Effect of percutaneous transhepatic one-step biliary fistulation combined with rigid choledochoscopy in the treatment of benign hepatic bile duct strictures / 中华肝胆外科杂志

Objective:To investigate the therapeutic effect of percutaneous transhepatic one-step biliary fistulation (PTOBF) combined with rigid choledochoscopy in the treatment of benign hepatic bile duct strictures.Methods:The clinical data of 46 patients with hepatic ductal stenosis and stones undergoing PTOBF combined with rigid choledochoscopy at the First Hospital of Guangzhou Medical University between September 2016 and September 2022 were retrospectively analyzed, including 20 males and 26 females, aged (48.5±17.6) years. The location of stones and strictures, stone retrieval rate, postoperative complications, stricture release rate, stone recurrence rate, and reoperation rate were analyzed to access the safety and effectiveness of this procedure.Results:A total of 58 sites of stenoses were found in 46 patients, and PTOBF lithotripsy combined with rigid choledochoscopy were performed for 77 times. The early postoperative complication rate was 19.6% (9/46), and the stenosis release rate was 93.5% (43/46). The mean follow-up time was (28.1±19.6) months, the complete stone retrieval rate was 91.3% (42/46), the stone recurrence rate was 19.6% (9/46), the reoperation rate was 8.7% (4/46), and the long-term postoperative complication rate was 6.5% (3/46).Conclusion:PTOBF combined with rigid choledochoscopic stenoplasty for benign hepatic duct strictures is a safe and feasible procedure to reduce the stone recurrence and long-term postoperative complications.

A retrospective study on combined percutaneous transhepatic one-step biliary fistulation followed by two stages cholangioscopic treatment for type Ⅰ and Ⅱa hepatolithiasis after cholangiojejunostomy / 中华肝胆外科杂志

Objective:To study the treatment outcomes of combining percutaneous transhepatic one-step biliary fistulation (PTOBF) followed by two stages cholangioscopic treatment for type Ⅰ and Ⅱa hepatolithiasis which developed after Roux-en-Y cholangiojejunostomy, and in treatment of cholangiojejunostomy stenosis.Methods:The clinical data of 95 patients with type Ⅰ and Ⅱa hepatolithiasis which developed after Roux-en-Y cholangiojejunostomy and were treated at Shandong Second Provincial General Hospital from September 2016 to December 2020 were analyzed retrospectively. There were 36 males and 59 females, with the age of (51.2±15.3) years (range 14 to 75 years). These patients initially underwent PTOBF rigid choledochoscopy, followed by electronic choledochoscopy via the fistula tract after 6-8 weeks. The hepatolithiasis removal, complications and hepatolithiasis recurrence rates, and the cholangio-intestinal anastomotic stenosis rate and treatments were recorded. The follow-up was performed to analyse prognosis.Results:All 95 patients successfully underwent PTOBF rigid choledochoscopy and electronic choledochoscopy via the fistula tract. In 92 patients (96.8%), stones were completely removed. In 3 patients, small amounts of peripheral bile duct stones were left behind. Of 49 patients had cholangio-intestinal anastomotic strictures. On cholangioscopic examination, the strictures were caused by anastomotic knots in the suture line in 25 patients and cicatricial stenosis in 24 patients. After biliary balloon dilation and removal of anastomotic suture line knots, the strictures were relieved in 49 patients. There were 2 patients who developed biliary bleeding and 2 patients pleural effusion after PTOBF rigid choledochoscopy. Hepatolithiasis recurred in 4 patients in 6 to 36 months later.Conclusion:PTOBF followed by two stages cholangioscopic treatment were safe and effective in treatment of type Ⅰ and Ⅱa hepatolithiasis after Roux-en-Y cholangiojejunostomy. A high hepatolithiasis removal rate was obtained. Balloon dilation and removal of biliary intestinal anastomotic suture knots effectively relieved biliary intestinal anastomotic stenosis. The long-term results needs to be further determined.

A retrospective comparative study on the therapeutic effect of one-stage means two-stage percutaneous transhepatic biliary fistulation lithotripsy in treatment of complex hepatolithiasis / 中华肝胆外科杂志

Objective:To compare the therapeutic effect of one-stage versus two-stage percutaneous transhepatic biliary fistulation lithotripsy in treatment of complex hepatolithiasis.Methods:A retrospective study was conducted on 145 patients with complex hepatolithiasis who were treated at the First Affiliated Hospital of Guangzhou Medical University between September 2013 and June 2018. There were 60 males and 85 females, aged 21 to 91 (56.5±14.1) years. According to the method of fistula establishment, patients were divided into the percutaneous transhepatic one-step biliary fistulation (PTOBF) group ( n=94) or the two-stage percutaneous transhepatic choledochoscopic lithotripsy (PTCSL) group ( n=51). The success rates of one-time puncture and fistula dilation, operation time of lithotripsy, operative conversion rate (PTCSL was converted to laparotomy and laparoscopic surgery), postoperative complications (including catheter dislodgement), residual stone rates and stone recurrence rates were compared between groups. Results:In the PTOBF group, operation time (105.8±43.6) min, success rate of one puncture 73.4% (69/94), and success rate of one fistula dilation 93.6% (88/94), the rate of operative conversion 0. All these results were significantly better than the corresponding results of the two-stage PTCSL group of (130.0±70.0) min, 54.9% (28/51), 68.6% (35/51), and 13.7%(7/51) respectively (all P<0.05). There were no significant differences in stone residual rate [17.0%(16/94) vs. 15.7% (8/51)] and stone recurrence rate [14.9%(14/94) vs. 17.6% (9/51)] between groups (both P>0.05). The postoperative complications rate was 7.4%(7/94) in PTOBF group, which was 39.2% (20/51) in two-stage PTCSL group (χ 2=22.02, P<0.001). The catheter dislodgement rate of PTOBF group was 2.1% (2/94), lower than that of two-stage PTCSL group 27.4% (14/51), the difference was statistically significant (χ 2=21.59, P<0.001). Conclusion:One-stage PTOBF and two-stage PTCSL were both safe and effective in treatment of complex hepatolithiasis. However, PTOBF had shorter operative times, lower catheter dislodgement and operative conversion rates than PTCSL.

Three-dimensional visualization technology in one-stage establishment of a percutaneous transhepatic biliary tract in treatment of complex hepatolithiasis / 中华肝胆外科杂志

Objective:To study the use of percutaneous transhepatic one-step biliary fistulation based on three-dimensional visualization technology (3D-PTOBF) in the treatment of complex hepatolithiasis.Methods:A retrospective analysis was conducted on 116 patients with complex hepatolithiasis treated in the First Affiliated Hospital of Guangzhou Medical University from January 2016 to December 2019. There were 56 patients in the 3D-PTOBF group (treated by 3D-PTOBF), and 60 patients in the traditional PTOBF group (received traditional PTOBF approach). The stone clearance rate, postoperative complication rate, intraoperative blood loss, hospitalization time, number of cholangioscopic treatment procedures and stone recurrence rate were compared between the two groups.Results:When compared with the traditional PTOBF group, the 3D-PTOBF group had significantly less procedures (1.43±0.71 vs. 2.07±1.22, P<0.05), and shorter hospital stay (4.6±2.3 d vs. 6.1±2.9 d, P<0.05). There were no significant differences in the immediate stone clearance, final stone clearance, postoperative complications and stone recurrence rates between the two groups (all P>0.05). Conclusion:3D-PTOBF was safe and feasible to treat complex hepatolithiasis. When compared with PTOBF, it had the advantages of shorter operation time and decreased hospital stay.

Percutaneous transhepatic one-step biliary fistulation for patients with hepatolithiasis and hepatobiliary surgery history / 中华肝胆外科杂志

Objective To observe the clinical effect of percutaneous transhepatic one-step biliary fistulation (PTOBF) and percutaneous transhepatic cholangioscopy (PTCS) in the treatment of hepatolithiasis with hepatobiliary surgery history,and to explore the clinical application value of PTOBF.Methods This is retrospective analysis of 68 patients with hepatolithiasis who were admitted to hepatobiliary surgery in the First Affiliated Hospital of Guangzhou Medical University from November 2009 to October 2017.Among these cases,35 patients in the observation group (group PTOBF) were treated with PTOBF,and 33 patients in the control group (group PTCS) received PTCS treatment.The final clearance rate,the postoperative complications rate,the hospitalization time,the operation times within the course of treatment,the recurrence rate and the residual stenosis rate of the two groups were compared.Results Compared with group PTCS,the clearance rate was significantly higher in group PTOBF(82.9％ vs 54.6％,P＜0.05),while the postoperative complications rate between the two groups are similar (14.3 ％ vs 30.3 ％,P＞ 0.05);Besides,the hospitalization time(12.3±5.3 d vs 17.4±7.0 d,P＜0.05),the operation times within the course of treatment (2.2±1.3 vs 2.8±1.0,P＜0.05) and the recurrence rate(17.4％ vs 39.4％,P＜0.05) of group PTOBF were obviously lower.Conclusions PTOBF is a safe and feasible treatment for hepatolithiasis with hepatobiliary surgery history.Compared with PTCS,it has the advantages of short hospitalization time,fewer operations and better recovery.

Ruminant feces used as inoculum for the in vitro gas production technique / Heces de rumiantes como fuente de inóculo para la técnica in vitro de producción de gases / Fezes de ruminantes como fonte de inoculo para a técnica in vitro de produção de gases

Background: ruminal feed fermentation can be studied through in vitro gas production. However, this technique requires fistulated animals from which to obtain the inoculum, which limits its use. Objective: the objective of this experiment was to evaluate the usefulness of feces instead of rumen fluid as the inoculum of reference, by determining the precision and accuracy resulting from both methods. Methods: six forage species (Gliricidia sepium, Panicum maximum, Pennisetum clandestinum, Lolium sp., Morus alba and Cynodon nlemfuensis) were incubated with bovine rumen fluid or feces to quantify gas production and dry matter degradation over time. Bacteria, fungi, and protozoa counts were assessed in both inocula. Results: cumulative gas production and gas production rate were higher for the ruminal inoculum during the initial incubation period. Ruminal liquid showed lower variability compared to its own mean. Conclusions: according to the Bland-Altman analysis, inocula are not interchangeable. The difference in gas production kinetics between both inoculum sources reflected a longer time to colonize the substrate and lower microbial concentration in the fecal fluid, which resulted useful solely in determining the extent of dry matter degradation.

Antecedentes: la fermentación ruminal de los alimentos puede ser estudiada a través de la técnica in vitro de producción de gases. No obstante, una de las limitaciones de la técnica es el requerimiento de animales fistulados para la obtención del inóculo. Objetivo: el objetivo de este experimento fue evaluar la utilización de las heces respecto al inóculo de referencia, líquido ruminal, a través de la determinación de la precisión y la exactitud. Métodos: para ello seis especies forrajeras (Gliricidia sepium, Panicum maximum, Pennisetum clandestinum, Lolium sp., Morus alba y Cynodon nlemfuensis) fueron incubadas con líquido ruminal y heces bovinas, cuantificando la producción de gas y la degradación de la materia seca en el tiempo. En los dos inóculos se realizó conteo de bacterias, hongos y protozoos. Resultados: la producción acumulativa de gas y la tasa de producción de gas durante el período inicial de incubación fueron superiores con el inóculo ruminal. En el análisis de repetibilidad, el líquido ruminal exhibió menor variabilidad respecto el valor medio obtenido. Conclusiones: el análisis de Bland-Altman permitió concluir que los dos inóculos no son intercambiables. La diferencia en la cinética de producción de gas entre ambas fuentes de inóculo reflejó el mayor tiempo de colonización del sustrato y la menor concentración de microorganismos en el fluido fecal, resultando sólo de utilidad para determinar la extensión de la degradación de la materia seca.

Antecedentes: a fermentação ruminal dos alimentos no rúmen pode ser estudada através da técnica in vitro de produção de gases. No entanto, uma das limitações da técnica é a exigência de animais fistulados para obter o inóculo. Objetivo: o objetivo deste experimento foi avaliar o uso das fezes em comparação ao inóculo de referência, líquido ruminal, através da determinação da precisão e exatidão. Metodos: seis forragens (Gliricidia sepium, Panicum maximum, Pennisetum clandestinum, Lolium sp., Morus alba e Cynodon nlemfuensis) foram incubadas com líquido ruminal e fezes bovinas, quantificando a produção de gás e a degradação da matéria seca no tempo. Contagem de bactérias, fungos e protozoários foi feita nos dois inóculos. Resultados: a produção acumulativa de gás e a taxa de produção de gás durante o período inicial de incubação foram maiores com o inoculo ruminal. Na análise de repetibilidade, o inoculo ruminal mostrou menor variabilidade ao redor do valor médio obtido. Conclusiones: a análise de Bland-Altman permitiu concluir que os dois inóculos não são intercambiáveis. A diferença na cinética de produção de gás entre as duas fontes de inóculo refletiu o maior tempo de colonização do substrato e a menor concentração de microorganismos no fluido fecal, resultando apenas útil para determinar a extensão da degradação da matéria seca.

Needle-knife fistulotomy for difficult cannulation during ERCP / 中华消化内镜杂志

Objective To evaluate the effectiveness and safety of needle-knife fistulotomy (NKF)for difficult cannulation during endoscopic retrograde cholangiopancreatography (ERCP). Methods Data of patients, who received NKF on the back of major papilla when bile duct could not be accessed by conventional cannulation and/or other pre-cut methods during ERCP, were retrospectively reviewed. The success rate of deep cannulation and its complications were observed and analyzed. Results NKF was performed in 108patients due to difficult cannulation, which succeeded in 97 (91.2%) in access to the bile duct and failed in 11 patients with malignant biliary strictures. The failure rate in patients with distal malignant obstruction was higher (25. 8%, 8/31) than those with proximal lesions (5.3%, 3/57) (P = 0. 014, χ2 = 5. 983).Post-ERCP pancreatitis occurred in 5 cases (4. 6%), with the incidence significantly higher in NKF-failure group (18. 2%, 2/11) than that in NKF-suocess group (3.1% ,3/97) (P = 0. 006, χ2 = 7.418). Intestinal perforation occurred in 1 patient and cholangitis developed in 4 others, which all recovered after conservative managements. Conclusion NKF for difficult cannulations in ERCP is safe and effective, especially in hands of experienced operators, but cannulation success rate is relatively low in distal malignant biliary obstruction.