Analysis of risk factors for bleeding in patients with malignant obstructive jaundice after endoscopic retrograde cholangiopancreatography / 国际外科学杂志

Objective:To investigate the risk factor analysis and model prediction of bleeding after endoscopic retrograde cholangiopancreatography in patients with malignant obstructive jaundice (MOJ).Methods:A retrospective analysis was performed on 302 patients with MOJ treated with ERCP who were treated in the No. 363 Hospital Affiliated to Southwest Medical University from January 2015 to June 2021. The general clinical data of the patients were collected, and the biochemical indicators of the pancreatic and bile ducts were detected. The patients were followed up after discharge, and the patients were divided into a bleeding group ( n=47) and a control group ( n=255) according to whether the follow-up patients were bleeding after ERCP. Compared the general and clinical data of the two groups of patients, including age, gender, platelet count, presence of bile duct stones, acute cholangitis, acute pancreatitis, number of stones, intraoperative bleeding, pancreatic cancer, cholangiocarcinoma, large stone diameter, stone incarceration, duodenal papillary diverticulum, and pre-surgical incision. The measurement data that obey the normal distribution were represented by the mean±standard deviation ( ± s), and the two independent sample t test was used for the comparison between groups; the data that do not conform to the normal distribution were represented by M ( Q1, Q3), and the comparison between groups was used Mann-Whitney U test. The comparison of enumeration data between groups adopted chi-square test. Logistic multivariate regression was used to analyze the independent risk factors of postoperative bleeding after ERCP, and a nomogram prediction model was established and verified according to the independent risk factors of postoperative bleeding. Results:The two groups of patients were compared in age, gender, platelet count, bile duct stones, acute cholangitis, acute pancreatitis, the number of stones, intraoperative bleeding and other aspects, the difference was not statistically significant ( P>0.05). The percentages of pancreatic cancer, cholangiocarcinoma, large stone diameter, stone incarceration, duodenal papillary diverticulum, and surgical pre-incision in the bleeding group were 12.77%, 17.02%, 19.15%, 51.06%, 59.57%, and 14.89%, respectively. , the percentages of the control group were 3.92%, 5.10%, 9.02%, 19.22%, 17.65%, and 5.88%, and the difference was statistically significant between the two groups ( P<0.05). Taking postoperative bleeding as the dependent variable, and using the indicators with statistical differences in univariate analysis as independent variables, multivariate Logistic regression analysis showed that the patient had pancreatic cancer ( OR=1.838, 95% CI: 1.524-4.613, P=0.041), cholangiocarcinoma ( OR=2.548, 95% CI: 1.870-5.116, P=0.015), stone incarceration ( OR=3.078, 95% CI: 2.374-6.012, P<0.001), duodenum Intestinal papillary diverticula ( OR=1.140, 95% CI: 1.045-1.628, P<0.001), surgical pre-incision ( OR=1.640, 95% CI: 1.321-1.928, P<0.001) were associated with postoperative bleeding in MOJ patients after ERCP independent risk factors. The predictive ability of duodenal papillary diverticulum was the highest; the predictive ability of stone incarceration and cholangiocarcinoma was the second, and there was no significant difference between them; the predictive ability of pancreatic cancer, stone diameter, and pre-incision on bleeding after ERCP in MOJ patients smaller. Pancreatic cancer, cholangiocarcinoma, large stone diameter, stone incarceration, duodenal papillary diverticulum, and pre-incision scores were 42, 63, 28, 65, 76, and 34 points respectively, and the total score was 308 points corresponding to the nomogram model. The predictive power of the nomogram was 61.6%, and overall, the nomogram had good predictive performance. Harrell concordance index analysis and ROC curve were used to evaluate the model discrimination, the C-index calculation result was 0.826 (95% CI: 0.771-0.847), the ROC curve AUC was 0.843 (95% CI: 0.801-0.884), and the ROC prediction The value and the calculation result of C-index are relatively close. The model discrimination is applied in this study and has a certain prediction effect. The nomogram model in the Calibration curve predicted the probability of postoperative bleeding after ERCP in MOJ patients with high consistency with the actual probability. Conclusion:ERCP is safe and feasible for most patients with MOJ, but for patients with pancreatic cancer, bile duct cancer, large stone diameter, stone incarceration, and duodenal papillary diverticulum, it should be performed with caution, and preoperative incision should be avoided, to reduce the risk of postoperative bleeding. In addition, the nomogram model has a strong predictive ability in predicting bleeding after ERCP in patients with MOJ, which is worthy of reference in clinical research.

Influencing factors for poor jaundice resolution after radical pancreaticoduodenectomy in patients with malignant obstructive jaundice / 中华消化外科杂志

Objective@#To investigate the influencing factors for poor jaundice resolution after radical pancreaticoduodenectomy in patients with malignant obstructive jaundice.@*Methods@#The retrospective case-control study was conducted. The clinicopathological data of 121 patients with malignant obstructive jaundice who were admitted to the Affiliated Changzhou No.2 People′s Hospital of Nanjing Medical University between March 2013 and June 2018 were collected. There were 70 males and 51 females, aged (69±9)years, with a range from 39 to 85 years. Of 121 patients, 112 underwent open radical pancreaticoduodenectomy, and 9 underwent totally laparoscopic radical pancreaticoduodenectomy. Observation indicators: (1) situations of jaundice resolution after pancreaticoduodenectomy; (2) influencing factors for poor jaundice resolution after pancreaticoduodenectomy. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Univariate analysis was performed using the chi-square test, t test, Fisher exact probability or Mann-Whitney U test. Multivariate analysis was performed by the Logistic regression model using P<0.10 as an inclusion criteria in the univariate analysis .@*Results@#(1) Situations of jaundice resolution after pancreaticoduodenectomy: of 121 patients, 97 had good jaundice resolution after pancreaticoduodenectomy, and 24 had poor jaundice resolution after pancreaticoduodenectomy. (2) Influencing factors for poor jaundice resolution after pancreaticoduodenectomy: results of univariate analysis showd that preoperative level of serum total bilirubin, comorbidity with diabetes mellitus were influencing factors for poor jaundice resolution after pancreaticoduodenectomy (t=-2.073, χ2=10.201, P<0.05). Postoperative pancreatic fistula was also an influencing factor for poor jaundice resolution after pancreaticoduodenectomy (P<0.05). Results of multivariate analysis showed that comorbidity with diabetes mellitus and postoperative pancreatic fistula were independent risk factors for poor jaundice resolution after pancreaticoduodenectomy (odds ratio=0.258, 0.129, 95% confidence interval: 0.087-0.769, 0.023-0.726, P<0.05).@*Conclusions@#Preoperative level of serum total bilirubin, diabetes mellitus, and postoperative pancreatic fistula are influencing factors for poor jaundice resolution after pancreaticoduodenectomy. Comorbidity with diabetes mellitus and postoperative pancreatic fistula are independent risk factors for poor jaundice resolution after pancreaticoduodenectomy.

Influencing factors for poor jaundice resolution after radical pancreaticoduodenectomy in patients with malignant obstructive jaundice / 中华消化外科杂志

Objective To investigate the influencing factors for poor jaundice resolution after radical pancreaticoduodenectomy in patients with malignant obstructive jaundice.Methods The retrospective case-control study was conducted.The clinicopathological data of 121 patients with malignant obstructive jaundice who were admitted to the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University between March 2013 and June 2018 were collected.There were 70 males and 51 females,aged (69±9)years,with a range from 39 to 85 years.Of 121 patients,112 underwent open radical pancreaticoduodenectomy,and 9 underwent totally laparoscopic radical pancreaticoduodenectomy.Observation indicators:(1) situations of jaundice resolution after pancreaticoduodenectomy;(2) influencing factors for poor jaundice resolution after pancreaticoduodenectomy.Measurement data with normal distribution were represented as Mean ± SD.Measurement data with skewed distribution were represented as M (range).Count data were described as absolute numbers.Univariate analysis was performed using the chi-square test,t test,Fisher exact probability or Mann-Whitney U test.Multivariate analysis was performed by the Logistic regression model using P＜0.10 as an inclusion criteria in the univariate analysis.Results (1) Situations of jaundice resolution after pancreaticoduodenectomy:of 121 patients,97 had good jaundice resolution after pancreaticoduodenectomy,and 24 had poor jaundice resolution after pancreaticoduodenectomy.(2) Influencing factors for poor jaundice resolution after pancreaticoduodenectomy:results of univariate analysis showd that preoperative level of serum total bilirubin,comorbidity with diabetes mellitus were influencing factors for poor jaundice resolution after pancreaticoduodenectomy (t =-2.073,x2 =10.201,P＜0.05).Postoperative pancreatic fistula was also an influencing factor for poor jaundice resolution after pancreaticoduodenectomy (P ＜ 0.05).Results of multivariate analysis showed that comorbidity with diabetes mellitus and postoperative pancreatic fistula were independent risk factors for poor jaundice resolution after pancreaticoduodenectomy (odds ratio=0.258,0.129,95％ confidence interval:0.087-0.769,0.023-0.726,P＜0.05).Conclusions Preoperative level of serum total bilirubin,diabetes mellitus,and postoperative pancreatic fistula are influencing factors for poor jaundice resolution after pancreaticoduodenectomy.Comorbidity with diabetes mellitus and postoperative pancreatic fistula are independent risk factors for poor jaundice resolution after pancreaticoduodenectomy.

The effect of biliary stent position on short?term and long?term outcomes of patients with low malignant obstructive jaundice after surgical treatment / 中国综合临床

Objective To explore the effect of the position of the biliary stents on the short?term and long?term effects of the patients with low malignant obstructive jaundice after treatment.Methods Seventy?eight patients with low?grade malignant obstructive jaundice diagnosed in Jiangyin Hospital Affiliated to Medical College of Southeast University who underwent biliary stenting were enrolled as the study object.According to the placement of the biliary stents,the stents were divided into the spanning group and the non?crossing group.The baseline data and related serological indexes were recorded,and the changes of jaundice between the two groups were compared by repeated measurements.All patients were followed up for 48 weeks.Multivariate Cox regression analysis was applied on the risk factors that might affect the prognosis of patients, and the degree of influence of various factors on the prognosis of patients was further evaluated.Results Repeated measures analysis showed that the biochemical indicators of the spanning group and the non?crossing group showed a significant downward trend and the difference was statistically significant (TBil: Fintra?group＝9.392,Pintra?group＝0.000; DBil: Fintra?group＝7.581,Pintra?group＝0.001).Among them,the total bilirubin (TBil) (Preoperative: (318.69±101.13) μmol／L,1 week after surgery: (135.98 ±63.61) μmol／L,2 weeks after surgery: (60.21±24.81) μmol／L) was lower than the non?crossing group preoperative: (309.07±109.97) μmol／L,1 week after surgery: (158.87±66.92) μmol／L,2 weeks after surgery: (75.91 ± 20.46) μmol／L), and the difference was statistically significant ( Finter?group ＝3.362, Pinter?group＝0.041).The direct bilirubin ( DBil) ( Preoperative: (171.93 ± 73.01) μmol／L,1 week after surgery: (90.38± 57.33) μmol／L,2 weeks after surgery:(36.64± 18.95) μmol／L) was lower than the non?crossing group ( Preoperative: ( 174.53 ± 82.74) μmol／L,1 week after surgery: ( 107.85 ± 49.07) μmol／L,2 weeks after surgery: ( 37.87 ± 14.55 ) μmol／L.The difference was statistically significant (Finter?group＝6.284,Pinter?group＝0.003).There was an interaction between the treatment regimen and treatment time (1 week after surgery and 2 weeks after surgery) (TBil: Finteraction＝12.262,Pinteraction＝0.000; DBil:Finteraction＝10.254,Pinteraction＝0.000).The results of the multi factor Cox proportional hazard model of the spanning group and the non?crossing group showed that the ALP, DBil, TBil and lymphatic metastasis of malignant tumor were the two independent risk factors that affect the prognosis.However, the pancreatic cancer,ALT and age in the spanning group across the ampulla also have a certain effect on the prognosis of the patients.Conclusion The effect of the placement of biliary stents across the Vater ampullary was more obvious in the short term on the decline of bilirubin.But in the long term,there was no significant difference in the prognosis of patients with biliary stenting position.ALP,TBil,DBil,and disease classification were all important risk factors affecting the prognosis of two groups of patients

EUS-guided rendezvous for malignant obstructive jaundice after failured ERCP / 中国内镜杂志

Objective To study the therapeutic effect of EUS-guided rendezvous (EUS-RV) when ERCP failed in patients with malignant obstructive jaundice. Methods 12 cases of malignant obstructive jaundice patients were underwent EUS-RV after unsuccessful ERCP. The operation success rate, liver function recovery 1 week and 1 month after operation, complication rates, hospital stay and patient survival were observed. Results All 12 patients were successfully operated and placed stents by endoscopic ultrasound puncture following by ERCP: 8 patients by the stomach, 4 patients by duodenum, the operation success rate was 100.00%; There were significant difference between the liver function recovery of preoperative and postoperative one week or postoperative one week and postoperative one month (P < 0.05). 1 bleeding occurred and were improved after conservative treatment, the complications rate was 8.33%; the hospital stay was (20.68 ± 5.76) d; the average survival time of patients was 224 d. Conclusion EUS-guided rendezvous may be the alternative treatment due to the diminutive trauma and good effect when ERCP failed in patients with malignant obstructive jaundice.

Clinical efficacy and impact on liver and immune function in ERCP stent implantation for elderly patients with malignant obstructive jaundice / 中国内镜杂志

Objective To probe into the clinical application value of ERCP stent implantation in treatment of elderly patients with malignant obstructive jaundice. Methods From January 2014 to December 2015, 97 elderly patients with malignant obstructive jaundice were selected in our hospital as study objects. According to the different treatment, the patients were divided into study group (n = 50) and control group (n = 47) randomly. The patients in study group were treated with ERCP biliary stent implantation. The patients in control group were treated with PTCD biliary stent implantation. The surgical treatment, clinical symptoms, liver function, immunologic function and incidence of complication of the patients between the two groups were compared and analyzed. Results Compared with control group, the patients in study group, the rate of successful operation was 96.00% (48/50), there was increased, but the differences were not significant statistically (P > 0.05); the patients in study group, total efficiency rate was 94.00% (47/50), there were increased significantly, the differences were significant statistically (P < 0.05); the patients in study group after 2 weeks treatment, TBIL were (110.24±60.05) μmol/L, DBIL were (82.43 ± 46.19) μmol/L, ALT were (86.79 ± 39.30) IU/L, AST were (53.65 ± 35.81) IU/L, ALP were (216.83 ± 127.74) IU/L, GGT were (196.52 ± 100.64) IU/L, there were improved significantly, the differences were significant statistically (P < 0.05);the patients in study group after treatment, the levels of CD3+ was (70.24 ± 5.62)%, CD4+ was (37.74 ± 3.85)%, CD4+/CD8+ was (1.35 ± 0.12) and CD8+ was (27.96 ± 3.14)%, there was reduced significantly, the differences were significant statistically (P < 0.05); the patients in study group, the incidence of total complication was 8.00% (4/50), there was decreased significantly, the differences were significant statistically (P < 0.05). Conclusion ERCP stent implantation has very important clinical significance in improving the treatment effect, liver function and immune function for elderly patients with malignant obstructive jaundice.

Biliary tract infection and risk factors of patients with malignant obstructive jaundice / 复旦学报（医学版）

Objective To investigate the information obtained by bile culture and susceptibility testing as while factors like styles of obstruction,abdominal surgical history,degree and time of jaundice related to bacterial infection of biliary tract for patients with malignant obstructive jaundice (MOJ).Methods A total of 93 patients with MOJ received percutaneous transhepatic biliary drainage (PTBD) during Jan.,2015 and Mar.,2016.Bile specimens were collected during the procedure for bacterial culture and susceptibility.Results A rate of 60.2％ (56/93) patients had a positive bile culture and 58 strains were identified,in which gram-positive bacteria accounted for 36.2 ％ (21/58) and gram-negative bacteria accounted for 63.8 ％ (37/58).The most common bacteria were Enterococcus Faecalis,Escherichia Coli,Klebsiella Pneumonia and Staphylococcus Epidermidis.Conclusions The bile cultures indicated that a different antibacterial therapy should be managed in the patients of biliary infection complicated by malignant biliary jaundice.Low obstruction and abdominal surgery history are independent factors related to infection,while time and degree of jaundice shows no relationship to infection.

Application of continuity nursing model in caring patients receiving percutaneous transhepatic biliary drainage / 介入放射学杂志

Objective To investigate the clinical value of continuity nursing model in caring patients with malignant obstructive jaundice treated with percutaneous transhepatic biliary drainage (PTBD).Methods A total of 120 patients with malignant obstructive jaundice treated by PTCD were enrolled in this study.The patients were divided into the control group (n=60) and the observation group (n=60).Routine discharge guidance and health education was conducted for the patients of control group,while for the patients of observation group,in addition to conventional discharge education,the continuity nursing was executed by the responsible nurse.Continuity nursing was meant to continue the service,to guide the observation of the wound and dressing change,the observation of the quantity and quality of drainage solution,to teach the knowledge of the management of PTCD catheter as well as its complications,to guide patient's diet and rest,and to establish the continuity nursing records.Results The patients of both groups were followed up for 3 months.The patients' awareness rate of the knowledge related to PTCD tube in the observation group was significantly higher than that in the control group.The wound infection rate,the rate of PTCD tube prolapse or blockage,and the tube-related re-hospitalization rate in the observation group were strikingly lower than those in the control group (P＜0.05).Conclusion The continuity nursing model can significantly improve patients' awareness rate about the knowledge related to PTCD tube,reduce the incidences of biliary tract infection,PTCD tube prolapse or blockage,wound infection,and tube-related re-hospitalization,therefore,the quality of life can be surely improved.

Clinical effectiveness analysis on biliary stent combined with 125I seed implantation in the treatment of malignant obstructive jaundice / 中国现代普通外科进展

Objective:To investigate the clinical effectiveness analysis on biliary stent combined with 125I seed implantation in the treatment of malignant obstructive jaundice.Methods:98malignant obstructive jaundice patients undergoing percutaneous transhepatic biliary drainage requirement of biliary stent were divided into combined group(n=53) and simple group(n=45).Patients in combined group were taken biliary stent combined with 125I seed implantation,while in simple group were only taken biliary stent.All patients were followed up for 4 to 28 months.The changes of total bilirubin were recorded before percutaneous bile duct drainage,7 d,30 d and 90 d after biliary stent implantation.The recurrences of biliary obstruction of the two groups were recorded.The changes of T lymphocyte subsets in peripheral blood were detected before percutaneous bile duct drainage and after biliary stent implantation 7 d.The survival times of the two groups were compared.Results:All patients were successfully completed biliary stent implantation,surgical success rate was 100％.The total bilirubin levels of patients in combined group 30 d and 90 d after stent implantation were significantly lower than the simple group,the differences were statistically significant (P＜0.05).After surgery 7 d,the CD4 level and CD4/CD8 ratio in combined group were increased compared with before surgery,while in the simple group were declined,the differences were statistically significant (P＜0.05).Compared with the simple group,the CD4 level and CD4/CD8 ratio in combined group after surgery 7d were significantly increased (P＜0.05).2 cases (3.8％) of patients were recurrence of biliary obstruction,which were lower than 17 cases (37.8％) in the simple group,the difference was statistically significant (P＜0.001).The median survival time in combined group was 10.6 months,which was significantly longer than 7.5 months in the simple group,the difference was statistically significant (P＜0.05).Conclusion:Biliary stent combined with 125I seed implantation in the treatment of malignant obstructive jaundice might relieve the symptom of biliary obstruction,and helped to improve cellular immune function of patients and reduce the recurrence of biliary obstruction.It had great significance to improve the quality of life of patients and prolong the survival time.

Observation of the clinical effect of ERCP biliary metal stent implantation and PTCD in the treatment of malignant obstructive jaundice / 中国综合临床

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.

Effect of compatibility of pethidine hydrochloride and anisodamine on the patients with advanced malignant obstructive jaundice in PTBS operation / 实用放射学杂志

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.

Current Status and Progress of Malignant Obstructive Jaundice with Biliary Tract Infection / 胃肠病学

Biliary tract infection is the most commonly seen severe complication of malignant obstructive jaundice (MOJ)with a high mortality rate. Bile bacterial infection in MOJ patients is related with a variety of clinical factors and the therapeutic approaches including surgical operation,ERCP and percutaneous transhepatic cholangial drainage( PTCD). Bile bacterial culture combined with drug sensitivity test is of great importance for selection of optimal antibacterial agents. In this article,the related factors,current status of therapeutics,biliary bacterial spectrum and drug sensitivity in MOJ with biliary tract infection were reviewed for defining the clinical indicators and guiding the use of antibacterial agents.

Analysis of biliary tract infections and anti-infection treatments on 101 cases of PTCD for malignant biliary obstruction / 药学实践杂志

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 .

Dual Interventional Therapy for Malignant Obstructive Jaundice / 中国微创外科杂志

[Summary] Malignant obstructive jaundice is the bile obstruction caused by the invasion of cholangiocarcinoma , pancreatic cancer or ampulla cancer .Due to lack of effective treatment , the prognosis is poor .In recent years , with the rapid development of medical technology and imaging technology , dual interventional treatment technology , such as percutaneous transhepatic cholangial drainage ( PTCD) or biliary stenting combined with radioactive seed implantation , ablation catheter lumen combined with biliary stent implantation , is applied in the treatment of malignant obstructive jaundice .This article is the summary of the clinical application of PTCD combined with radioactive seed implantation , biliary stent combined with radioactive seed implantation and intraluminal catheter radiofrequency ablation combined with biliary stent implantation technique .

Nursing experience for patients with malignant obstructive jaundice after receiving biliary radiofrequency ablation and stent implantation / 介入放射学杂志

Objective To summarize the clinical nursing experience for patients with malignant obstructive jaundice after receiving percutaneous biliary radiofrequency ablation (RFA) and stent implantation. Methods The postoperative nursing experience in 9 patients with malignant obstructive jaundice who received percutaneous biliary RFA together with stent implantation were retrospectively analyzed. The postoperative complications and the nursing intervention measures were analyzed and evaluated. Results Biliary RFA and subsequent stent implantation were successfully carried out in all 9 patients. After the procedure, biliary fistula occurred in one patient, biliary hemorrhage in 2 patients and biliary infection in 2 patients. The patient, who developed biliary fistula, died one week later, and the clinical conditions in the remaining 4 patients were improved after symptomatic treatment. During the follow-up period of one month, the patients were in good condition. Conclusion The main purpose of postoperative nursing for patients after receiving percutaneous biliary RFA is to prevent the occurrence of bile duct perforation, hemorrhage, infection, etc. It is very important to keep the patients under close observation and comprehensive nursing so as to make an early detection and timely treatment of such complications, thus to reduce the incidence of complications causing serious consequences as well as to promote an early recovery.

Clinical effect of percutaneous intraluminal radiofrequency ablation combined with biliary stenting and biliary stenting alone in the treatment of malignant obstructive jaundice / 军事医学

Objective To compare the effect of percutaneous intraluminal radiofrequency ablation ( RFA ) combined with biliary stenting and that of percutaneous transhepatic puncture combined with biliary stenting .Methods A total of 56 patients with unresectable malignant obstructive jaundice were reviewed retrospectively .Among them, 25 patients had received percutaneous intraluminal RFA combined with biliary stenting ( RFA group) while another 31 patients had been simultaneously selected for the simple biliary stent implantation ( stent group ) .The changes of the serum total bilirubin ( TB) and direct bilirubin ( DB) before and after 7-14 days of treatment , surgical complications , stent median patency and the median survival were observed.Follow-up information was obtained through telephone reviews or check-up records. Results The technical success rate was 100%.No procedure-related peritonitis or perforation occurred .There were respectively 3 cases with cholangeitis in RFA group and 3 in stent group.All the cases was controlled by effective clinical treatment.There was obvious statistically significant difference after treatment in TB and DB in the two groups (P<0.01, P<0.01).TB and DB fell by (149.05 ±110.71) and (96.93 ±69.12)μmol/L after 7-14 days in RFA group vs (151.40 ±94.47) and (94.21 ±67.36)μmol/L in stent group.The changes of the two groups were of no statistical significances .The stent patenmedian time was 122 ( 9 -550 ) and 157 ( 16 -510 ) d, while the median survival was 125(9-550) and 163 ( 16 -520 ) d.The difference was of no statistical significance .Conclusion Percutaneous intraluminal RFA combined with biliary stenting and percutaneous transhepatic puncture combined with biliary stenting are both safe and feasible therapeutic options for unresectable malignant obstructive jaundice .There is no statistically significant diffference between the two groups in the recent and long-term curative effects .

The diagnostic value of contrast-enhanced ultrasonic intravenous imaging and cholangiography in ;diagnosis of malignant obstructive jaundice / 实用医学杂志

Objective To explore the diagnostic value of contrast-enhanced ultrasonic intravenous imaging and cholangiography in the diagnosis of malignant jaundice obstructive. Methods Forty three patients who were diagnosed with malignant obstructive jaundice by contrast-enhanced computed tomography and contrast-enhanced computed magnetic resonance imaging were enrolled in this study. All of them underwent conventional ultrasound, IV-CEUS and IC-CEUS. According to the results of operation, the diagnosis accuracies were compared among conventional ultrasound, IV-CEUS, IC-CEUS and IV- CEUS combined with IC-CEUS. Results Diagnostic accuracy by the conventional ultrasound , IV-CEUS , IC-CEUS and IV- CEUS combined with IC-CEUS were 72.1%(31/43), 83.7%(36/43), 81.4%(35/43) and 93.0%(40/43), respectively. IV- CEUS combined with IC-CEUS was superior to the conventional ultrasound (P = 0.021). There were no significant differences when the conventional ultrasound was compared with IV-CEUS or IC-CEUS alone (P = 0.194 and 0.307). Conclusions Preoperative evaluation by IV- CEUS combined with IC-CEUS can elaborate the intra-cavitary and extra-cavitary changes of malignant obstructive jaundice. The diagnostic accuracy rate could be effectively improved by IV-CEUS combined with IC-CEUS, which can bring favorable clinical benefit.

Nursing care for patients with malignant obstructive jaundice receiving biliary stenting combined with linear 125I seeds strand implantation / 介入放射学杂志

Objective To discuss the nursing points for patients with malignant obstructive jaundice who are receiving biliary stenting combined with linear 125I seeds strand implantation. Methods A total of 41 patients with malignant obstructive jaundice were enrolled in this study. Biliary stenting combined with linear 125I seeds strand implantation was performed in all the 41 patients. Sufficient preoperative preparation and psychological intervention were carefully implemented. During the operation, active cooperation with the surgical procedures and close observation of patient’s vital signs as well as adverse reactions such as nausea and vomiting were strictly carried out. After the treatment the management of PTCD drainage tube, the protection of radiation and the early detection of complications were further emphasized. Results The technical success rate of biliary stenting together with linear 125I seeds strand implantation was 100%. The serum total bilirubin levels, determined at one week, one and 3 months after the treatment, were significantly decreased when compared with the preoperative data. Clinically, the jaundice basically subsided. Bile-cardiac reflex occurred in one case and displacement of PTCD drainage tube in 2 cases. Twelve patients developed chills and fever after operation. Acute renal insufficiency occurred in one patient, which was relieved after effective management. The median survival time was 10.9 months. Conclusion Careful and comprehensive preoperative preparation can ensure a successful operation. Intraoperative close observation of patient’s condition and skilled cooperation with the operator, and high quality postoperative nursing measures and close observation for early signs of complications are essential nursing points to ensure that the patients can safely get over the rehabilitation period.

Biliary stenting combined with 125I seed implantation intracavitary irradiation for the treatment of malignant obstructive jaundice / 介入放射学杂志

Objective To discuss the method, safety and clinical value of biliary stenting combined with 125I seed implantation intracavitary irradiation in treating malignant obstructive jaundice. Methods A total of 36 patients with malignant obstructive jaundice were enrolled in this study. PTCD was carried out in all patients, which was followed by biliary stenting combined with 125I seed implantation intracavitary irradiation treatment. The results were analyzed. Results During the interventional management, displacement of the stent and 125I seeds were observed in two cases, and the displaced stent and 125I seeds were replaced to the right position with the help of biliary biopsy forceps. The technical success rate was 100%, and the remission rate of the jaundice was 100%. All the patients were followed up for 1-23 months. No radioactive particles leaking or complications such as radiation enteritis occurred. No in-stent obstruction due to tumor recurrence was observed although slight dilatation of intrahepatic bile duct was detected in 25%of patients, which was resulted from intimal hyperplasia at the stent mesh and/or biliary stone formation. The median survival time was 10.9 months. Conclusion For the treatment of malignant obstructive jaundice, biliary stenting combined with 125I seed implantation intracavitary irradiation is safe, reliable and effective. This technique can prolong stent patency time as well as the patient’s survival time.

The clinical application of single channel and double Chinese-made biliary stent in high biliary malig-nant obstructive jaundice / 实用肿瘤学杂志

Objective To discussion the efficacy and safety of single channel and double chinese -made biliary stent in high biliary malignant hilar obstructive jaundice .Methods We reviewed the clinical data of 24 malignant hilar obstructive jaundice patients treated with single channel and double chinese -made biliary stent from October 2012 to December 2013 retrospectively.Of which 9 cases(study group)were used for single channel and double stenttreatment,and 15 cases(control group)were treated by the bilateral channel;We compared the number of intraoperative percutaneous puncture hepatic duct , radiation exposure doses , operation time , drainage effectiveness and complication rates in the two groups .Results The average number of percutaneous puncture hepatic duct in the study group was 1.44 ±0.53 times,which was significantly lower than the control group (3.73 ±0.70 times).The fluoroscopy time and radiation exposure dose of study group was 1152.22 ±335.61 s and 653.22 ±207.02 mGy,which was slightly less than the control group (1236.93 ±463.43 s and 727.00 ±348.52 mGy),the difference was not statistically significant (P=0.638;P=0.572).Liver function was tested after 4 W, the drainage effectiveness of study group and the control group were 88.9%(eight-nineths),86.7%(thirteen-fifteenths),the difference was not statistically significant .One case occurred bile leakage in the study group ,2 pa-tients with hemobilia in control group ,both groups showed no serious complication .Conclusion The single chan-nel and double chinese -made biliary stent to treat high biliary malignant hilar obstructive jaundice is minimally injured and effective ,which can be selectively applied to treat patients with hepatic hilum malignant obstructive jaundice .