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Objective To evaluate the curative value of the tauroursodeoxycholic acid (TUDCA) and Danning table (DN) in the prevention of bile duct stones recurrence after ERCP. Methods 210 patients with Choledocholithiasisby ERCP were randomly divided into 3 groups. The patients in the control group were not given any medicine. The patients in the TUDCA group took TUDCA every night. The patients in the DN group took Danning tablets of three times a day. The course of medication and followed up for the patients was 24 months after the operation. All the patients would be examined regularly by Biliary color doppler ultrasound and MRCP. The recurrence rates of Choledocholithiasis, cholesterol saturation index and serum lipid were recorded and compared statistically between the three groups. Results In total, 190 patients completed the treatment and follow-up according to the experimental design. The recurrence rates of the control, TUDCA and DN group were 17.46%(11/63), 6.34% (4/63) and 10.94% (7/64). The recurrence rates in the TUDCA and DN group were significantly lower than those the control group (P < 0.05).The recurrence rate in the TUDCA group was significantly lower than that in the DN group; On the tenth days after the operation, the CSI in the TUDCA were significantly lower than those the control group and the DN group (P < 0.05). There was no statistically significant difference between the DN group and the control group (P > 0.05); To the patients without recurrence, the level of TC, LDL in the TUDCA group were significantly lower than those the control group and and the DN group (P < 0.05). The level of HDL in the TUDCA group were significantly higher than those the control group and and the DN group (P < 0.05). There was no statistically significant difference on the level of HDL between the DN groupand the control group (P > 0.05). Conclusion The application of TUDCA and DN for patients with Choledocholithiasis after ERCP can effectively reduce the recurrence rates, the curative effect of TUDCA more than DN.
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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 investigate the anesthetic effect and adverse events on different doses of oxyco-done combined with propofol target controlled infusion(TCI)in patients with choledocholithiasis undergoing endo-scopic retrograde cholangio pancreatography(ERCP)with endoscopic sphincterotomy(EST).Methods One hun-dred and twenty patients with choledocholithiasis underwent ERCP with EST in Department of Gastroenterology, Fuzhou General Hospital,from January,2016 to March,2017 were enrolled in this study.Patients were randomly divided into 4 groups(n=30 in each group)including the sufentanil control group(Group A),low dose of oxyco-done group(Group B),moderate dose of oxycodone group(Group C),and high dose of oxycodone group(Group D).Patients in Group A received 0.10 μg/kg intravenous sufentanil,and patients in Group B,C,and D received 0.08 mg/kg,0.10 mg/kg,and 0.12 mg/kg intravenous oxycodone,respectively,at 5 min before induction of gener-al anesthesia followed by propofol TCI. Effect of compartment concentration(Ce)of propofol,mean arterial pres-sure(MAP),and heart rate(HR)at the given time point when patients transferring to operation room(T0),after induction(T1),endoscope through throat(T2),and endoscope through major duodenal papilla(T3)were record-ed.The accumulative dose of propofol,duration of operation,and recovery time were also recorded.Intraoperative sever hypotension,bradycardia,respiratory depression,coughing and moving,and postoperative nausea and vom-iting were recorded. Results Propofol Ce at T1~T3as well as MAP and HR at T2and T3in Group B were signifi-cantly higher than those in Group A,C,and D,respectively(P < 0.05). The accumulative dose of propofol in Group B was more than that in Group A and C,while the accumulative dose of propofol in Group D was less than that in Group A,B,and C,respectively(P<0.01).Recovery time in Group D was longer than that in Group A, B,and C,respectively(P<0.05).Similar incidences of intraoperative sever hypotension,bradycardia,respiratory depression,coughing and moving,and postoperative nausea and vomiting were also observed. Conclusions 0.10 mg/kg intravenous oxycodone at 5 min before induction of general anesthesia combined with propofol TCI presents a favorable anesthetic effect in patients with choledocholithiasis undergoing ERCP with EST without a prolonged recovery time and the increased incidence of adverse events.
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Objective To study the combined used of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic surgery in the treatment of Mirizzi syndrome and in the prevention of bile duct injury in minimally invasive surgery.Methods A retrospective analysis was conducted on patients who suffered from Mirizzi syndrome treated with ERCP and laparoscopic surgery from March 2011 to February 2016 at the Center Hospital of Xianyang City,Southern Medical University.Results Of 1762 patients who underwent ERCP,56 patients were diagnosed to suffer from Mirizzi syndrome (3.2％).Thirty-six patients with type Ⅰ disease successfully completed LC.The adjacent tissues were used to repair the defects in the first stage for type Ⅱ disease in 12 patients and for type Ⅲ disease in 4 patients.T tube was not used.The bile was drained with a ENBD drainage tube.After LC,a bile duct to jejunum Roux-en-Y anastomosis was carried out for the type Ⅱ disease in 2 patients and for the type Ⅲ disease in 2 patients.There was no perioperative death for the whole group of patients.Two patients developed symptoms of cholangitis,and the disease was stable after non-operative treatment.For the other patients,follow-up for more than 2 years showed good results.Conclusions ERCP was useful in the diagnosis of Mirizzi syndrome and in the Csendes typing before operation.ENBD could be used as a guide to find the hepatic duct,thus avoiding bile duct injury during laparoscopic surgery and for the placement of T tube drainage.ERCP combined with laparoscopic surgery in the treatment of Mirizzi syndrome was safe and effective.It is an operation which has the advantage of minimal trauma,less pain and rapid recovery.
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Objective To study the combined used of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic surgery in the treatment of Mirizzi syndrome and in the prevention of bile duct injury in minimally invasive surgery.Methods A retrospective analysis was conducted on patients who suffered from Mirizzi syndrome treated with ERCP and laparoscopic surgery from March 2011 to February 2016 at the Center Hospital of Xianyang City,Southern Medical University.Results Of 1762 patients who underwent ERCP,56 patients were diagnosed to suffer from Mirizzi syndrome (3.2％).Thirty-six patients with type Ⅰ disease successfully completed LC.The adjacent tissues were used to repair the defects in the first stage for type Ⅱ disease in 12 patients and for type Ⅲ disease in 4 patients.T tube was not used.The bile was drained with a ENBD drainage tube.After LC,a bile duct to jejunum Roux-en-Y anastomosis was carried out for the type Ⅱ disease in 2 patients and for the type Ⅲ disease in 2 patients.There was no perioperative death for the whole group of patients.Two patients developed symptoms of cholangitis,and the disease was stable after non-operative treatment.For the other patients,follow-up for more than 2 years showed good results.Conclusions ERCP was useful in the diagnosis of Mirizzi syndrome and in the Csendes typing before operation.ENBD could be used as a guide to find the hepatic duct,thus avoiding bile duct injury during laparoscopic surgery and for the placement of T tube drainage.ERCP combined with laparoscopic surgery in the treatment of Mirizzi syndrome was safe and effective.It is an operation which has the advantage of minimal trauma,less pain and rapid recovery.
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Objective To determine the independent risk factors for postoperative nausea and vomiting (PONV) after endoscopic retrograde cholangio-pancreatography (ERCP) under total intravenous anesthesia.Methods Ninety patients,47 males and 43 females,aged 18 years old or more,falling into ASA physical status Ⅰ-Ⅲ,undergoing ERCP under total intravenous anesthesia from July 18,2016 to August 31,2016 in Ruijin Hospital were included in our study.General information and intraoperative situation of patients were collected.The incidence of PONV within 24 h was recorded.A multivariate Logistic regression model was performed to analyze the independent risk factors of PONV after ERCP under total intravenous anesthesia.Results In total,90 patients were included in this study,with 33 patients (36.7%) suffering PONV.Logistic analyses showed that female (OR=3.73,95%CI 1.36-10.27),history of PONV/motion sickness(OR=4.39,95%CI 1.40-13.76),and serum-amylase greater than 3 times the normal value (OR=5.22,95%CI 1.30-20.95) were the independent risk factors for PONV after ERCP under total intravenous anesthesia.Conclusion Female,history of PONV/motion sickness,and serum-amylase greater than 3 times the normal value were the independent risk factors for PONV after ERCP under total intravenous anesthesia.
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Objective To investigate the causes, diagnosis and surgical treatment of ERCP related duodenal per﹣foration. Methods Clinical data of 6 cases of surgical treatment of ERCP related duodenal perforation were retro﹣spective analyzed. All the 6 perforation patients underwent emergency surgical procedure, including 3 cases trans﹣fered from other hospital after duodenal perforation. 4 cases with a history of abdominal surgery. Preoperative con﹣firmed bravery manager stone 4 cases, 1 case of obstructive jaundice after gallbladder surgery, bile duct expansion in 1 case. Results Perforation causes include duodenum mirror improper operation related in 2 cases, duodenal papilla sphincterotomy related 3 cases (1 case of pre-dissection operation with needle knife), small endoscopic sphincteroto﹣my combined with endoscopic papillary balloon dilation lead to perforation in 1 case.4 cases of intraoperative found right kidney week pneumatosis, 2 cases of postoperative CT found after peritoneal pneumatosis, effusion. All patients with surgery including common bile duct exploration, T tube drainage, duodenal perforation repair, jejunum colostomy, among them 2 cases at the same time line of gastrointestinal anastomosis. 5 cases recovered, 1 case died. Conclusions Inappropriate duodenal papilla sphincter incision indications and Many previous abdominal surgery have higher perforated ration;Found in time, reasonable treatment is the most important;For serious typeⅠand typeⅡperforation, active surgical treatment in time, can effectively reduce serious consequences caused by the ERCP related perforation.
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Objective To evaluate the clinical effect of ultrasound-guided percutaneous transhepatic cholangial drainage (PTCD) combined with endoscopic retrograde cholangio-pancreatography (ERCP) in treating malignant obstructive jaundice, and to discuss its technical points. Methods A total of ten cases with malignant biliary obstruction were enrolled in this study. After the failure of ERCP treatment, the patients had to be treated with ultrasound-guided PTCD immediately. The guide-wire was inserted into the duodenum through intrahepatic bile duct and common bile duct to connect with ERCP, which was followed by the biliary stent implantation or the removal of physical factors causing obstruction. The clinical results were analyzed. Results Technical success was obtained in all 10 cases. In the patients who underwent a successful guide-wire docking with ERCP the postoperative serum bilirubin was significantly decreased. The main complications were fever, elevation of amylase and transient bloody bile. Conclusion With the help of docking technique the combination use of ultrasound-guided PTCD and ERCP is a new tentative treatment for malignant obstructive jaundice after the failure of initial ERCP treatment. This technique carries promising value in clinical practice as it can significantly increase the success rate of ERCP.
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Objective To observe the clinical effects of external application of Chinese medicine ion introduction through acupiont in the prevention and treatment of hyperamylasemia and pancreatitis following endoscopic retrograde cholangio pancreatography (ERCP). Methods Three hundred subjects were divided into treatment group and control group randomly, and treated with routine therapy after surgery, moreover, treatment group was treated with external application of Chinese medicine ion introduction through acupiont. The incidence of hyperamylasemia and pancreatitis, the time of serum amylase returned to normal in patients with hyperamylasemia and pancreatitis was observed, and the abdominal pain after ERCP was scored. Results Excluding 17 cases according to the exclusion criteria, the treatment group included 142 cases and the control group included 141 cases. The hyperamylasemia and pancreatitis happened less frequently in the treatment group than in control group, but there was no significant difference (P>0.05). The time of serum amylase returned to normal in patients with pancreatitis was (4.25±0.95)d in treatment group and (5.28±1.11)d in control group, with no significant difference (P>0.05). The time of serum amylase returned to normal in patients with hyperamylasemia was (2.88 ± 0.78)d in treatment group and (3.81±1.62)d in control group, showed a significant difference (P<0.05). The score of abdominal pain was 0.95±1.04 in treatment group and 1.21±1.12 in control group, showed a significant difference (P<0.05). Conclusion External application of Chinese medicine ion introduction through acupoint can promote the recovery of the patients postoperative ERCP combined with hyperamylasemia or pancreatitis, and can better alleviate abdominal pain.
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Objective The value of endoscopic retrograde choledocho－ pancreatography( ERCP ) to detect narrow－ winding cystic duct and the effect of surgery were studied .Methods The clinical presentations, pathogenesis, diagnostic procedures and outcome of surgery were collected and analysed in 17 patients with this change. All had preoperative ERCP as well as intraoperative cholangiography. The operation was simple cholecystectomy. Results Satisfaction was obtained througthout the followup period for 2～ 5 years . Conclusion Narrow－ winding cystic duct is not a rare biliary disorder with high rate of confirmation by ERCP and fine result following cholecystectomy.