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Wilson's disease (WD) is a rare autosomal recessive disorder with a complex pathogenesis involving multiple systems, multiple visceral organs, and the complex copper homeostasis regulation system within the body. The liver is the most common organ for copper deposition, and liver injury is the earliest and most common manifestation of WD; therefore, it is important to find an ideal animal model for WD research. By summarizing the animal models of WD commonly used in the world, this article systematically summarizes the background, liver and nervous manifestations, and application of different models and compares the characteristics of different animal models, so as to provide a reference for the application of various animal models of WD.
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Objective:To study the feasibility and safety of percutaneous jejunal drainage in treatment of hepatolithiasis after choledochojejunostomy.Methods:The clinical data of 24 patients with hepatolithiasis after choledochojejunostomy treated by percutaneous jejunal drainage at the Cholelithiasis Center, Shanghai East Hospital Affiliated to Tongji University from May 2021 to May 2022 were retrospectively analyzed. There were 16 males and 8 females, aged (50.46±10.89) years old. Ultrasound and X ray guided percutaneous jejunography was performed under local anesthesia for patients with hepatolithiasis after choledochojejunostomy. Then the fistula was directly dilated to 16.0Fr, and percutaneous jejunal choledochoscopy was performed 3 days later. The success rate, complication rate and stone removal rate were analysed.Results:Twenty-four patients were treated with percutaneous jejunography, with a success rate of 79.2%(19/24), including 19 patients after anterior colonic cholangiojejunostomy with a success rate of 94.7%(18/19), and 5 patients after retrocolonic cholangiojejunostomy with a success rate of 20.0%(1/5). There was no complication including bleeding, intestinal leakage and bile leakage. In 19 patients with successful percutaneous jejunography, the success rate of fistula dilation was 100%(19/19), and there was no complication. Five patients with failed percutaneous jejunography underwent open choledocholithotomy through the jejunal output-loop, and bile leakage occurred in one patient. Thirteen patients with anastomotic stenosis, 5 with intrahepatic biliary strictures, and 6 with anastomotic and intrahepatic biliary strictures were diagnosed by choledochoscopy and selective cholangiography in these 24 patients. After choledochoscopic electrotomy, cylindrical balloon dilation, stone removal, stenting and other treatments, the stenosis relief rate was 100%(24/24), and the clearance rate of intrahepatic bile duct stones was 91.7%(22/24).Conclusion:Percutaneous jejunal drainage was a feasible, safe and minimally invasive method for treatment of hepatolithiasis after choledochojejunostomy. The procedure was especially suitable for patients with anterior colonic cholangiojejunostomy.
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Objective:To investigate the effect of short single reverse-α fixation of nasobiliary tube after endoscopic nasobiliary drainage.Methods:From January 2019 to October 2019, the patients who performed with endoscopic nasolbiliary drainage in Tongji University Affiliated Shanghai East Hospital were randomly divided into experimental group (short single reverse-α fixation, 155 cases) and control group (routine reverse-α fixation, 137 cases). The incidences of the fixation time, prolapse rate, nursing time, scores of nasal comfort and bile flow rate of nasobiliary duct were evaluated between the two groups.Results:The average time of nasobiliary duct fixation was (18.31±1.67) s, the prolapse rate was 5.2% (8/155) and the time of nursing was (35.03±2.68) s, which were lower than those of the control group (46.50±5.50) s, 13.9% (19/137) and (72.07±7.63) s. The difference was statistically significant ( t or χ 2 values were 60.795, 6.570, 56.629, P<0.01 or 0.05). The comfort score of the experimental group was (4.61±1.06) points, the bile flow rate was (241.52±53.95) ml/days, which were higher than (5.76±0.76) points and (174.09±47.55) ml/days of the control group, the difference was statistically significant ( t values were 10.448, 11.265, P<0.01). Conclusions:Shortening the length of nasobiliary duct combined with single reaction "α" method has the advantages of simper operation and nursing, low prolapse rate, high comfort and good drainage effect. It is worthy of clinical application.
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Pancreatic tuberculosis is a chronic and specific disease of the pancreas, which is rare in clinic.Pancreatic tuberculosis accounts for less than 5% of general miliary tuberculosis.This disease is often secondary to tuberculosis in other parts of the body.Because of the lack of awareness of pancreatic tuberculosis, it is easy to be misdiagnosed as pancreatic cancer.In the past, there were reports of pancreatic tuberculosis misdiagnosed as pancreatic cancer and then underwent pancreaticoduodenectomy treatment.In clinical practice, most of the cases of pancreatic tuberculosis were confirmed by during operation or postoperative pathology.In recent years, with the increase of the incidence of tuberculosis, the reports of pancreatic tuberculosis have also increased.Therefore, the study reviewed the literature of pancreatic tuberculosis in recent years in order to improve the understanding of pancreatic tuberculosis by the medical workers.
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Pancreatic tuberculosis is a chronic and specific disease of the pancreas ,which is rare in clinic. Pancreatic tuberculosis accounts for less than 5% of general miliary tuberculosis.This disease is often secondary to tuberculosis in other parts of the body.Because of the lack of awareness of pancreatic tuberculosis ,it is easy to be misdiagnosed as pancreatic cancer.In the past,there were reports of pancreatic tuberculosis misdiagnosed as pancreatic cancer and then underwent pancreaticoduodenectomy treatment .In clinical practice,most of the cases of pancreatic tuberculosis were confirmed by during operation or postoperative pathology.In recent years,with the increase of the incidence of tuberculosis,the reports of pancreatic tuberculosis have also increased.Therefore,the study reviewed the literature of pancreatic tuberculosis in recent years in order to improve the understanding of pancreatic tuberculosis by the medical workers.
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Objective To evaluate endoscopic pancreaticobiliary separation (EPBS) in patients with gallstone and occult pancreaticobiliary reflux (OPBR).Methods The clinical data of 47 cases with gallstone and OPBR from Oct 2013 to Oct 2016 was analyzed retrospectively.Results The mean gallbladder bile amylase (GBA) was (864 ± 575) U/L.40 cases have undergone the treatment of endoscopic retrograde cholangiopancreatography.26 cases were diagnosed as duodenal papillitis,16 cases as periampullary diverticula,14 cases as long nipple,5 cases as atrophic papilla,3 cases as ampulla stone and 2 cases as papillary tumor.9 were diagnosed as pancreaticobiliary maljunction in the 14 patients with long nipple.33 cases were performed with EPBS.GBA was tested in 16 cases,and the GBA of 15 cases returned to normal level.The difference of GBA was statistically significant [(1 161 ±764) U/L vs.(47 ± 17) U/L,(t =5.641,P ＜ 0.05)].Patients were followed up for 1 to 4 years,among 36 cases without cholecystectomy,there was no recurrence of cholecystolithiasis after EPBS in 27 cases,but 2 cases had recurrent gallstones in 9 cases without EPBS,and the difference of gallstone recurrence rate was statistically significant (x2 =21.340,P ＜ 0.05).Conclusions Pancreaticobiliary junction diseases is an important cause for gallstone formation and OPBR.EPBS can avoid pancreaticobiliary reflux and reduce the recurrence rate of gallstone after choledochoscopic lithotomy.
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Objective@#To study the impact of aging on pancreatic atrophy, fibrosis and exocrine hypofunction in patients with post-ERCP pancreatitis (PEP) and its severity.@*Methods@#A retrospective study was conducted on 786 patients who underwent ERCP at the Affiliated Zhongshan Hospital of Dalian University from June 2011 to April 2018. Patients who were aged over 75 years were grouped into the elderly group while those aged less than 75 years were grouped into the younger group. The incidences and severity of post-ERCP pancreatitis in the two groups were analyzed.@*Results@#In the elderly group, there were 308 patients. The average age was (81.8±4.8) years. In the younger group, there were 478 patients. The average age was (57.7±12.0) years. The average operation time for the elderly group was (52.5±14.1) minutes, and that for the younger group was (50.7±14.9) minutes. There were no significant differences in operation time and in the related factors between the two groups (P>0.05). There was no significant difference in the rates of hyperamylasemia between the two groups (29.9% vs 30.1%, P>0.05). The overall rate of PEP was 11.3% (89/786). In the elderly group, the rate of PEP was 6.5% (20/308), which was significantly lower than that in the younger group (χ2=11.765, P<0.05). The rates of mild, moderate and severe PEP in the elderly group was significantly lower than those in the younger group (all P<0.05). Hyperamylasemia and pancreatitis in the 2 groups were alleviated after conservative treatment.@*Conclusions@#Aging (≥75 years) resulted in pancreatic atrophy, fibrosis, exocrine hypofunction which had a protective effect on PEP.
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0bjective To study the impact of aging on pancreatic atrophy,fibrosis and exocrine hy-pofunction in patients with post.ERCP pancreatitis(PEP)and its severity.Methods A retrospective study was conducted on 786 patients who underwent ERCP at the Affiliated Zhongshan Hospital of Dalian Universi-ty from June 201 1 to April 2018.Patients who were aged over 75 years were grouped into the elderly group while those aged less than 75 years were grouped into the younger group.The incidences and severity of post-ERCP pancreatitis in the two groups were analyzed.Results In the elderly group,there were 308 patients.The average age was(8 1.8±4.8)years.In the younger group,there were 478 patients.The average age was(57.7±12.0)years.The average operation time for the elderly group was(52.5±14.1)minutes,and that for the younger group was(50.7±14.9)minutes.There were no significant differences in opera-tion time and in the related factors between the two groups(P＞0.05).There was no significant difference in the rates of hyperamylasemia between the two groups(29.9％vs 30.1％,P＞0.05).The overall rate of PEP was 11.3％(89/786).In the elderly group,the rate of PEP was6.5％(20/308),which was signifi-cantly lower than that in the younger group(x2=11.765,P＜0.05).The rates of mild,moderate and severe PEP in the elderly group was significantly lower than those in the younger group(all P＜0.05).Hyperamylasemia and pancreatitis in the 2 groups were alleviated after conservative treatment.Conclusions Aging(≥75 years)resulted in pancreatic atrophy,fibrosis,exocrine hypofunction which had a protective effect on PEP.
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Objective To investigate the effect of X-ray assisted nasal catheter extractor on nose biliary oronasal conversion. Methods A total of 892 patients,receiving endoscopic nasal biliary drainage in Affiliated Zhongshan Hospital of Dalian University from January 2014 to December 2015, were randomly divided into experiment group and control group. X-ray assisted nasal catheter extractor was used in the experiment group,and guide wire was used in the control group. The mean extracting number and operation time, the total success rate, one-time success rate, response to stimulation and the incidence of complications were compared between the two groups. Results There were 457 cases in the experiment group. The mean extracting number was 1.08±0.32,the mean operation time was 1.07±0.29 min,the total success rate was 100.00%(457/457)and one-time success rate was 93.65%(428/457). The stimulation degree score was 1.27±0.50 with 348 cases of mild response,96 cases of moderate response and 13 cases of severe response. The rate of adverse reaction was 15.54%(71/457)with 50 cases of nausea, 18 cases of vomiting and 3 cases of mucosal bleeding. There were 435 cases in control group. The mean extracting number was 1.68±0.61,the mean operation time was 1.75±0.53 min, the total success rate was 75.63%(329/435)and one-time success rate was 38.16%(166/435). The stimulation degree score was 1.59 ±0.62 with 210 cases of mild response,194 cases of moderate response and 31 cases of severe response. The rate of adverse reaction was 35.86%(156/435)with 87 cases of nausea,36 cases of vomiting,27 cases of mucosal bleeding,and 6 cases of nasal duct prolapsed for vomiting. There were significant differences in the mean extracting number, mean operation time, stimulation degree score and the adverse reaction rate between the two groups(all P<0.001). The total success rate and one-time success rate in the experiment group were higher than those in the control group(all P<0.001).Conclusion X-ray assisted nasal catheter extractor can improve the success rate of operation,shorten the operation time,reduce the stimulation degree and the rate of adverse reactions in nose biliary oronasal conversion.
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Objective To investigate the clinical value,safety and efficacy of pancreatic stent in prevention of postoperative acute pancreatitis in patients with benign biliary stricture (BBS) treated by fullcovered self-expanding removable metal stents (FCSERMSs).Methods From Jan 2011 to Dec 2017,92 BBS patients who met the inclusion criteria were admitted and divided into pancreatic stent (PS) group and control group.The acute pancreatitis (AP) and hyperamylase (HP) after FCSERMS implantation and removal was observed.Results 55 cases in PS group and 37 cases in control group underwent successful FCSERMS implantation.The incidences of postoperative elevated amylase and HP had no significant differences between the two groups (23.6％ vs.32.4％,3.6％ vs.10.8％,all P ＞0.05).The incidences of postoperative AP and moderately elevated amylase had significant differences (0 vs.13.5％,20.0％ vs.8.1％,all P ＜ 0.05).The average placement time of FCSERMSs was 7.84 ± 1.22 months.The incidence of elevated amylase,AP,HP and moderately elevated amylase after the FCSERMS and PS removed had no statistical differences (3.6％ vs.14.3％,0vs.2.9％,0 vs.2.9％,3.6％vs.8.6％,all P＞0.05).Conclusion The placement of pancreatic stents in the treatment of BBS with FCSERMS is a simple,safe and effective method for the prevention of post-ERCP pancreatitis.
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The clinical data of 7 patients who underwent the treatment of gradual and persistent balloon dilatation (GPBD) by percutaneous transhepatic cholangiography (PTC)for traumatic biliary stricture in Zhongshan Hospital Affiliated to Dalian University were analyzed retrospectively.Balloon catheters were successfully implanted in 5 cases by PTC,and with the help of ERCP in 2 PTC failed cases.There was no bleeding,acute pancreatitis and other complications.Two balloon catheters were damaged and displaced,respectively.All the biliary strictures were relieved.No biliary sludge was attached on the surface of the balloon and in the bile duct.Bile duct mucosa had congestion edema and cellulose attachment.There was no biliary stricture recurrence in the follow-up of 5 to 27 months.This study showed GPBD by PTC was a simple,safe and effective method for treating traumatic biliary strictures.
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Objective To investigate the nursing points of endoscopic full-covered self-expanding removable metal stents (FCSERMS) implantation for bile duct anastomotic strictures after liver transplantation. Methods The clinical data of patients who were treated by endoscopic full-covered self-expanding removable metal stents implantation for bile duct anastomotic strictures after liver transplantation from January 2013 to July 2015 were retrospectively analyzed, and the nursing process were summarized. Results The group of 9 patients were successfully placed and removed with FCSERMS. There was no postoperative complication, such as stent migration, acute pancreatitis, biliary bleeding and intestinal leakage. All the bile duct strictures were relieved after FCSERMS removement. Followed up for 10-32 months, there was no symptom and sign of bile duct anastomotic stricture recurrent. Conclusions The key in nursing points of FCSERMS implantation for bile duct anastomotic strictures after liver transplantation are introducing the function of FCSERMS and therapeutic process to improve patient compliance, mastering the endoscopic operations, the placement and removal method of FCSERMS to short operation time, strengthening postoperative nasal bile duct care, paying attention to the observation, detection and treatment of postoperative complications after the metal stent placement and removement, as well as the continuing care during the period between placement and removment of FCSERMS.
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Endoscopic retrograde cholangiopancreatonraphy (ERCP) is the main treatment modality for common bile duct stone.Biliary hemorrhage easily occurred in patients suffering from cirrhosis during and after ERCP.From May 2012 to May 2016,8 cases diagnosed with cirrhosis and common bile duct stones who developed post-ERCP refractory biliary hemorrhage were treated with full-covered self-expanding removable metal stents (FCSERMS),including 5 cases with perioperative hemorrhage of ERCP and 3 cases with delayed onset of biliary hemorrhage post ERCP.All the patients were successfully implanted with FCSERMS.Seven patients had successful hemostasis,and the other one case with ineffective hemostasis was treated with interventional arterial embolization later.Four stents were removed within 4 weeks and one in 8 months after ERCP.No evidence of biliary hemorrhage,intestinal fistula and other complications was observed during removal procedures.Spontaneous stent dislodgment occurred in one patient in postoperative 4 weeks,one patient died of liver failure in postoperative 6 months and one patient carried FCSERMS for 23 months.
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Objective To compare the value of ERCP plus EST and laparotomy in the treatment of common bile duct stones.Methods 56 cases of common bile duct stones were treated with ERCP and EST in our hospital from June 2012 to June 2013 (endoscopy group),78 cases were treated with laparotomy and common bile duct exploration (laparotomy group).The two groups were compared on success rate of stone removal,operation time,intraoperative bleeding volume,incidence of infection and pancreatitis and hyperamylasemia,common bile duct stone recurrence rate,hospital stays,hospital costs.Results Operation time,intraoperative bleeding volume and infection rate in endoscopic group was lower than the laparotomy group,the incidence of hyperamylasemia,hospital costs in the endoscopic group was higher than laparotomy group.The success rate of stone removal and the recurrence rate of common bile duct stone in the endoscopic group was lower than the laparotomy group,incidence of pancreatitis in the endoscopic group was higher than the laparotomy group,though the differences were not statistically significant.Conclusions ERCP and EST is a time saving procedure fast relieving the bile duct obstruction,less traumative,spelling lower infection rate,less hospital stays,though causing higher incidence of hyperamylasemia and hospital costs.
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Objective To investigate the value of percutaneous transhepatic cholangioscopy (PTCS) for diagnosis and treatment of biliary cast after liver transplantation. Methods Data of 11 patients with biliary cast after liver transplantation, who underwent PTCS from April 2008 to November 2010, were retrospectively analyzed. Results In 11 patients , one had biliary cast in common bile duct, 3 in right intra-hepatic bile duct, 4 in left intra-hepatic bile duct, and 3 distributed in intra- and extra-hepatic bile ducts. A total of 68 times of PTCS were performed in 11 patients, achieving significant decrease in levels of serum transaminase and bilirubin in 10. Occasional fever occurred in 1 patient after closure of drainage tube,which was managed by replacement with a thinner one. There were no severe complications such as biliary fistula or uncontrollable bleeding. Partial rupture of fistula occurred in 1 case. All patients were followed up for 10-30 months and were all in good condition except one patient died from other disease during the followup. Conclusion PTCS is a safe, effective and applicable method to treat the biliary cast after liver transplantation.
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Objective To explore the effect of covered endoesophageal stent in treatment of terminal esophageal carcinoma complicated with malignant esophageal fistula in the elderly. Methods The covered endoesophageal stent was placed at the focus of lesion for each elderly patient in guidance by the iron wire and the stent-transporter under the endoscopy or X-ray. Results All of the stents were successfully implanted in 225 elderly patients without technical failure. The fistula was fully closed in all 19 patients. The symptoms of dysphagia and bucking were relieved obviously in 184cases (81.8%). The 176 cases (78.2%) of patients could have semi-fluid food in first week after stent implant, then have full meal. The inspiration pneumonia caused by fistula was brought under control. Conclusions For elderly patients with esophageal carcinoma, when they lose the operative opportunity or can not tolerate an operation, the treatment with covered endoesophageal stent is effective and safe.
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Objective To investigate the endoscopic and pathological characteristics of Barrett's esophagus (BE).Methods Data of 152 patients who were diagnosed as having BE with endoscopy and pathology were retrospectively analyzed.Results BE was most commonly seen in patients of 40-60 years old.The clinical manifestations overlapped in different patients,including regurgitation and heartburn in 78 (51.32%),dysphagia in 9 (5.92%),retrosternal pain in 12 (7.89%),upper abdominal pain or discomfort in 67 (44.08%),and asymptomatic in 8 (5.26%).Long segment BE (LSBE) was determined in 7 patients (4.61%),and short segment BE (SSBE) in 145 (95.39%).The metaplasia pattern under endoscopy included island like in 98 (64.47%),tongue like in 39 (25.66%) and circumferential in 15 (9.87%).Stratified squamous epithelia in the lower part of the esophagus were replaced by columnar epithelia in all cases,and intestinal metaplasia occurred in 68 cases (44.74 %).Conclusion BE is most frequently seen in the middle-aged and can be diagnosed by endoscopy and pathology without special clinical manifestations.Island pattern occurs in most cases and is with lowest rate of intestinal metaplasia,which is associated with age.Patients with specialized intestinal metaplasia and dysplasia should be followed up for surveillance of cancer.
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@#Objective To analyze the constituent ratio and clinical characteristics of spine trauma and spinal cord injury of the survivors in the Sichuan earthquake.Methods198 cases wounded in the Sichuan earthquake were divided into four groups according to age for collecting the type of fracture, nerve damage, spinal fractures combined injuries of data from multiple sites, analyzing their clinical characteristics.ResultsFracture types are most common compression fractures (49.3%), followed by the burst fractures (45.9%). 105 of them had spinal cord injury, ASIA grade: A grade: 20 cases, B Grade: 18 cases, C grade: 25 cases, D Grade: 42 cases. 41 cases had combined injury. T12, L1, and L2 vertebral fractures were common types.ConclusionCompression fractures and burst fractures as spinal injuries occurred commonly in Sichuan earthquake mainly in the 18～65 years old, and spinal cord injury accounted for 53.03% spinal injury.
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BACKGROUND: Biliary complications are a common cause of death in patients after liver transplantation, biliary endoscopic minimally invasive technique is gradually becoming an important tool to solve biliary complications following orthotopic liver transplantation.OBJECTIVE: To analyze the literatures on the biliary tract complications after liver transplantation, and to demonstrate a clear role of bile duct endoscopy in biliary complications.METHODS: Using "orthotopic liver transplantation, biliary complications, biliary tract, endoscope technique" in English for the search term, Pubmed database were searched between January 1980 and October 2008; Using "liver transplantation, biliary complications, bile duct cast, cholangioscopy" in Chinese for the search term, Vip Chinese Periodical Database and CNKI database were searched between 1994 and January 2009. Literature language was limited to English and Chinese. The studies related to bile duct injury-caused biliary complications after liver transplantation were included, while other research unrelated to biliary complications after liver transplantation were excluded.RESULTS AND CONCLUSION: A total of 52 literatures were screened out by the primary computer inspection, according to inclusion and exclusion criteria, 30 ones were involved for analysis. Biliary complications and vascular complications are considered as a common cause of death in patients after liver transplantation, particularly in biliary complications has become the major reason limiting the development of liver transplantation. Because of the difficulties on early recognition and treatment, the importance of the treatment for the complications in liver transplant patients is increasingly attracting more and more attention. Endoscopic operation technology and their subsidiary parts are improving, particularly therapeutic endoscopic retrograde cholangiopancreatography and biliary mirror technology are developing and continuously improving, biliary endoscopic minimally invasive technique is gradually becoming a major approach to solve biliary complications after orthotopic liver transplantation, The minimally invasive endoscopic diagnosis and treatment is an intuitive, reliable and credible means for the biliary complications after liver transplantation, serving as the most preferred method for diagnosing and treating biliary complications after liver transplantation.
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Objective To provide information and assistance for research of bile duct injury in OLT through endoscopic observation and treatment of biliary complications after liver transplantation.Methods After OLT, all the cases in normal group, bile duct injury group and hepatic artery injury group were observed, diagnosed and recorded respectively. Meanwhile, the biopsy was performed through the endoscopy for pathological examination. For those cases without T tube, the biopsy was conducted by choledochoscopy in combination with duodenoscopy. Results The exterior and interior bile duct anatomy of the 9 cases in the normal group was normal. They had no bile duct stenosis and scar, their bile duct mucous membrane looked good and the anastomosis of the donor-receptor bile duct healed well. Restored mucous tissue coating with intact epithelium was found by pathological examination. Fibrous tissue and small vascular proliferation happened under epithelium scattered with plasmocyte and lymphocyte. Various kinds of bile duct stones-simple, multiple and casting mould type, were found in 12 cases with bile duct injury. Bile duet mucous membrane injured in different degrees was repaired after stone removed and obstruction relieved by endoscope. Bile duct tree becoming normal was seen by pacification examination. Three cases in the hepatic injury group had bile duct ischemic necrosis, losing of normal structure without bile duct wall and mucous membrane. Conclusion Bile ducts are injured in different degrees in OLT. The choledochofibroscopy is of the first choice for diagnosis and treatment of complications after OLT.