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Abstract Objectives This study aimed to investigate the efficacy of ultrasound-guided Percutaneous Transhepatic Biliary Drainage (PTCD) for the treatment of Acute Obstructive Suppurative Cholangitis (AOSC) combined with septic shock due to choledocholithiasis, and its effect on inflammatory factors. Methods Clinical data of 86 patients with AOSC and septic shock admitted to our hospital between January 2019 and May 2021 were retrospectively analyzed and grouped according to different treatment methods. Among them, 43 patients who underwent Endoscopic Retrograde Cholangiopancreatography (ERCP) and Endoscopic Nasobiliary Drainage (ENBD) were included in the Control Group (CNG), and 43 patients who underwent ultrasound-guided PTCD were included in the Study Group (SG). Results The total effective rate in the SG (88.37%) was higher than that in the CNG (69.77%) (p <0.05); after surgery, the serum inflammatory factors PCT, IL-6, TNF-α, CRP levels, liver function indicators such as TBIL, DBIL, AST, ALT levels, and stress response indicators including NPY, PGE2, 5-HT levels were reduced, and were lower in the SG than in the CNG (p <0.05); postoperatively, CD3+, CD4+, and CD4+/CD8+ levels in the CNG were significantly lower than those before surgery (p <0.05); Postoperatively, CD3+, CD4+, and CD4+/CD8+ levels in the SG were significantly higher than those in the CNG (p <0.05); and the complication rate in the SG (6.98%) was lower than that in the CNG (25.58%) (p <0.05). Conclusions Ultrasound-guided PTCD for AOSC combined with septic shock can facilitate the recovery of liver and immune functions with a low complication rate.
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Objective To evaluate the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP)-based comprehensive minimally invasive treatment for biliary anastomotic stenosis (BAS) after liver transplantation. Methods Clinical data of 60 BAS recipients after liver transplantation were retrospectively analyzed, 54 male and 6 female, aged (48±10) years. ERCP was initially carried out. If it succeeded, plastic or metallic stents were placed into the biliary tract. If it failed, percutaneous transhepatic cholangial drainage (PTCD) or single-operator cholangioscopy (SpyGlass) was adopted to pass through the stenosis. If all these procedures failed, magnetic anastomosis or other special methods were delivered. The incidence and treatment of BAS after liver transplantation were summarized. The efficacy, stent removal and recurrence were observed. Results The median time of incidence of BAS after liver transplantation was 8 (4, 13) months. Within postoperative 1 year, 1-2 years and over 2 years, 39, 16 and 5 recipients were diagnosed with BAS, respectively. All 60 BAS recipients after liver transplantation were successfully treated, including 56 cases initially receiving ERCP, and 41 completing BAS treatment, with a success rate of 73%. The failure of guide wire was the main cause of ERCP failure. The success rates of PTCD, SpyGlass and magnetic anastomosis were 5/9, 5/7 and 7/8, respectively. Two recipients were successfully treated by percutaneous choledochoscope-assisted blunt guide wire technique and stent placement in the biliary and duodenal fistula. After 3 (3, 4) cycles of ERCP and 13 (8, 18) months of stent indwelling, 38 recipients reached the stent removal criteria, including 25 plastic stents and 13 metallic stents. The indwelling time of plastic stents was longer than that of metallic stents (P < 0.05). Six cases suffered from stenosis recurrence at 12 (8, 33) months after stent removal, and the recurrence rate was 16%. Six patients were treated with ERCP, and 5 of them did not recur after the stents were successfully removed. Multivariate analysis showed that delayed diagnosis of stenosis and frequent ERCP before stent removal were the independent risk factors for BAS recurrence (both P < 0.05). Conclusions ERCP-based comprehensive minimally invasive treatment may improve the success rate of BAS treatment after liver transplantation and yield satisfactory long-term efficacy. Delayed diagnosis of BAS and high frequent ERCP required for stent removal are the independent risk factors for BAS recurrence.
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Objective To evaluate the clinical efficacy of early diagnosis by contrast-enhanced ultrasound (CEUS) combined with mesenchymal stem cell (MSC) therapy in the treatment of biliary ischemia after liver transplantation. Methods Clinical data of 9 recipients presenting with biliary ischemia detected by CEUS within 4 weeks after liver transplantation and diagnosed with non-anastomotic biliary stricture (NAS) within postoperative 1 year were retrospectively analyzed. In the conventional treatment group, 4 recipients were treated with conventional treatment including liver protection, cholagogic therapy and interventional therapy. In MSC treatment group, 5 recipients received intravenous infusion of MSC at 1, 2, 4, 8, 12 and 16 weeks after biliary ischemia detected by CEUS on the basis of conventional therapy. The interventional treatment and clinical prognosis within 1 year after liver transplantation were analyzed between two groups. Results Two recipients in the MSC treatment group required interventional therapy, which was initially given at 7-9 months after liver transplantation for 1-2 times. All recipients in the conventional treatment group required interventional therapy, which was initially delivered at postoperative 1-3 months for 2-6 times, earlier than that in the MSC treatment group. Within 1 year following liver transplantation, diffuse bile duct injury occurred in 2 recipients in MSC treatment group, and no graft dysfunction was observed. In the conventional treatment group, all recipients developed diffuse bile duct injury, and 2 recipients presented with graft dysfunction. Conclusions Early diagnosis of biliary ischemia after liver transplantation by CEUS combined with MSC therapy may delay and reduce the requirement of interventional therapy for NAS, and also improve clinical prognosis of the recipients.
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Objective To compare the clinical curative effect of endoscopic retrograde cholangio-pancreatography (ERCP) and percutaneous transhepatic cholangial drainage (PTCD) in treatment of malignant obstructive jaundice. Methods Clinical data of 97 patients with malignant obstructive jaundice were collected and analyzed retrospectively, includs 54 patients in ERCP group and 43 patients in PTCD group. The clinical curative effect, postoperative complications, comfort score and hospitalization time and costs were compared between the two groups. Results The symptoms improved compared with preoperative. The total remission rate of jaundice in ERCP group and PTCD group was 77.78％ vs 79.07％, and the remission rate of high obstructive jaundice was 55.00％, vs 89.29％, and the remission rate of low obstruction jaundice was 91.18％, vs 60.00％.There was significant difference between the two groups (P < 0.05); The incidence of postoperative complications in ERCP group and PTCD group was 37.04％ vs 16.28％. There was significant difference between the two groups (P < 0.05); The comfort scale of ERCP group and PTCD group was (15.13 ± 3.89) points vs (16.60 ± 3.15) points. There was significant difference between the two groups (P < 0.05); The hospitalization time of ERCP group and PTCD group were (8.74 ± 4.94) days vs (11.12 ± 4.82) days, and the hospitalization costs were (22.70 ± 6.30) thousand yuan vs (21.90 ± 3.40) thousand yuan. Conclusion Satisfactory clinical curative effect for patients with malignant obstructive jaundice can be derived from both ERCP and PTCD. The treatment of ERCP has more advantages than PTCD in patients with low obstruction, while PTCD is better than ERCP in patients with high obstruction. But ERCP group is better than PTCD in comfort score and shorter in hospitalization time. There is no obvious difference on hospitalization costs.
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Objective To study the effect of the combination of pathidine hydrochloride and anisodamine on the intraoperative effiacy of transhepatic biliary drainage and stent implantation done on the patient with advanced malignant obstructive jaundice.Methods 100 cases of percutaneous transhepatic catheterizde drainage (PTCD) and percutaneous transhepatic biliary stenting (PTBS) done for advanced malignant obstructive jaundice were divided into control group and experimental group,50 cases in each group.In experimental group,100 mg pethidine hydrochloride and 10 mg anisodamine were injected intramuscularly 30 min before operation,while in control group,no analgesic or antispasmodic were used before and during operation.The blood pressure and heart rate were observed,the incidence rate of biliary-cardiac reflex and operating time were recorded,while the scale of pain felt by patient was evaluated with visual analogue scale.Results Compared to the control group,the patients in experimental group have more stable vital signs,feel more comfortable,suffering shorter operative time,less incidence rate of biliary cardiac reflex and less pain by using pethidine hydrochloride and anisodamine.Conclusion Application of pathidine hydrochloride and anisodamine during the transhepatic biliary drainage and stent implantation done on the patient with advanced malignant obstructive jaundice may release pain,reduce operating time.It is safe,at lower cost and can be used as routine medicine before PTCD or PTBS.
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Objective To analyze the clinical data of patients with hilar cholangiocarcinoma (HCCA),and to compare the therapeutic effects of different methods on treating these patients.Methods The clinical data of 101 patients with HCCA in China-Japan Union Hospital of Jilin University were analyzed.Results The overall 1-year and 2-year survival rates in the radical operation group were 95.5％ and 40.9％,respectively.There was a significant difference between the radical operation group and the palliative resection group (P ＜ 0.05).The overall 1-year and 2-year survival rates in the palliative resection group were 75.0％ and 16.7％,respectively,which were much better than those in patients treated with PTCD,biliary stent on open abdominal biliary drainage (P ＜ 0.05).There were no significant differences among the PTCD,biliary stent and open abdominal biliary drainage groups (P ＞ 0.05).Conclusions Radical HCCA resection is still the best and the first choice treatment for patients with HCCA.The therapeutic effects of radical operation were much better than those of palliative resection,biliary stent,PTCD and open abdominal biliary drainage.
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Objective To study the indications,feasibility and efficacy of rigid choledochoscopy via biliary fistula tracts to remove bile duct stones.Methods A retrospective analysis was performed on the clinical data of 86 patients with bile duct stones treated with rigid choledochoscopy via biliary fistula tracts at our hospital between November 2011 and July 2016.Patients with bile duct stones were divided into the percutaneous transhepatic cholangio drainage (PTCD) group and the T tube tract group.There were 40 patients who underwent lithotomy using rigid choledochoscopy via the PTCD tract and 46 patients who underwent choledocholithotomy using rigid choledochoscopy via the T-tube tract.A comparison was conducted to compare the duration of the procedures,the amount of perioperative bleeding,the postoperative complication rates and residual stone rates between the two groups.Results In the PTCD group,the average operation time was (77.0 ± 36.5) min,the amount of perioperative bleeding was (26.5 ± 54.1) ml,and the postoperative complication rate was 37.5 ％ (15/40).Complete lithotomy in one-stage was successful in 33 patients,and in two-stages in 1 patient.The residual stone rate was 15.0％ (6/40).In the T tube tract group,the average operation time was (82.5 ± 44.1) min,the amount of perioperative bleeding was (14.8 ± 21.0) ml,and the postoperative complication rate was 32.6％ (15/46).Complete lithotomy in one-stage was successful in 34 patients,and two-stages in 2 patients.The residual stone rate was 21.7％ (10/46).There were no significant differences in the residual stone rates,complication rates and operation time between the two groups (P ＞ 0.05).The amount of operative bleeding was significantly better in the T tube tract group than the PTCD group,(P ＜ 0.05).Conclusions There was no significant differences in the clinical efficacy in the treatment of bile duct stones using choledochoscopy either via the PTCD tract or the T tube tract group.Both approaches can be used for bile duct stones.
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Objective To observe the clinical effect of endoscopic retrograde cholangiopancreatography (ERCP)biliary stent implantation and percutaneous transhepatic cholangiography(PTCD)in the treatment of malignant obstructive jaundice(MOJ).Methods Eighty-eight patients with MOJ treated in the Second Affiliated Hospital of Hainan Medical University from January 2013 to March 2016 were selected and then randomly divided into ERCP group and PTCD group,44 cases in each group.ERCP group received biliary tract stent implantation via ERCP pathway, and PTCD group underwent percutaneous transhepatic biliary puncture.The success rate,clinical efficacy,liver function and complication rate of the two groups were compared.Results The success rate of ERCP group was 93.18%(41/44),and the success rate of PTCD group was 90.91%(40/44).There was no significant difference between the two groups(P>0.05).In terms of the clinical curative effect,the total effective rate of ERCP group was 92.68%(38/41),the total effective rate of PTCD group was 90.00%(36/40),there was no significant difference between the two groups(P>0.05);the low obstruction efficiency in ERCP group was significantly higher than that of PTCD group(100.00%vs.75%),the high obstruction efficiency in ERCP group was significantly higher than that of PTCD group (96.43% vs.83.33%),the differences between the groups were statistically significant(χ2=3.503,2.771,P<0.05);in terms of the liver function recovery after treatment,the liver function index of patients with low obstruction in ERCP group were better than that in patients with high obstruction,while in PTCD group,patients with high obstructive had better liver function,compared to the low obstruction patients,the differences were statistically significant(P<0.05); the complication rate in ERCP group and PTCD group were11.36% and 15.91%,the difference was not statistically significant(P>0.05).Conclusion The ERCP pathway and PTCD pathway implantation of biliary metal stent have great clinical efficacy,while in comparison,ERCP pathway performs better in low obstruction and PTCD pathway was more suitable in high obstruction.In the course of clinical treatment,the selection of surgical approach should be based on the different obstruction sites of the patients,so as to obtain the best therapeutic effect.
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Objective To retrospectively study the clinical value and the advantages in " planned hepatectomy" for the "central type" intrahepatic and extrahepatic choledochal cysts.Methods The clinical data of 7 patients with the "central type" of intrahepatic and extrahepatic choledochal cysts which were treated with "planned hepatectomy" from January 2014 through April 2017 at the Department of Biliary Tract Surgery of the Eastern Hepatobiliary Surgery Hospital,Second Military Medical University were retrospectively analyzed.Results All the patients completed radical resection of the intrahepatic and extrahepatic choledochal cysts in accordance with the " planned hepatectomy".The operations included 6 patients who were treated with percutaneous transhepatic cholangial drainage (PTCD) and 5 patients with portal vein embolization (PVE) prior to the surgical excision.Combined right liver resection was performed in 6 patients,and combined left liver resection in one patient.All the 7 patients had a history of chronic cholangitis.Liver volume tests demonstrated that the hemiliver volume to be removed (the embolized hemiliver) significantly decreased after PVE,whereas the hemilivers to be persevered were remarkably enlarged.No complication associated with PTCD and PVE occurred.The mean postoperative hospitalization was 12 days.Liver function tests suggested all the patients recovered well.No postoperative complication of bleeding,infection or liver function failure was observed,except in one patient who experienced pleural and abdominal effusion.Conclusions Combined subtotal hepatectomy may increase the risk of complications associated with the "central type" intrahepatic and extrahepatic choledochal cysts.The surgical strategy in planned hepatectomy can be used effectively to treat the "central type" of intrahepatic and extrahepatic choledochal cysts,with improved surgical safety,decrease in incidences of postoperative liver function failure and residual choledochal cysts.
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Objective To assess the safety and efficacy of extended liver resection using preoperative PTCD (percutaneous transhepatic cholangial drainage) and PVE (portal vein embolization) to treat patients with locally advanced hilar cholangiocarcinoma.Methods We collected and analyzed the clinical data of 27 patients with Bismuth types Ⅲ and Ⅳ hilar cholangiocarcinoma who underwent extended hepatecomy using preoperative PTCD and PVE in our hospital.Results There were 21 patients with R0 resection and 6 patients with R1 resection.The mortality rate was 0％.Eight patients died of cancer recurrence.Conclusion Preoperative PTCD and PVE combined with extended hepatectomy were safe and efficacious in treating patients with locally advanced hilar cholangiocarcinoma,which resulted in potential cure.
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Objective To find out the main pathogenic bacteria distribution and sensitivity to antibiotics in patients post PTCD for malignant biliary obstruction ,to evaluate the therapeutic effectiveness of antibiotics and provide evidences for rational use of antibiotics .Methods The clinical data were collected and analyzed retrospectively from 423 PTCD cases with malignant biliary obstruction from September 2013 to October 2014 .Results Among 423 patients underwent PTCD ,101 patients were confirmed with infections .67 patients showed positive pathogenic bacteria culture .A total of 94 strains of pathogenic bacteria were detected .There were 62 strains of gram negative bacteria (65 .96% ) and 32 strains of gram positive bacteria (34 .04% ) . The main pathogenic bacteria were klebsiella pneumoniae , Escherichia coli ,enterococcus faecalis and Enterobacter cloacae . Klebsiella pneumoniae and Escherichia coli are the two gram negative bacteria most resistant to antibiotics .The three popular gram negative bacilli in this study had the lowest resistance to imipenem/cilastatin ,piperacillin/tazobactam and amikacin .The three main gram positive bacteria were most sensitive to daptomycin ,linezolid and vancomycin .The total effective rate of anti-biotic treatments for post PTCD infections was 88 .1% .Conclusion Our hospital had an appropriate treatment plan with antibi-otics to control the infections post percutaneous transhepatic cholangio-drainage for malignant biliary obstruction .According to the results of drug sensitivity test ,ceftriaxone had high resistance rate .The outcome with ceftriaxone treatment was unsatis-factory .Clinical pharmacists should advise doctors to reduce the usage of ceftriaxone .Glycopeptide antibiotics can be used to control methicillin-resistant staphylococcus (MRS) gram positive bacteria .
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Objective To prospectively study the clinical significance of the MELD scoring system in surgical treatment of obstructive jaundice.Methods 112 patients with obstructive jaundice who were admitted into our hospital from January 2009 to December 2013 were divided into two groups:group A (Stage Ⅰ PTCD and stage Ⅱ open operation,n =53) and group B (1 stage open surgery,n =59).The amount of intraoperative bleeding blood loss,operation time,postoperative complications,duration of hospitalization,mortality rate,and the changes in liver function after surgery were compared between the two groups.Results The differences in the liver function index of the two groups on the same postoperative date were significantly different (P ＜ 0.05).The liver function of group A recovered faster than group B.Patients in group A with a MELD ＜ 10 points stayed in hospital significantly longer when compared with patients in group B.For patients in group A with MELD ＞ 10 points,the operation time,bleeding volume,postoperative complications and hospitalization were significantly less than the patients in group B (P ＜ 0.05).There were 3 patients (group B) who died with MELD ≥ 20 points after operation.Conclusions In patients with obstructive jaundice with a MELD score greater than 10 points,especially those with a score equal to or greater than 20,PTCD should be performed first to relieve biliary tract obstruction,followed by a stage Ⅱ open surgical operation after the liver function had improved.MELD had important clinical significance in the evaluation of operation risk in patients with obstructive jaundice.
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Objective To review the results of minimally invasive intervention on acute suppurative cholangitis(ASC);the effects of intervention was analyzed.Methods ASC patients had been admitted to our hospital from 2001,6 to 2005,6,and their data was analyzed;35 cases were selected according to the ASC diagnosis criteria,among whom 28 cases were treated by intervention;the data change of WBC and ratio of N before and after treatment were analyzed by T test.Results Twenty-two cases were treated by therapeutic ERCP only;all of them were cured after intervention,among whom 9 cases were drained by therapeutic ERCP for biliary duct obstruction.The effects of 5 cases who suffered from extrohepatic duct obstruction were better than those of 4 cases who suffered from hepatic duct obstruction,but the symptoms of all cases were released after drainage;4 cases were cured by combination of therapeutic ERCP and PTCD;2 cases were treated by PTCD only,among whom one was cured and one was released after treatment.No obvious complication occurred.Conclusion The minimally invasive methods of therapeutic ERCP,PTC and combined therapeutic ERCP and PTCD are good methods for ASC.