 4 patients. At month 9 after LAGB, 3 of 5 patients with insulin treatment before LAGB were changed to oral hypoglycemics, 1 was continuously administered with a reduced dose of insulin, and 4 patients stopped any medication. Conclusion LAGB is an effective procedure in the treatment of morbid obesity complicated with type 2 diabetes with a favorable short-term outcome.
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Objective To determine operation procedure according to Oddi's sphincter functions decteted by preoperative duodenoscopy combined with intraoperative choledochoscopy (IOC). Methods The duodenal papillae and Oddi's sphincter functions of 319 cases with hepatobiliary calculus were detected by preoperative duodenoscopy, ERCP and IOC. Results As for the functions of Oddi's sphincter, 79 cases were superior, 152 cases favorable and 88 cases poor. Conclusions For patients with hepatobiliary calculus whether Oddi's sphincter is reserved according to the Oddi's sphincter function.
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ObjectiveTo study the treatment efficacy and practicality of emergency bedside endoscopic nasobiliary drainage(ENBD) for senile severe acute cholangitis (SAC). MethodsTwenty two senile SAC patients undergone emergency bedside ENBD without X ray guidance. The ENBD tube,with the help of straightened curl tailed guide wire, was put into bile duct directly at preestablished depth.ResultThe procedure was finished in all patients within 2?hrs after admission. The symptom immediatly ameliorated in all patients, and temperature began to subside. After 24 hrs patients were all able to eat liquid food.There was no mortality in this group and all patients were discharged. Conclusion Emergency bedside ENBD has special advantages in the treatment of senile SAC .