A study comparing PTCD with ENBD on jaundiced patients before laparoscopic pancreaticoduodenectomy / 中华肝胆外科杂志

Objective:To compare and analyze the perioperative outcomes of jaundiced patients undergoing laparoscopic pancreaticoduodenectomy (LPD) using preoperative percutaneous transhepatic cholangial drainage (PTCD) versus endoscopic nasobiliary drainage (ENBD).Methods:The perioperative data of 173 patients who underwent LPD at the Second Hospital of Hebei Medical University from January 2016 to December 2020 and were treated preoperatively with either PTCD versus ENBD to alleviate jaundiced were retrospectively analyzed. There were 100 males and 73 females, with age of (60.4±10.8) years old. These patients were divided into the PTCD group ( n=126) and the ENBD group ( n=47). Clinical data including operation time, blood loss, transfusion volume, R 0 resection, and postoperative complications were compared. Results:There was no convension to open surgery. There were no significant differences in operation time, blood loss, transfusion volume, R 0 resection rate, pathological results and hospital stay between the two groups ( P>0.05). For the PTCD group, the pancreatic fistula rate was 10.3% (13/126) and the post-operative hemorrhage rate was 8.7% (11/126). They were both significantly lower than those of the ENBD group [25.5% (12/47) and 25.5% (12/47) respectively, P<0.05]. There were also significant differences in the postoperative complications according to the Clavien-Dindo classification system between the two groups ( P=0.008). Conclusion:Compared with ENBD, PTCD had the advantages of lower post-operative pancreatic fistula and post-operative hemorrhage rates, resulting in a better postoperative recovery.

Clinical application of endoscopic nasobiliary drainage combined with nasojejunal tube feeding in elderly patients with severe acute cholangitis / 中华消化内镜杂志

Objective:To evaluate endoscopic nasobiliary drainage (ENBD) combined with nasojejunal tube feeding for elderly patients with severe acute cholangitis.Methods:Data of 43 elderly patients with severe acute cholangitis, who received ENBD combined with nasojejunal tube feeding from January 1, 2016 to May 31, 2018 at Affiliated Hangzhou First People′s Hospital, Zhejiang University School of Medicine were retrospectively analyzed and were included in the observation group, and 43 other patients who received ENBD combined with conventional therapy in the same period were included in the control group with the matching principle of 1∶1. Liver function indices (ALT and AST), nutritional status (Hb, TP and ALB) and inflammation indices (WBC, NEU% and CRP) of the two groups before the operation, 3 days and 7 days of nutritional support after the operation were compared. Adverse reactions (abdominal distention and diarrhea), mortality, hospitalization time and expenses of the two groups were also compared.Results:There were no significant differences in gender composition, mean age, preoperative APACHE-Ⅱ score, NRS2002 score, liver function index, nutritional index, or inflammatory index between the observation group and the control group ( P>0.05). The baseline data of the two groups were comparable. After 3 days of nutritional support, ALT, AST, TP were 21.0 (15.0, 35.5) U/L, 26.0 (21.0, 36.5) U/L, and 64.2±5.2 g/L, respectively in the observation group, and 47.0 (29.5, 82.5) U/L ( P<0.05), 47.0 (29.0, 75.0) U/L ( P<0.05), and 60.5±6.4 g/L ( P<0.05), respectively in the control group. The levels of other indicators were not statistically different at this time point ( P>0.05). At 7 days postoperative nutritional support, ALT, AST, TP, ALB and CRP of the observation group were 22.0 (14.0, 31.5) U/L, 26.0 (20.5, 38.5) U/L, 67.6±5.4 g/L, 34.6±3.7 g/L, and 28.0 (18.5, 35.5) mg/L, respectively, and 43.0 (18.0, 59.5) U/L ( P<0.01), 34.0 (24.0, 60.5) U/L ( P=0.02), 64.5±5.7 g/L ( P=0.01), 31.5±7.0 g/L ( P=0.02), and 34.0 (24.0, 66.5) mg/L ( P<0.05) in the control group. There were no significant differences in the levels of other indicators between the two groups at this time point ( P>0.05). In the observation group, the incidence of diarrhea, abdominal distension, mortality, hospitalization time and hospitalization expenses were 32.6% (14/43), 30.2% (13/43), 9.3% (4/43), 16.0±7.0 days and 40±10 thousand yuan, respectively, and in the control group, the above indicators were 4.7% (2/43) ( P<0.05), 7.0% (3/43) ( P<0.05), 11.6% (5/43) ( P=0.72), 19.3±3.7 days ( P<0.05)) and 53±23 thousand yuan ( P<0.05), respectively. Conclusion:For elderly patients with severe acute cholangitis, enteral nutrition with ENBD can effectively improve the nutritional status, reduce inflammatory reaction, the impact on liver function, and hospital costs, and shorten the hospitalization time, which is suitable for further clinical application.

Combined gastroscopic and choledochoscopic transabdominal nasobiliary drainage / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Common bile duct (CBD) stones are a frequent problem in Chinese populations, and their incidence is particularly high in certain areas (Wang et al., 2013). In recent years, laparoscopic common bile duct exploration (LCBDE) and endoscopic retrograde cholangiopancreatography (ERCP) have been the main surgical procedures for CBD stones, although each has different advantages and disadvantages in the treatment of choledocholithiasis (Loor et al., 2017; Zhou et al., 2017). For patients with large stones, a dilated CBD, especially concurrent gallstones, LCBDE is the preferred and most economical minimally invasive procedure (Koc et al., 2013). However, a T-tube is often placed during LCBDE to prevent postoperative bile leakage; this is associated with problems such as bile loss, electrolyte disturbance, and decreased gastric intake (Martin et al., 1998). In addition, the T-tube usually must remain in place for more than a month, during which time the patient's quality of life is seriously compromised. Many skilled surgeons currently perform primary closure of the CBD following LCBDE, which effectively speeds up rehabilitation (Hua et al., 2015). However, even in sophisticated medical centers, the incidence of postoperative bile leakage still reaches ≥10% (Liu et al., 2017). Especially for a beginner, bile leakage remains a key problem (Kemp Bohan et al., 2017). Therefore, a safe and effective minimally invasive surgical approach to preventing bile leakage during primary closure of the CBD after LCBDE is still urgently needed.

Clinical Analysis of Biliary Drainage of Biliary Obstruction Diseases Under Endoscopic Retrograde Cholangiopancreatography / 胃肠病学

Background: There are many biliary drainage methods for the treatment of biliary obstruction diseases, and the application of endoscopic biliary drainage has been increased gradually. Aims: To compare the effect and complications of different endoscopic biliary drainage for the treatment of biliary obstruction diseases. Methods: A total of 75 patients with biliary obstruction diseases received endoscopic retrograde cholangiopancreatography (ERCP) from February 2012 to December 2017 at the People's Hospital of Xuancheng City were enrolled. The patients were divided into nasobiliary drainage group and biliary stenting group. The success rate, effect, complication of drainage were compared between the two groups, and the cause of biliary re-obstruction after ERCP was analyzed. Results: Before treatment, TBIL, DBIL levels were significantly increased in biliary stenting group than in nasobiliary drainage group (P<0.01). After the treatment, no significant difference in success rate of drainage was found between the two groups. No significant differences in TBIL, DBIL before and after treatment were found between the two groups. After the treatment, ALT, AST, GGT was significantly decreased, and AMS was significantly increased in nasobiliary drainage group (P<0.05); while ALT, GGT, AMS were significantly decreased in biliary stenting group (P<0.05). No significantly difference in incidence of complication was found between the two groups. The causes of biliary re-obstruction after ERCP were mainly bile mud or sedimentary calculus, massive stone, tumor invasion. Conclusions: The nasobiliary drainage and biliary stenting drainage can both improve liver function, and relieve the clinical symptoms of biliary obstruction. No significant difference in drainage effect and complication are found between the two drainage methods.

Comparison between endoscopic retrograde biliary drainage and endoscopic nasobiliary drainage in treatment of acute cholangitis / 中华消化内镜杂志

Objective To compare the safety and effectiveness of endoscopic retrograde biliary drainage ( ERBD ) and endoscopic nasobiliary drainage ( ENBD ) in treatment of acute cholangitis. Methods A retrospective analysis was performed on data of 272 patients with acute cholangitis who underwent emergent endoscopic retrograde cholangiopancreatography ( ERCP ) in Beijing Chaoyang Hospital from January 2009 to June 2017. Patients were divided into ERBD group ( n=143) and ENBD group ( n=129) according to the drainage measures. In the ERBD group, there were 63 cases of gradeⅠ(mild) acute cholangitis, 51 of grade Ⅱ ( moderate) , and 29 of grade Ⅲ ( severe) , and the corresponding cases in the ENBD group were 54, 37 and 38, respectively. The rate of improvement of inflammation, ERCP-related complications and interventions to drainage were compared between the two groups in all patients and each grade. Results The rates of improvement of inflammation in the ERBD group and the ENBD group were 89. 5％ (128/143) and 94. 6％ (122/129), respectively, in overall patients (χ2=2. 399, P=0. 126), 93. 7％ (59/63) and 98. 1％ (53/54), respectively, in grade Ⅰ patients (χ2 =0. 548, P=0. 459), 90. 2％ (46/51) and 94. 6％ (35/37), respectively, in grade Ⅱ patients (χ2=0. 125, P=0. 724), and 79. 3％ (23/29) and 89. 5％ (34/38), respectively, in grade Ⅲ patients (χ2=0. 657, P=0. 418). The incidence of ERCP-related complications in the ERBD group and the ENBD group were 11. 9％ ( 17/143) and 7. 8％ ( 10/129) , respectively, in overall patients (χ2=1. 298, P=0. 225) , 9. 5％ ( 6/63) and 7. 4％( 4/54) , respectively, in grade Ⅰ patients (χ2=0. 006, P=0. 939) , 13. 7％ ( 7/51) and 8. 1％ ( 3/37) , respectively, in grade Ⅱ patients (χ2=0. 230, P=0. 632), and 13. 8％ (4/29) and 7. 9％ (3/38), respectively, in grade Ⅲ patients (χ2=0. 144, P=0. 705) . There were no significant differences in the rate of improvement of inflammation and ERCP-related complications between the two groups. The incidences of interventions to drainage in the ERBD group and the ENBD group were 10. 5％ ( 15/143 ) and 3. 1％(4/129), respectively, in overall patients (χ2=5. 699, P=0. 017), 6. 3％ (4/63) and 1. 9％ (1/54), respectively, in grade Ⅰ patients (χ2 = 0. 548, P = 0. 495 ) , 9. 8％ ( 5/51 ) and 5. 4％ ( 2/37 ) , respectively, in grade Ⅱ patients (χ2=0. 125, P=0. 724), and 20. 7％ (6/29) and 2. 6％ (1/38), respectively, in grade Ⅲ patients (χ2 = 3. 965, P= 0. 046 ) . There were significant differences in the incidence of interventions to drainage between the two groups in overall and gradeⅢpatents. Conclusion ERBD and ENBD are equally safe and effective in treatment of different grades of acute cholangitis, but ENBD can reduce the incidence of interventions to drainage.

Transcystic biliary drainage versus nasobiliary drainage during primary closure of the laparoscopic choledochotomy / 中华外科杂志

Objective@#To compare the clinical efficacy of transcystic biliary drainage with nasobiliary drainage during primary closure following laparoscopic choledochotomy.@*Methods@#The clinical data of 106 patients with cholecystolithiasis and choledocholithiasis treated by laparoscopy at Department of General Surgery, Danyang People′s Hospital from May 2014 to June 2017 were analyzed prospectively. The patients were divided into 2 groups by means of random number method: the study group was treated with transcystic biliary drainage, and the control group adopted nasobiliary drainage. The operation time, postoperative drainage volume, postoperative hospital stay and postoperative complications were compared between the 2 groups.@*Results@#All patients in the two groups completed the operation successfully. Compared with nasobiliary drainage, the operation time of transcystic biliary drainage was shortened ((133.9±14.7) minutes vs. (143.3±21.7) minutes, t=-2.617, P<0.05). Postoperative hospital stay ((8.2±1.7) days vs. (7.7±2.5) days), the difference between the two groups was not statistically significant(P>0.05). The quantity of bile drainage was no significant difference in the two groups of patients. There were 1 case of duct obstruction and 2 cases of catheter slippage during transcystic biliary drainage, without causing bile leakage. During nasobiliary drainage, there were 3 cases of catheter obstruction, 1 case of catheter slippage, 2 cases of self extubation, 1 case of bile peritonitis caused by catheter blockage, transferred to laparotomy and T tube drainage. The patients were followed up for 1 month to 17 months, with an average of 8 months. B-ultrasound showed no bile duct stenosis and hepatic function was normal.@*Conclusions@#Transcystic biliary drainage could achieve the same biliary drainage as well as nasobiliary drainage during primary closure following laparoscopic choledochotomy. In addition, transcystic biliary drainage maintain the physiological function of bile duct, it is simple and minimally invasive under certain conditions.

Analysis of 6 cases ERCP-related Ⅲ Stapfer perforation in the bile duct successfully treated by placement of covered metal stents joint nasobiliary drainage / 中国内镜杂志

Objective To summarize the efficacy and safety of covered metal stents joint nasobiliary drainage in treated with ERCP-related Ⅲ Stapfer bile duct perforation. Method Covered metal stent were immediately placed with patients for ERCP-related III Stapfer bile duct perforation. Then, nasobiliary drainage were placed. The stents were removed after 2 ～ 4 weeks. Result 6 patients were all improved, and no surgical patients. The effective rate was 100.00％. No stent related complications occurred. The symptoms of abdominal infection occurred in 1 patient during hospitalization, the rate was 16.67％. Conclusion The method of treatment for ERCP-related III Stapfer bile duct perforation was safe and effective, it was worthy of clinical popularization and application.

Controversy and strategy of preoperative biliary drainage reducing jaundice in hilar cholangiocarcinoma / 中华消化外科杂志

The radical resection is the only curative way for hilar cholangiocarcinoma,and combined hepatectomy is usually needed to achieve the goal of radical resection.Most patients with hilar cholangiocarcinoma are accompanied by obstructive jaundice.Although preoperative biliary drainage (PBD) can improve liver function,blood coagulation function,nutritional status and immunologic function,control acute cholangitis and promote liver regeneration,but a series of its drawbacks currently lead to a big controversy about application value of radical resection of hilar cholangiocarcinoma.Through reviewing literatures and combining with clinical practice experiences,author suggested some ideas on effects,disadvantages,application value,indication and method selection of PBD that will provide a reference in clinical practices.

Clinical efficacies of free endoscopic nasobiliary drainage in primary duct closure following laparoscopic common bile duct exploration: a multicenter retrospective study (A report of 312 cases) / 中华消化外科杂志

Objective To investigate the clinical efficacies of free endoscopic nasobiliary drainage (ENBD) in primary duct closure (PDC) following laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis.Methods The retrospective cohort study was conducted.The clinical data of 312 patients with extrahepatic bile duct stones accompanied with or without cholecystolithiasis who were admitted to the 11 medical centers [86 in the Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,62 in the Second Affiliated Hospital of Zhejiang University School of Medicine,44 in the West China Hospital of Sichuan University,29 in the First Affiliated Hospital of Xi'an Jiaotong University,27 in the First Hospital Affiliated to Army Medical University (Third Military Medical University),25 in the Hunan Provincial People's Hospital,17 in the Beijing Friendship Hospital of Capital Medical University,10 in the First Affiliated Hospital of Hainan Medical University,5 in the Henan Provincial People's Hospital,4 in the Beijing Tian Tan Hospital of Capital Medical University,3 in the First Affiliated Hospital of Fujian Medical University] from January 2011 to June 2017 were collected.All patients underwent LCBDE+PDC,and 81 and 231 patients with and without ENBD were respectively allocated into the ENBD group and PDC group.Observation indicators:(1) comparisons of operation situations;(2) comparisons of postoperative recovery;(3) comparisons of postoperative complications;(4) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative complications up to June 2017.Measurement data with normal distribution were represented as x±s.Comparison between groups was analyzed by the t test.Measurement data with skewed distribution were represented M [interquartile range (IQR)],and comparison between groups was analyzed by the nonparametic test.Comparisons of count data were analyzed using the chi-square test and Fisher exact probability.Results (1) Comparisons of operation situations:all the 312 patients underwent successful laparoscopic LCBDE + PDC,without conversion to open surgery,including postoperative death of 1 patient in the PDC group.The common bile duct diameter,cases using interrupted sutures,continuous sutures,absorbable threads and nonabsorbable threads were respectively (1.2±0.4)cm,106,125,195,36 in the PDC group and (1.1±0.5)cm,76,5,79,2 in the ENBD group,with statistically significant differences between groups (t =2.497,x2 =56.706,8.457,P＜0.05).The numbers of stones,stone diameter,cases with common bile duct wall (≤ 3 mm and ＞3 mm),normal and abnormal Oddi sphincter contraction function,volume of intraoperative blood loss and operation time were respectively 2.1±1.7,(1.1-±0.6)cm,148,83,226,5,20 mL (10-45 mL),(116± 49)minutes in the PDC group and 1.9±1.6,(1.0±0.6)cm,49,32,75,6,20 mL (15-30 mL),(113± 23)minutes in the ENBD group,with no statistically significant difference between groups (t =1.021,0.329,x2 =0.329,3.428,Z=1.147,t=0.521,P＞0.05).The further analysis:of 312 patients,cases and time using interrupted sutures and continuous sutures were respectively 182,130 and (133±.49) minutes,(103±34) minutes,with a statistically significant difference between groups (t =-6.605,P＜0.05).The volume of intraoperative blood loss and cases with postoperative complications using interrupted sutures and continuous sutures were respectively 20 mL (15-31 mL),21 and 20 mL (10-45 mL),18,with no statistically significant difference between groups (Z =-0.285,x2 =0.369,P＞ 0.05).Of 312 patients,cases,operation time,volume of intraoperative blood loss and postoperative complications using absorbable threads and non-absorbable threads were respectively 274,(116±44)minutes,20 mL (15-40 mL),33 and 38,(115±35) minutes,18 mL (10-26 mL),6,with no statistically significant difference between groups (Z =0.971,t =0.023,x2 =0.154,P＞ 0.05).(2) Comparisons of postoperative recovery:recovery time of gastrointestinal function,time of abdominal drainage-tube removal,using time of antibiotics and duration of hospital stay were respectively (2.0± 1.5) days,(4.0 ± 2.4) days,(4.0±2.8) days,(5.5±3.0) days in the PDC group and (4.0±1.9) days,(6.9±3.5) days,(10.0± 3.9) days,(11.1±3.7)days in the ENBD group,with statistically significant differences between groups (t =-9.507,-8.258,-15.103,-13.575,P＜0.05).The total expenses of hospital stay in the Affiliated Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology were respectively (5.1 ±0.6)× 104 yuan in the PDC group and (6.5-±0.5)× 104 yuan in the ENBD group,with a statistically significant difference between groups (t =-9.516,P＜0.05).(3) Comparisons of postoperative complications:incidence of complications in the PDC group was 14.29％ (33/231),including 16 with biliary fistula,11 with biliary tract infection,3 with wound infection,1 with biliary tract bleeding,1 with residual stones of common bile duct and 1 with death;incidence of complications in the ENBD group was 6.17％ (5/81),including 2 with biliary fistula,2 with biliary tract infection and 1 with biliary tract bleeding,showing no statistically significant difference between groups (x2 =3.151,P＞0.05).(4) Follow-up situations:of 312 patients,252 were followed up for 2-67 month,with a median time of 15 months,including 175 in the PDC group and 77 in the ENBD group.During the follow up,there was no occurrence of jaundice,cholangitis and pancreatitis,and stone recurrence and postoperative cholangiostenosis were not detected by abdominal color Doppler ultrasound or CT or magnetic resonanced cholangio-pancreatography.Conclusion On the basis of grasping operative indication strictly,ENBD in PDC following LCBDE for choledocholithiasis is safe and effective.

Effect of Metal Stents Combined With Nasobiliary Drainage on Preventing post-ERCP Cholangitis in Patients With Cholangiocarcinoma / 胃肠病学

Background:Cholangitis is common in patients with advanced cholangiocarcinoma after endoscopic metal biliary endoprothesis (EMBE). Aims:To explore the effect of EMBE combined with endoscopic nasobiliary drainage (ENBD)on preventing post-ERCP cholangitis in patients with cholangiocarcinoma. Methods: A total of 263 advanced cholangiocarcinoma patients underwent EMBE were enrolled and divided into EMBE group and EMBE plus ENBD group. Incidence of post-ERCP cholangitis,adverse event rate and hospital stay were evaluated between the two groups. Results:Compared with EMBE group,incidence of post-ERCP cholangitis (2. 3% vs. 10. 8%,P ＝0. 032 )and hospital stay [(4. 68 ± 1. 43)days vs. (5. 18 ± 1. 45 )days,P ＝0. 011 ]were significantly lower in EMBE plus ENBD group, especially in patients with hilar cholangiocarcinoma [incidence of post-ERCP cholangitis:3. 5% vs. 15. 0%,P＝0. 045;hospital stay:(5. 18 ± 1. 44)days vs. (5. 68 ± 1. 39)days,P＝0. 033]. C-reactive protein,white blood cell count, percentage of neutrophil after 3,24,72 hours were significantly decreased in EMBE plus ENBD group than in EMBE group (P＜0. 05). No significant difference in procedure-related adverse event was found between the two groups (P＞0. 05). Conclusions:The combination of EMBE with ENBD is safe and effective in preventing post-ERCP cholangitis,especially in patients with hilar cholangiocarcinoma.

Clinical outcomes of preoperative endoscopic nasobiliary drainage versus percutaneous transhepatic biliary drainage for patients with perihilar cholangiocarcinoma / 中华肝胆外科杂志

Objective To compare the clinical outcomes of endoscopic nasobiliary drainage (ENBD) versus percutaneous transhepatic biliary drainage (PTBD) in patients with perihilar cholangiocarcinoma.Methods This retrospective case-control study was conducted on 55 patients with perihilar cholangiocarcinoma who were treated by of hepatobiliary and pancreatic surgeons at the Nanjing Drum Tower Hospital between December 2010 and August 2017.Results There was no significant difference in the effectiveness of the two drainage methods (P＞0.05).Morbidity after drainage was significantly higher in the ENBD group than the PTBD group (86.7％ vs 28.0％,P＜0.05).24 patients in the ENBD group developed postERCP pancreatic complications which included hyperamylasemia (n =20) and pancreatitis (n =4).All these patients responded well to conservative treatment.A patient in the PTBD group developed catheter tract tumor implantation.There were no significant differences in the surgical outcomes and in the different Clavien-Dindo grades of complications (P＞0.05).Abdominal infection after surgery was more common in the PTBD group than the ENBD group (64.3％ vs 26.3％,P＜0.05).Conclusion As PTBD caused catheter tract tumor implantation and increased the incidence of abdominal infection after surgery,ENBD was recommended for patients with perihilar cholangiocarcinoma treated in a tertiary medical center.

Current status and progress on preoperative biliary drainage of hilar cholangiocarcinoma / 中华肝胆外科杂志

Preoperative biliary drainage (PBD) is an important part of preoperative management of patients with hilar cholangiocarcinoma which could reduce serum total bilirubin,remove jaundice,improve liver function,and reduce the mortality and morbidity.Although PBD is widely used in biliary surgery now,there are still several controversial issues in clinical applications about the indication of PBD,the best way of PBD,implantation metastasis of PBD and so on.With the development of medical image and surgical technology,we had a better understanding of PBD now.This review summarizes the recent scenario and current advancement about the above-mentioned controversy.

The value of contrast-enhanced ultrasound guiding normal saline injection in the detection of residual common bile duct stones / 中华超声影像学杂志

Objective To investigate the diagnostic value of contrast-enhanced ultrasound (CEUS) guiding normal saline (NS) injection through endoscopic nasobiliary drainage duct(ENBD) on evaluation for residual stones in common bile duct.Methods Fifty-five patients with bile duct stones were treated by endoscopic retrograde cholangio-pancreatography (ERCP) and duodenoscopic sphincterotomy incision surgery (EST) and ENBD.All patients received normal ultrasonography and CEUS guiding NS injection ultrasonography after EST.The length and width of common bile duct and the detection rate of residual stones before and after NS injection were compared.Results In the 55 patients,1 patient failed in injection of contrast agent into the ENBD.In the other 54 patients,the difference of the length and width of common blie duct before and after NS injection were statistically significant [(2.94±1.76)cm vs (6.09±1.46)cm,(0.58±0.30)cm vs (1.11±0.98)cm](all P<0.001).The full display rate of the common bile duct before and after NS injection were 13.0%(7/54) and 90.7%(49/54),respectively.Before injection,none of common bile duct stones was suspected.After injection,5 cases of common bile duct stones were suspected.Three cases were confirmed by ERCP,1 case was confirmed by operation and 1 case was false positive.Conclusions CEUS of the common bile duct through ENBD performs its patency and course.On this basis the injection of NS increases the display rates of common bile duct,thus improving the detection rate of residual stones.

The therapeutic value of endoscopic nasobiliary drainage for the infection of biliary tract associated with endoscopic retrograde cholangiography / 中华消化内镜杂志

Objective To explore major risk factors for postoperative biliary tract infection associated with endoscopic retrograde cholangiography (ERC), and to evaluate endoscopic nasobiliary drainage (ENBD) for intervening the infection.Methods A total of 512 patients who underwent ERC at the First People's Hospital of Yunnan Province from January 2010 to June 2016 were enrolled and divided into group A and B randomly.Group A underwent ENBD after ERC while group B without.The incidence rates of biliary tract infection in different causes and lesions were compared between the two groups.Results Among the 512 patients, there were 276 cases in group A and 236 cases in group B.The overall postoperative biliary infection rate was 4.30%(22/512).Patients in group A showed a smaller chance of developing postoperative biliary tract infection than that in group B [1.09%(3/276) VS 8.05%(19/236), χ2=15.00, P=0.000].Malignant biliary obstruction was the most common cause (13.46%, 14/104) and the most common site was hepatic portal (13.43%, 9/67).Conclusion ENBD can ensure smooth drainage of bile duct therefore effectively prevent biliary tract infection after ERC, especially for patients with malignant biliary obstruction and hepatic portal lesion.

Clinical Study on Observing Common Bile Duct Residual Stones by Saline Injection Through ENBD Under the Guidance of Ultrasound / 中国微创外科杂志

Objective To investigate the accuracy of observing common bile duct ( CBD ) residual stones by saline injection through endoscopic nasobiliary drainage ( ENBD ) under the guidance of ultrasound after endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST) and endoscopic stone extraction . Methods From October 2014 to August 2015, 58 patients with CBD stones received ENBD after endoscopic stone extraction .Ultrasound examination was performed on the 1-5 postoperative days .After routine examination by a professional ultrasound doctor , a total of 50-200 ml saline was injected through ENBD slowly at a rate of 100 ml/min.Ultrasonic results, including changes of bile duct diameter and detection rate of CBD residual stones , were compared before and after the injection . Results All the 58 patients were given ENBD cholangiography after endoscopic stone extraction .Among them, CBD residual stones were detected positive in 3 patients and negative in 55 patients by ENBD cholangiography .Among the 55 patients, CBD residual stones were detected in 1 patient by routine ultrasound which was confirmed after injection .Among the other 54 patients who were not detected stones by routine ultrasound , failure of injection occurred in 1 patient due to the damage of ENBD , and 2 patients showed bad tolerance of abdominal pain after injection of 20 ml saline and 3 patients were detected CBD residual stones after injection .While the other 48 patients were negative with CBD residual stones.For the 3 patients who were detected residual stones by cholangiography , routine ultrasound showed negative results but stones were detected after injection .Stone removal was achieved in 5 patients.The Youden index for CBD residual stones by saline injection through ENBD under ultrasound was 0.98, which was higher than cholangiography (0.4) and routine ultrasound (0.2).Among the 57 patients who underwent injection , obvious dilation of the diameter and length of the CBD was observed after injection in 56 patients (P<0.05). Conclusions For patients with ENBD, observing CBD residual stones by saline injection through ENBD under ultrasound has advantages of non-invasion, non-radiation, inexpensive cost , repeatedly checking and dynamic observation .It has a very important reference value in diagnosing CBD stones and proposes a new examination .

Endoscopic papillotomy and nasobiliary drainage during the course of common bile duct exploration: a report of 219 cases / 中华肝胆外科杂志

To explore the operation methods and indications of the duodenoscopic papillotomy (IEST) with endoscopic nasobiliary drainage (IENBD) for the treatment of duodenal papilla stenosis during the course of common bile duct operation.The clinical data of 219 cases of cholecystolithiasis with choledocholith and the stenosis of papillary underwent endoscopic sphincterotomy (IEST) plus endoscopic nasobiliary drainage (IENBD) in the Second People's Hospital of Chengdu were retrospectively analyzed.It was successful in 198 cases who had the gallbladder and common bile duct stones removed,and endoscopic papillary dissection was performed and the nasobiliary tube was successfully inserted.Nasobiliary drainage was successful in 186 cases (93.9％) of 198 cases.No liquid outflow was observed in nasobiliary drainage in 7 cases (3.5％).Nasal bile duct slipped early in 5 case (2.5％).Primary closure of bile duct incision was completed in 198 cases.It failed in 4 cases (2.0％) who had the bile leakage with primary closure of duct incision.Mild pancreatitis after operation occurred in 3 cases (1.5％).Nose bile duct ligation was performed in 1 case (0.5％).The overall postoperative complication rate was 4.0％ (8/198).IEST + IENBD in open laparotomy was successful in 21 cases.No perforation of intestine and bile duct,bleeding,severe pancreatitis and other complications and death were detected postoperatively in two groups.During the course of laparoscopy and open laparotomy,IEST + IENBD in treating cholecystolithiasis with choledocholith and the stenosis of papillary and primary closure of duct incision after the endoscopic nasobiliary drainage is safe and effective.

Comparison of two kinds of drainage methods in choledocholithiasis with obstructive jaundice / 中国内镜杂志

Objective To discuss which drainage method is more efficient in treatment of choledocholithiasis with obstructive jaundice. Methods Compared the difference of serum total bilirubin,direct bilirubin, the variation of serum total bilirubin and direct bilirubin before and after drainage and daily biliary drainage by endoscopic nasobil-iary drainage (ENBD) and endoscopic nasobiliary drainage with continuous negative-pressure suction after three days. Results The daily biliary drainage about the patients by ENBD with continuous negative-pressure suction is much more effective than the patients by ENBD. The serum total bilirubin and direct bilirubin about the patients by ENBD with continuous negative-pressure suction is less than the patients by ENBD after three days. The variation of serum total bilirubin and direct bilirubin before and after drainage about the patients by ENBD with continuous neg-ative-pressure suction is more than the patients by ENBD. Conclusion The ENBD with continuous negative-pres-sure suction is more effective for choledocholithiasis with obstructive jaundice.

The application of closed needle- free style injection connector in endoscopic nasobiliary drainage / 中国实用护理杂志

Objective To observe the nursing effect of closed needle-free style injection connector in endoscopic nasobiliary drainage (ERCP). Methods From June 2013 to June 2014, 400 patients of the common bile duct stones underwent ERCP technique and placed nasobiliary were divided into two groups according to chronological. Between June 1st, 2013 and December 20th, 200 patients were set as control group, between December 21th, 2013 and June 30, 2014, 200 patients were set as experimental group. For the control group, the nasobiliary duct was directedly connected to the disposable drainage bag. For the experimental group, the nasobiliary duct was connected to closed needle-free style injection connector, and then to the drainage bag. The incidences of the detached connection, the fracture of the connection with the nasobiliary duct, bile leakage from the connection, and post-ERCP infection were compared between two groups. Results The incidence of bile leakage, crack pipes, separation and postoperative infection occurred at the junction nasobiliary rates in the experimental group were 0,0,0,2%(4/200), which were far lower than 35% (70/200),11% (22/200), 6% (12/200), 6%(12/200) of the control group. The difference was statistically significant (χ2=31.75~169.60, P < 0.01). Conclusions The application of closed needle-free style injection connector can effectively avoid the detachment and fracture of the connection, the occurrence of bile leakage, and post-ERCP infection. This will be helpful to decrease the burden of nursing care and increase patients′satisficationdegree.

The evaluation of diagnosis and treatment effects of ERCP in bile leaks following orthotopic liver transplantation / 天津医药

Objective To evaluate the curative efficacy of endoscopic retrograde cholangiopancreatography (ERCP) on bile leaks after orthotopic liver transplantation (OLT). Methods Data of 12 cases, hospitalized in our hospital from March 2013 to February 2016, with bile leaks after OLT confirmed by magnetic resonance imaging of the pancreas (MRCP) or ERCP were retrospectively analyzed . The curative efficacy of ERCP was evaluated including clinical symptoms of bile leaks and complications, occurrence time and location, diagnosis and treatment process and efficacy. Results In this study, 12 cases were male patients, with the average age of 49.75 ± 8.55 (age from 35 to 62 years old). Among them 11 cases were successfully treated by endoscopic nasobiliary drainage (ENBD), and the success rate of endoscopical therapy was 91.7%, the curative rate of bile leaks was 91.7%(11/12). No ERCP related serious complications and death were found in patients. Nine cases combined with biliary strictures and/or biliary duct stone/bile plug were performed endoscopic sphinctrotomy (EST) during the first time of ERCP, and accepted further ERCP treatment after 2 weeks when the bile leaks were healed. All patients with ENBD were carried out well except one case. Conclusion ERCP is a safe and effective minimally invasive treatment method for different types of bile leaks after OLT.

Investigation of the optimal operative time interval from EST +ENBD to LC / 中国基层医药

Objective To investigate the optimal operative time interval from the combined application of endoscopic sphincteropapillotomy ( EST) and endoscopic nasobiliary drainage ( ENBD) to laparoscopic cholecystecto-my ( LC) in the treatment of concurrent cholecystolithiasis and choledocholith.Methods Retrospective analysis was made in the 180 patients who had received sequential treatment of concurrent cholecystolithiasis and choledocholith with the combined application of EFS+ENBD+LC.Patients in group A received LC 3 days after EST +ENBD;patients in group B received LC 7 days after EST +ENBD;patients in group C received LC 30 days after EST +ENBD.Comparative analysis was made in the duration of LC,the intraoperative blood loss,the number of conversion to laparotomy and the total hospital expenses among patients in the three groups.Results Operation time in group A,B and C was separately (34.70 ±2.24)min,(51.00 ±2.31)min and (34.43 ±2.51)min.Patients in group B suffered significantly-extended surgical duration ( F=6.15,P<0.01);Intraoperative blood loss in the three groups was separately (28.86 ±3.35)mL,(50.43 ±3.90)mL,(28.57 ±3.40)mL.Significant increase was observed in group B(F=7.23,P<0.01).There were 1,6 and 1 patients who underwent conversion to laparotomy in the three groups. Slight increase was found in group B(χ2 =6.54,P<0.05).Total hospitalization expenses was separately (10 093.29 ± 496.05)yuan,(10 845.86 ±744.27)yuan and (15 250.57 ±1 006.67)yuan.Patients in group C had incurred a significant increase(F=6.62,P<0.01).Statistical difference was equally found.Conclusion 3 days after EST+ENBD is the optimal operative time for LC.