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1.
Pediátr Panamá ; 50(2): 33-36, 1 October 2021.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1343241

ABSTRACT

Reportamos el caso de lactante con colestasis que fue diagnosticado como síndrome de Alagille sindrómico. La característica principal de la enfermedad es la escasez de conductos biliares. Es una enfermedad hereditaria, de transmisión autosómica dominante con penetración incompleta, secundaria a mutaciones en los genes JAG1 (más del 90%) y NOTCH21, que inducen una alteración del desarrollo embriológico que afecta a estructuras dependientes del mesodermo.Describimos el caso y discutimos sus hallazgos clínicos y radiológicos.


We report the case of an infant with cholestasis who was diagnosed as syndromic Alagille syndrome. The main feature of the disease is a shortage of bile ducts. It is a hereditary disease, of autosomal dominant transmission with incomplete penetration, secondary to mutations in the JAG1 (more than 90%) and NOTCH21 genes, which induce an alteration of embryological development that affects mesoderm-dependent structures. We describe the case and discuss its clinical and radiological findings.

2.
Journal of Clinical Hepatology ; (12): 2737-2741, 2021.
Article in Chinese | WPRIM | ID: wpr-905033

ABSTRACT

Benign biliary stricture (BBS) refers to complete or incomplete stricture of the biliary tract caused by a series of non-malignant diseases. BBS often has complex and diverse etiologies, and severe complications may occur if it is not adequately treated. Diagnostic methods currently used in clinical practice include imaging, endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography, and choledochoscopy, and treatment methods include balloon dilatation, stent implantation, percutaneous transhepatic biliary drainage, and surgical treatment. At present, endoscopic diagnosis and treatment of BBS has become the preferred method. However, there is still no clear classification of BBS, which needs further investigation. By consulting related literature in China and globally, this article summarizes the issues associated with the endoscopic diagnosis and treatment of BBS.

3.
Journal of Clinical Hepatology ; (12): 2632-2635, 2021.
Article in Chinese | WPRIM | ID: wpr-905006

ABSTRACT

Objective To investigate the endoscopic ultrasound (EUS) features of distal biliary stricture (DBS), and to provide a clinical basis for the evaluation of DBS by EUS. Methods Related clinical data were collected from 175 patients with DBS who underwent EUS examination in The First Affiliated Hospital of Anhui Medical University from April 2016 to March 2020 to analyze their clinical manifestation, laboratory examination results, imaging findings, and EUS findings, and the patients were followed up to summarize the EUS features of DBS. The chi-square test was used for comparison of categorical data between groups, and the t -test was used for comparison of continuous data between groups. Results Among the 175 patients with DBS, 85(48.57%) had benign DBS and 90(51.43%) had malignant DBS. Compared with the patients with benign DBS, the patients with malignant DBS had a significantly longer length of stricture on EUS (14.1±3.0 mm vs 7.9±3.0 mm, t =13.358, P < 0.001) and significantly higher incidence rates of the characteristic changes on EUS such as hypoechoic space-occupying lesions in lumen (57.8% vs 34.1%, χ 2 =9.843, P =0.002), peripheral lymph node enlargement (26.7% vs 12.9%, χ 2 =5.147, P =0.023), and pancreatic duct dilatation (51.1% vs 28.2%, χ 2 =9.532, P =0.002). EUS combined with magnetic resonance cholangiopancreatography had a sensitivity of 70.6% in the diagnosis of benign DBS and a sensitivity of 92.2% in the diagnosis of malignant DBS. Conclusion The characteristic EUS features of DBS, such as long length of stricture, hypoechoic lesion, peripheral lymph node enlargement, and pancreatic duct dilatation, may help with the differential diagnosis of DBS in clinical practice.

5.
Radiol. bras ; 53(4): 262-272, July-Aug. 2020. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1136091

ABSTRACT

Abstract Cholangiopathies are chronic diseases that affect the bile ducts, comprising a heterogeneous group of progressive and potentially fatal entities. The diagnosis of these diseases is a great challenge for radiologists because of the overlapping of their clinical, biochemical, and imaging findings. Nevertheless, identifying the precise etiology is crucial, given that the therapeutic options are distinct and influence the prognosis of the patient. The purpose of this review article is to discuss some of the non-neoplastic causes of cholangiopathies and to provide a useful diagnostic algorithm.


Resumo As colangiopatias são doenças crônicas que afetam as vias biliares, constituindo um grupo heterogêneo de doenças progressivas e potencialmente fatais. O seu diagnóstico configura um grande desafio para os radiologistas, uma vez que seus aspectos clínicos, laboratoriais e de imagem se sobrepõem. Apesar disso, a busca etiológica é crucial, tendo em vista que as opções terapêuticas são distintas e influenciam o prognóstico do paciente. O objetivo deste artigo de revisão é discutir algumas das causas não neoplásicas de colangiopatias e fornecer um algoritmo útil na abordagem diagnóstica.

6.
Rev. méd. Urug ; 36(1): 93-98, mar. 2020. tab, graf
Article in Spanish | LILACS, BNUY | ID: biblio-1094230

ABSTRACT

Resumen: Presentamos la primera experiencia en Uruguay de una biopsia endobiliar con pinza por acceso percutáneo que realizáramos en una paciente con estenosis biliar hiliar de probable causa neoplásica. Hasta nuestro conocimiento, no existen reportes de esta técnica en Uruguay. La difusión de la disponibilidad de esta técnica en nuestro medio es de gran importancia, ya que permite al equipo médico tratante disponer de una nueva herramienta para el manejo diagnóstico de las estenosis biliares.


Abstract: The study presents the first experience in Uruguay of a forceps biopsy of biliary ducts via percutaneous catheterization performed in a patient with hilar biliary strictures probably caused by a tumor. As far as we know, no reports on this technique have been published in our country. It is important to spread the availability of this technique in our country since it provides the medical team with a new tool for the diagnostic handling of biliary strictures.


Resumo: Apresentamos a primeira experiência no Uruguai de uma biópsia endobiliária com pinça de acesso percutânea realizada em um paciente com estenose biliar hilar de provável causa neoplásica. Para nosso conhecimento, não há relatos dessa técnica no Uruguai. A difusão da disponibilidade dessa técnica em nosso ambiente é de grande importância, pois permite à equipe médica responsável o tratamento ter uma nova ferramenta para o manejo diagnóstico da estenose biliar.


Subject(s)
Humans , Female , Middle Aged , Biliary Tract Diseases/diagnosis , Biopsy/methods , Constriction, Pathologic/diagnosis
7.
Article in Chinese | WPRIM | ID: wpr-865020

ABSTRACT

Objective To investigate the application value of real-time virtual sonography (RVS)in the diagnosis and treatment of complicated hepatolithiasis.Methods The retrospective and descriptive study was conducted.The clinical data of 10 patients with complicated hepatolithiasis who were admitted to Hunan Provincial People's Hospital between October 2017 and March 2018 were collected.There were 3 males and 7 females,aged from 40 to 69 years,with an average age of 57 years.Patients received abdominal color Doppler ultrasound examination,magnetic resonance cholangiopancreatography,and upper abdominal spiral computed tomography (CT) thinly scanning +enhanced examination.Data of CT examination were imported into RVS.RVS was used to locate hepatolithiasis,relationship between stones and vessels,anatomy of bile ducts and vessels in hepatic hilus.Surgical methods included RVS-guided hilar cholangiotomy,biliary stricturoplasty,bilateral hepatojejunostomy,hepatic segmentectomy (lobectomy),and hepatolithotomy.Observation indicators:(1) surgical and postoperative situations;(2) typical case analysis;(3) follow-up.Follow-up using outpatient examination was performed to detect residual stones up to June 2019.Measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers.Results (1) Surgical and postoperative situations:10 patients underwent RVS-guided surgeries successfully for complicated hepatolithiasis,with successful match in RVS (difference between CT images and ultrosound images < 2 mm).No residual stone was identified by choledochoscope during operation.The operation time and volume of intraoperative blood loss were 285 minutes (range,210-360 minutes) and 200 mL (range,100-600 mL),respectively.No blood transfusion was needed during the operations.The duration of hospital stay was 20.5 days (range,14.0-29.0 days).There was no perioperative death.One patient had postoperative biliary leakage and abdominal infection,and was cured after conservative treatment.(2) Typical case analysis:the tenth patient,female,60 years old,was diagnosed with complicated hepatolithiasis,and was prepared to undergo hepatolithotomy + quadrate lobectomy and hilar cholangioplasty+bilateral hepatojejunostomy.Preoperative CT images and intraoperative color Doppler ultrasound images of the patient were fused and matched on the sagittal section of the portal vein and the cross section of the right branch of portal vein,and stones and important vessels were marked on the images.After accurate positioning,a curette was used to remove the stones.Removal of biliary stones through hepatic parenchyma and peripheral dilated bile ducts was conducted at the site where stones obviously existed.After the stones were removed,the intrahepatic bile duct and hilar bile duct merged.The left end of the bile duct split was confirmed by real-time ultrasound.After location of portal vein was determined by ultrasound,vascular plastic surgery was perfomed to avoid stenosis.(3) Follow-up:10 patients were followed up for 6-12 months,with a median followup time of 8 months.One of 10 patients was suspected residual stones at the right peripheral hepatic anterior lobe by postoperative angiography at 2 months after surgery,and was not removed stones by choledochoscope.The patient had no recurrent symptoms after T-tube removal.The other 9 patients had no residual stones.Conclusion RVS applied in complicated hepatolithiasis is helpful for the precise intraoperative diagnosis,and the surgical treatment can be safe and effective.

8.
Article in Chinese | WPRIM | ID: wpr-865018

ABSTRACT

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.

9.
Article in Chinese | WPRIM | ID: wpr-798913

ABSTRACT

Objective@#To investigate the application value of real-time virtual sonography(RVS)in the diagnosis and treatment of complicated hepatolithiasis.@*Methods@#The retrospective and descriptive study was conducted. The clinical data of 10 patients with complicated hepatolithiasis who were admitted to Hunan Provincial People′s Hospital between October 2017 and March 2018 were collected. There were 3 males and 7 females, aged from 40 to 69 years, with an average age of 57 years. Patients received abdominal color Doppler ultrasound examination, magnetic resonance cholangiopancreatography, and upper abdominal spiral computed tomography (CT) thinly scanning + enhanced examination. Data of CT examination were imported into RVS. RVS was used to locate hepatolithiasis, relationship between stones and vessels, anatomy of bile ducts and vessels in hepatic hilus. Surgical methods included RVS-guided hilar cholangiotomy, biliary stricturoplasty, bilateral hepatojejunostomy, hepatic segmentectomy (lobectomy), and hepatolithotomy. Observation indicators: (1) surgical and postoperative situations; (2) typical case analysis; (3) follow-up. Follow-up using outpatient examination was performed to detect residual stones up to June 2019. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers.@*Results@#(1) Surgical and postoperative situations: 10 patients underwent RVS-guided surgeries successfully for complicated hepatolithiasis, with successful match in RVS (difference between CT images and ultrosound images <2 mm). No residual stone was identified by choledochoscope during operation. The operation time and volume of intraoperative blood loss were 285 minutes (range, 210-360 minutes) and 200 mL (range, 100-600 mL), respectively. No blood transfusion was needed during the operations. The duration of hospital stay was 20.5 days (range, 14.0-29.0 days). There was no perioperative death. One patient had postoperative biliary leakage and abdominal infection, and was cured after conservative treatment. (2) Typical case analysis: the tenth patient, female, 60 years old, was diagnosed with complicated hepatolithiasis, and was prepared to undergo hepatolithotomy+ quadrate lobectomy and hilar cholangioplasty+ bilateral hepatojejunostomy. Preoperative CT images and intraoperative color Doppler ultrasound images of the patient were fused and matched on the sagittal section of the portal vein and the cross section of the right branch of portal vein, and stones and important vessels were marked on the images. After accurate positioning, a curette was used to remove the stones. Removal of biliary stones through hepatic parenchyma and peripheral dilated bile ducts was conducted at the site where stones obviously existed. After the stones were removed, the intrahepatic bile duct and hilar bile duct merged. The left end of the bile duct split was confirmed by real-time ultrasound. After location of portal vein was determined by ultrasound, vascular plastic surgery was perfomed to avoid stenosis. (3) Follow-up: 10 patients were followed up for 6-12 months, with a median follow-up time of 8 months. One of 10 patients was suspected residual stones at the right peripheral hepatic anterior lobe by postoperative angiography at 2 months after surgery, and was not removed stones by choledochoscope. The patient had no recurrent symptoms after T-tube removal. The other 9 patients had no residual stones.@*Conclusion@#RVS applied in complicated hepatolithiasis is helpful for the precise intraoperative diagnosis, and the surgical treatment can be safe and effective.

10.
Article in Chinese | WPRIM | ID: wpr-798911

ABSTRACT

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.

11.
Medisur ; 17(3): 437-442, mayo.-jun. 2019. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1091190

ABSTRACT

RESUMEN Las lesiones o fugas biliares que ocurren luego de una colecistectomía abierta o laparoscópica, son poco frecuentes, con una incidencia de 0,1-1 %. La presentación clínica de la fuga biliar postoperatoria se caracteriza por dolor en el cuadrante superior derecho, náuseas, vómitos, anorexia y fiebre. Se presentan dos pacientes, de 53 y 58 años de edad, respectivamente, que después de haber sido intervenidos quirúrgicamente, tuvieron manifestaciones clínicas e imagenológicas de fuga biliar. Ambos fueron tratados mediante colangiopancreatografía retrógrada endoscópica con esfinterotomía biliar y colocación de prótesis. La evolución fue satisfactoria. El objetivo del trabajo es exponer el resultado del tratamiento endoscópico en la fuga biliar postcolecistectomía.


ABSTRACT Biliary lesions or leaks that occur after an open or laparoscopic cholecystectomy are rare, with an incidence of 0.1-1%. The clinical presentation of postoperative bile leak is characterized by pain in the upper right quadrant, nausea, vomiting, anorexia and fever. Two patients, 54 and 58 years of age, respectively are presented. After having undergone surgery, they had clinical and imaging manifestations of biliary leakage. Both were treated by endoscopic retrograde cholangiopancreatography with biliary sphincterotomy and prosthesis placement. The evolution was satisfactory. The objective of the work is to expose the result of endoscopic treatment in the biliary leak post- cholecystectomy.

12.
Article in Chinese | WPRIM | ID: wpr-778810

ABSTRACT

The bile duct is the channel for bile transport in the liver, and the lining epithelial cells in the bile duct have functional and morphological heterogeneity and are the target of various bile duct diseases. In addition to bile metabolism and secretion, biliary epithelial cells are also involved in tissue damage and repair. Biliary epithelial cells have an immune barrier function and can secrete different proinflammatory factors and chemokines. Under the stimulation of endogenous and exogenous factors, biliary epithelial cells present immune reactivity and initiate immune response in the host. This article reviews the current status of research on bile duct lesions and related liver diseases.

13.
Journal of Clinical Hepatology ; (12): 2627-2631, 2019.
Article in Chinese | WPRIM | ID: wpr-778682

ABSTRACT

Cholecystectomy is the most common cause of iatrogenic bile duct injury. The causes, classification and diagnosis of bile duct injury were analyzed. According to the different opportunity of bile duct injury, different treatment strategies and infection control were adopted. The selection of definitive repair of bile duct injury, especially the key points of Roux-Y cholangiojejunostomy, was described in detail. In addition, under the condition of strict indication, it can be combined with hepatectomy or even liver transplantation.

14.
Article in Chinese | WPRIM | ID: wpr-746093

ABSTRACT

Objective To explore the efficacy and safety of endoscopic retrograde cholangiopancreatography ( ERCP ) for the diagnosis and treatment of children with pancreaticobiliary diseases. Methods Clinical data of 115 children with pancreaticobiliary diseases who underwent ERCP between July 2006 and June 2016 at Hangzhou First People' s Hospital were reviewed. Anesthesia types, therapeutic methods,success rate and postoperative complications were summarized. Results A total of 221 ERCP procedures were performed on 115 patients. Eighty one cases were diagnosed as common bile duct stones, 22 bile duct cysts, 3 biliary ascariasis, 66 chronic pancreatitis, 45 pancreas divisum, and 43 acute pancreatitis. Thirty-one procedures were performed under general anesthesia. Dissection of pancreatic duct and biliary duct, calculus removal, insertion of pancreatic duct and biliary duct, and draining in pancreatic duct or biliary duct were performed. The success rate of the ERCP procedure was 98. 6% ( 218/221) with complication rate of 7. 2%( 16/221 ) . In terms of postoperative complications, post-ERCP pancreatitisoccurred in 7 ( 3. 2%) cases, bleeding in 5 ( 2. 3%) , and postoperative cholangitis in 4 ( 1. 8%) . All the complications were cured after treatment. Conclusion Congenital anatomic anomalies are common in children with pancreaticobiliary diseases. Early diagnosis and treatment of ERCP by an experienced endoscopist for children with pancreaticobiliary diseases is effective and safe.

15.
Article in Chinese | WPRIM | ID: wpr-745359

ABSTRACT

Objective To establish a laparoscopic classification of extrahepatic biliary dilatations (EHBD) that can guide minimally invasive treatment.Methods According to inclusion criteria,124 patients with EHBD who were admitted and treated from July 2001 to July 2017 in the First Hospital Affiliated to Army Military Medical University were included in this study.A new laparoscopic classification of EHBD was proposed based on the preoperative imaging data and laparoscopic findings of the position and extent of EHBD.The minimally invasive diagnosis and treatment strategies were made based on the new classification.Results According to the preoperative imaging data and intraoperative laparoscopic findings,124 patients with EHBD were divided into the following groups:type A (upper segment,34 cases),type B (middle segment,27 cases),type C (lower segment,20 cases),and type D (entire bile duct,43 cases).The clinical symptoms (abdominal pain,jaundice and mass) and reoperation rates were not significantly different among the 4 groups(both P>0.05).The incidences of comorbidities (calculus or inflammation) were significantly different (P<0.05).The operative time(type A:237.6±66.7 min,type B:259.2±60.0 min,type C:286.1 ± 74.7 min,type D:347.5±94.4 min) and blood loss (type A:192.6±102.2 ml,type B:201.5±120.2 ml,type C:297.5±162.1 ml,type D:305.8±237.3 ml) were significantly different among the groups (P< 0.05).The short-term complication rates after surgery (5.9% ~ 20.0%) were significantly different (P< 0.05),while the long-term complication rates after surgery (7.4% ~ 10.0%) were not significantly different.The conversion rates to open surgery were significantly higher in patients with type C and D lesions than in those with type A and B lesions (P<0.05).Conclusion This laparoscopic classification predicted the difficulty of laparoscopic surgery for EHBD and had a guiding significance in the minimally invasive treatment for this disease entity.

16.
Article in Chinese | WPRIM | ID: wpr-755171

ABSTRACT

Objective To study the diagnostic value of endoscopic ultrasonography (EUS) in patients with cholangiopancreatic duct dilatation (CPDD).Methods Forty-five patients with CPDD and without any visual or detected obstructive lesions after traditional uhrasonography (US) were re-examined by EUS,CT and MRI.The diagnostic rates of EUS and the other imaging technologies were compared.Results All the 45 patients underwent successful EUS examination.Among them,there were 18 patients with periampullary tumor,10 patients with lower common bile duct stones,1 patient with pancreatic duct stones,3 patients with chronic pancreatitis,1 patient with an intrapancreatic choledochal cyst,4 patients with inflammatory strictures of papilla of duodenum and 2 patients with terminal bile duct inflammatory stenosis.However,1 patient with a lower common bile duct tumor,1 patient with a small pancreatic head carcinoma and 1 patient with sphincter of Oddi dysfunction (SOD) were not diagnosed.The diagnostic rates of obstructive lesions by US,EUS,CT and MRI were 7.1%,92.9%,33.3%,31.0%,respectively.The diagnostic rates of tumor were 10.0%,90.0%,35.0%,25.0%,respectively.As compared with the other examination methods,EUS was best in detecting small carcinoma.Conclusion EUS plays an important role in the diagnosis of lesions causing cholangiopancreatic duct dilatation.

17.
Article in Chinese | WPRIM | ID: wpr-800297

ABSTRACT

Objective@#To study the incidence, influencing factors and corresponding treatment of complications of endoscopic retrograde cholangiopancreatography (ERCP) in children with pancreaticobiliary diseases.@*Method@#Clinical data of 172 children aged under 16 years with pancreaticobiliary diseases receiving ERCP between January 2008 and December 2017 in Hangzhou First People′s Hospital were studied retrospectively. Anesthesia type, diagnosis, therapeutic methods and postoperative complications were analyzed.@*Results@#A total of 375 ERCP procedures were performed on 172 patients, among whom there were 210 cases (56.0%) of bile duct diseases and 245 (65.3%) pancreatic diseases. Dissection of pancreatic duct and biliary duct, calculus removal, insertion of endoprosthesis and drainage of pancreatic duct or biliary duct were performed. The success rate of ERCP was 99.5% (373/375). The incidence of complications was 6.7% (25/375) including 13 cases (3.5%) of post-ERCP pancreatitis, 8 cases (2.1%) of bleeding, and 6 cases (1.6%) of postoperative cholangitis. All the complications were cured. No severe pancreatitis, perforation or ERCP-related death occured. The first ERCP procedure and repeated cannulations were the risk factors of post-ERCP pancreatitis (P<0.05). Children had higher risk of post-ERCP bleeding after endoscopic sphincterotomy (P<0.05).@*Conclusion@#The incidence of post-ERCP complications in children is similar to that of adults and is related to therapeutic methods. More attention and timely treatment should be given to those children. ERCP can be effectively and safely for children operated by an experienced endoscopic physician with appropriate therapeutic methods.

18.
Article in Chinese | WPRIM | ID: wpr-797795

ABSTRACT

Objective@#To evaluate diagnostic efficacy of endoscopic ultrasonography (EUS) for extra-hepatic bile duct dilation of unknown reasons which failed to be identified by traditional radiological methods.@*Methods@#Data of consecutive 892 patients who underwent EUS from February 2016 to September 2017 were retrospectively studied. Final diagnosis was determined by endoscopic retrograde cholangiopancreatography (ERCP)-based biopsy, surgical pathology, or a follow-up of at least 10 months.@*Results@#A total of 82 patients with extra-hepatic bile duct dilation (width ≥ 7 mm) and mean age of 61.5±9.6 years were included. The width of common bile duct was 13.0±4.25 mm. Reasons for extra-hepatic bile duct dilation could be determined by EUS in most patients with abnormal liver function. No malignant causes were detected in patients with normal liver function. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of EUS were 92.7%, 100.0%, 96.3%, 100.0%, and 93.2%, respectively.@*Conclusion@#For patients with dilated extra-hepatic bile duct without clear etiology, EUS may be an alternative for determining the etiology of extra-hepatic bile duct dilation. For those with extra-hepatic bile duct dilation with abnormal liver function, malignant causes should not be neglected.

19.
Chinese Journal of Pathology ; (12): 755-761, 2019.
Article in Chinese | WPRIM | ID: wpr-796828

ABSTRACT

Objective@#To evaluate the diagnostic value of a histologic scoring system in congenital biliary atresia and its prognostic relevance.@*Methods@#From January 2017 to June 2018 at Children′s Hospital of Fudan University, 172 wedge liver biopsy specimens were obtained from infants with neonatal cholestasis [119 patients with congenital biliary atresia (CBA) and 53 patients with non-obstructive cholestasis as control]. A pathologist, single-blinded to the final diagnosis, made the histological diagnosis individually based on an 8-feature (portal ductal proliferation, bile duct reaction, bile plugs in portal ductules, liver fibrosis, edema in portal region, cholestasis, inflammatory cells infiltration in portal region, and ductal plate malformation), 21-point scoring system.@*Results@#The main pathologic changes of biliary atresia were hepatocyte cholestasis, hyperplasia of bile ducts, fibrosis and infiltration of inflammatory cells in the portal area. There were significant difference in the degree of portal edema, bile duct hyperplasia and fibrosis between two groups (P<0.01). In addition, there were characteristic bile duct thrombosis in 97.5%(116/119) of the cases and abnormal development of bile duct plate in 9.2%(11/119) of the cases. Compared with non-CBA infant cholestasis group, the difference was statistically significant (P<0.05). The scoring system has high sensitivity, specificity (both 94.1%) and accuracy (94.3%) in the diagnosis of CBA. A score equal to or more than 11 points supported a diagnosis of CBA; whereas a score less than 11 points might suggest cholestasis. The degree of hepatic fibrosis and ductal plate malformation were related to prognosis.@*Conclusions@#The liver pathology scoring system (8-feature, 21-point) is more accurate in diagnosing CBA than previous methods, which may guide the clinicopathological diagnosis. This histological scoring system also helps to assess the prognosis of CBA.

20.
Article in Chinese | WPRIM | ID: wpr-792058

ABSTRACT

Objective To evaluate diagnostic efficacy of endoscopic ultrasonography ( EUS ) for extra-hepatic bile duct dilation of unknown reasons which failed to be identified by traditional radiological methods. Methods Data of consecutive 892 patients who underwent EUS from February 2016 to September 2017 were retrospectively studied. Final diagnosis was determined by endoscopic retrograde cholangiopancreatography (ERCP)-based biopsy, surgical pathology, or a follow-up of at least 10 months. Results A total of 82 patients with extra-hepatic bile duct dilation (width ≥7 mm) and mean age of 61. 5±9. 6 years were included. The width of common bile duct was 13. 0±4. 25 mm. Reasons for extra-hepatic bile duct dilation could be determined by EUS in most patients with abnormal liver function. No malignant causes were detected in patients with normal liver function. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of EUS were 92. 7%, 100. 0%, 96. 3%, 100. 0%, and 93. 2%, respectively. Conclusion For patients with dilated extra-hepatic bile duct without clear etiology, EUS may be an alternative for determining the etiology of extra-hepatic bile duct dilation. For those with extra-hepatic bile duct dilation with abnormal liver function, malignant causes should not be neglected.

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