Résumé
Objective To investigate the value of endoscopic papillary incision combined with balloon di-lation in the treatment of choledocholithiasis with periampullary diverticula(PAD). Methods A total of 118 pa-tients with choledocholithiasis and PAD admitted to our hospital from January 2015 to January 2017 were retrospec-tively analyzed.According to the operation method,all patients were divided into two groups:sEST+EPBD group (60 cases)and EST group(58 cases).The success rate of ERCP and the success rate of one-step stone removal, the changes of serum TBil and DBil before and after operation,and the incidence of postoperative complications were compared between the two groups. Results The successful rates of ERCP and stone removal in sEST+EPBD group were significantly higher than those in EST group(P < 0.05). The levels of serum TBil and DBil in both groups were significantly lower than those before operation(P<0.05).The overall incidence of postoperative com-plications in sEST + EPBD group was significantly lower than that in EST group(P < 0.05). Conclusions The treatment of choledocholithiasis with PAD in patients with endoscopic papillary small incision and balloon dilation treatment effect is significant,which can significantly improve the success rate of ERCP and success rate of one-time stone,benefitting the prognosis of patients.
Résumé
Objective To explore the effectiveness and safety of limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation (ESBD)for patients with large common duct stones and periampul-lary diverticula (PAD).Methods Data of 40 patients with large common duct stones (diameter ≥10 mm) and PAD who underwent ESBD were retrospectively reviewed.The clinical feature,operation method,suc-cess rates of stone removal and early complications rates during hospitalization were evaluated according to PAD subtypes.Results The stone removal rate in first session was 90.0%(36 /40,with a median time of 29 minutes per procedure.Three patients underwent a second procedure to remove residual stones.The over-all stone removal rate was 97.5% (39 /40).The early complications rate was 15%(6 /40),including mild pancreatitis in two cases(5%),hyperamylasemia in two (5%),postoperative late bleeding in two (5%), which were cured with conservative treatment.No perforation,massive hemorrhage or death occurred.No significant differences in success stone removal rate and early complication rate were found between PAD sub-types.Conclusion ESBD is an effective and safe procedure for removing choledocholithiasis in patients with PAD,regardless of PAD subtypes.
Résumé
Objective To evaluate the safety and effectiveness of three endoscopic methods for re-moval of common bile duct stones (CBDs)accompanied with periampullary diverticula(PAD).Methods A total of 154 patients hospitalized at Taizhou Hospital and Taizhou No.1 People′s Hospital of Zhejiang prov-ince from December 2012 to July 2013 were divided randomly into three groups,i.e.,EST,EPBD and ES-BD group,and received the treatment of EST,EPBD and limited EST plus EPBD (ESBD)to extract CBDs, respectively.After 12 months of follow-up,the rate of full stone clearance,stones clearance rate in one time,the rate of mechanical lithotripsy,the rate of urgent lithotripsy,the average procedures,the average removal time and the complication incidence among three groups were compared.Results The rates of stone clearance in one time in group ESBD was higher than those of group EST and group EPBD (94.12% VS 78.43%,73.08%;P <0.05)with significant difference.The average procedures in group ESBD was lower than that of group EPBD (1.08 VS 1.31,P <0.05),which also showed significant difference.The occur-rence rates of early complication in group ESBD was lower than that of group EPBD (15.69% VS 34.61%, P <0.05).The occurrence rates of post-ERCP hyperamylasemia in group ESBD was lower than that of group EPBD (5.88% VS 21.15%)with significant difference (P <0.05).The incidence of pneumobilia in group EST was higher than those of group EPBD (52.27% VS 26.19%,P =0.013)and group ESBD (52.27%VS 27.66%,P =0.016).Conclusion The stone extraction efficiency of ESBD is better than that of EST and EPBD.Compared with conventional EST,ESBD shows similar safety level,and is safer than EPBD.So ESBD is a safe and effective method to remove CBDs with PAD.
Résumé
Objective To evaluate the usefulness of MRCP in the diagnosis of Lemmel's syndrome.Methods 49 patients with periampullary diverliculum(PAD) were examined by MRCP.The clinical manifestations and imaging signs were analyzed,the detecting rate of PAD by MRCP,the anatomic relationship between pancreaticobiliary tract system and PAD were evaluated.Results Of 49 patients,47 PAD were showed on MRCP,in which 34 PAD located above the papilla,7 located below papilla,4 located in the neck edge of diverticula,and 2 were intradiverticular papilla.Conclusion MRCP as a newly developed and noninvasive imaging technique can improve the diagnosis of Lemmel's syndrome and will play an important role in the future.
Résumé
Objective To discuss the clinical applied value of MSCT MPR in displaying the relation between periampullary diverticula(PAD) and pancreaticobiliary duct.Methods There were 32 patients with PAD found through the volume scans by MSCT, and proved by endosope or GI. The axial source images after being reconstructed were transmitted to Vitrea workstation for observation, and the images which were valid to show the relation between PAD and pancreaticobiliary duct were get.Results In 32 patient,34 PADs were found,22PADs located above the papilla , 7 located in the neck edge of diverticula , 4 were papilla in diverticula and 1 located below papilla .Conclusion MPR can clearly display PAD and pancreaticobiliary duct, their relation and pancreaticobiliary disease.