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Article in Chinese | WPRIM | ID: wpr-469244


Objective To evaluate the efficacy and safety of peroral direct cholangioscopy (PDCS) in the treatment of refractory common bile duct stones after retrograde cholangiopancreatography (ERCP).Methods Data of 13 patients who underwent peroral direct cholangioscopy for refractory common bile duct stones after retrograde cholangiopancreatography at our institution from April 2012 to August 2014 were retrospectively analyzed.Completion rate,side-effects and complications were summarized.Results Peroral direct cholangioscopy was successfully performed with electrohydraulic lithotripsy and stones were removed in 12 of the 13 patients.Lithotripsy and stone removal failed in one patient,though the ultraslim endoscope accessed distal common bile duct near the stone.Stones were removed directly with extraction basket under PDCS in 7 patients,and duodenoscopy was performed in 5 patients due to too many stone fragments.Stone removal was successfully completed at one time in 9 cases.Stones removal failed in 3 cases at one time because of too many stone fragments,but was successful with duodenoscopy a week later after a temporary biliary tract stenting.Andoxygen saturation decreased in one patient due to vomit during the operation.Sputum in oropharyngeal area was immediately sucked out and the gastric juice at the bottom of the stomach was also sucked by endoscopy.Oxygen saturation returned to normal levels and the subsequent operation was not affected.No aspiration pneumonia occurred after the operation.Hyperamylasemia occurred in two patients,and postoperative biliary tract infection occurred in one,but the situation was controlled after appropriate treatment.Conclusion PDOS using an ultraslim endoscopy is an effective and feasible endoscopic procedure for the refractory common bile duct stones.This study provides a new method for the treatment of refractory common bile duct stones.

Article in Chinese | WPRIM | ID: wpr-456486


Objective To investigate the diagnostic and therapeutic value of peroral cholangioscopy for residual stones after retrograde chalangiopancreatography (ERCP).Methods The soft-tipped guidewire (0.021in) was linked to 3-0 silk thread on the front of extraction balloon catheter outside as a guide device.After retrograde chalangiopancreato-graphy (ERCP) for common bile duct stones,extraction balloon with the guide device was sent to intrahepatic bile duct by duodenoscopy,and residual stones were observed and removed with a stone basket directly under ultrathin upper endoscope if the residual stones were small ; if the stones were large,they were crushed with electrohydraulic lithotripsy before being removed.Results The ultrathin upper endoscope were successfully inserted into hilar bile duct in 42 cases of 46 patients,and failed in 4 cases,and the success rate of insertion was 91.3%.The mean time was 11.3 min from the mouth into hilar bile duct.Stones were found larger than 4 mm in diameter in 6 of 42 patients,and stone residual rate was 14.3%.The biggest stone was 10 mm× 12 mm in diameter.Stones were found in in 2 of 27 patients after ERCP,and the stone residual rate was 7.4%.Stones were found in 4 of 15 patients after ERCP basket lithotripsy,and the stone residual rate was 26.7%.Stones were removed directly in 5 in 6 cases with extraction basket,they were crushed in 1 case by electrohydraulic lithotripsy and then removed with basket.No serious complications were observed.Conclusion The application of peroral cholangioscopy using an ultrathin upper endoscope is feasible.The method is a useful endoscopic procedure for extraction of residual stones,which helps to avoid repeated treatment.

Article in Chinese | WPRIM | ID: wpr-431947


Objective To study the effect of auricular-plaster and meridian-pressing instrument on the prevention of gallstones recurrence after stone removeol.Methods 120 cases which were after endoscopic minimally cholecystolithotomy were selected and randomly divided into the control group and treatment group.All cases were observed for 3 years.Results This research altogether fell off 6 cases,including 2 cases in the control group and 4 cases in the treatment group.The treatment group's gallbladder wall (2.13 ± 0.36)mm was more thinner than the control group's(3.21 ± 0.40)mm,the treatment contract function was more strenghen than the control group,and the gallstone recurrence after stone removeol of the treatment was more smaller.Conclusion Aricular-plaster and meridian-pressing instrument can reduce inflammation of the gallbladder wall,enhance the gallbladder contraction function,and prevent the recurrence of gallstone.

Article in Chinese | WPRIM | ID: wpr-383736


Objective To evaluate the therapeutic effect of extra-fine choledochoscope in treating polypoid lesions of gallbladder by percutaneous trans-hepatic and trans-gallbladder puncture(PTGB). Methods Extra-fine choledochoscope(2. 7 mm diameter)was inserted into tract soon after it was made per-cutaneously trans-hepatic and dilated in one session,gallbladder polyps was removed with biopsy forceps or snare or basket,and PTCD drainage tube(10. 2 F diameter)was imbedded for external drainage until 10 days after. If the gallbladder puncture point fell on the bed and gallbladder polyps were not clearly visual-ized,or puncture points were on non-gallbladder bed of the body,drainage tube(10. 2 F diameter)was placed for external drainage. Results Forty-two patients were successfully punctured,and 40 patients were punctured accurately on the bed in,and the fresh endoscope tract of these patients was established in 45 mi-nutes on average. Of the 29 cases of simple bottom and body ventral polyps,complete clearance of gallbladder polyps was achieved in 27. Gallbladder polyps clearance rate was 93. 10%. Complications of minor hemobi-lia occurred in 9 cases,and infection of biliary tract occurred in 3 cases after operation. There was no recur-rence after a follow-up of 15 months on average. Conclusion Extra-fine choledochoscope by PTGB is a less invasive,more reliable and effective method to cure benign polypoid lesions of the gallbladder. The gallblad-der is preserved and for malignant polyps,it can help to achieve early diagnosis and provide reliable evidence for further treatment.