RESUMO
Objective To investigate the value of SpyGlass single-operator choledochoscopy system in the diagnosis and treatment of patients with unexplained biliary stricture, complex bile duct stones, or other biliary tract diseases. Methods A retrospective analysis was performed for the clinical data of the patients with biliary tract diseases who were diagnosed and treated with SpyGlass in The Second Affiliated Hospital of Nanjing Medical University from December 2017 to June 2020. For the patients with biliary stricture, the biliary lesions were fully visualized under the guidance of SpyGlass, and SpyBite biopsy was performed if necessary; the patients with bile duct stones were treated with SpyGlass-guided direct-view laser lithotripsy; for the patients with gallbladder disease, the cystic duct was superselected with the assistance of SpyGlass. The SpyGlass system was analyzed in terms of its sensitivity, specificity, and accuracy rate in diagnosis and treatment, lithotripsy success rate, stone clearance rate, procedure success rate, and incidence rate of complications. Results A total of 58 patients underwent SpyGlass procedure. SpyGlass was used to evaluate biliary stricture of unknown nature in 44 (76%) patients; SpyGlass visual impression had a diagnostic sensitivity of 92% (24/26), a specificity of 94% (17/18), and an accuracy of 93% (41/44), and SpyBite biopsy had a diagnostic sensitivity of 71% (15/21), a specificity of 92% (11/12), and an accuracy of 79% (26/33). SpyGlass was used for the treatment of bile duct stones in 8 patients (14%), with a lithotripsy success rate of 83% (5/6) and a stone clearance rate of 88% (7/8). A guide wire under the SpyGlass system was to superselect the cystic duct in 5 patients (9%), with a procedure success rate of 80% (4/5). In one patient (1%), SpyGlass was used to assist the removal of common bile duct stones after liver transplantation and the treatment of bile duct anastomotic stricture. A total of 5 patients (9%) experienced complications after surgery. Conclusion The SpyGlass choledochoscopy system is accurate, safe, and effective in the diagnosis and treatment of unexplained biliary stricture, complex bile duct stones, and other biliary tract diseases.
RESUMO
Objective To investigate the value of SpyGlass single-operator choledochoscopy system in the diagnosis and treatment of patients with unexplained biliary stricture, complex bile duct stones, or other biliary tract diseases. Methods A retrospective analysis was performed for the clinical data of the patients with biliary tract diseases who were diagnosed and treated with SpyGlass in The Second Affiliated Hospital of Nanjing Medical University from December 2017 to June 2020. For the patients with biliary stricture, the biliary lesions were fully visualized under the guidance of SpyGlass, and SpyBite biopsy was performed if necessary; the patients with bile duct stones were treated with SpyGlass-guided direct-view laser lithotripsy; for the patients with gallbladder disease, the cystic duct was superselected with the assistance of SpyGlass. The SpyGlass system was analyzed in terms of its sensitivity, specificity, and accuracy rate in diagnosis and treatment, lithotripsy success rate, stone clearance rate, procedure success rate, and incidence rate of complications. Results A total of 58 patients underwent SpyGlass procedure. SpyGlass was used to evaluate biliary stricture of unknown nature in 44 (76%) patients; SpyGlass visual impression had a diagnostic sensitivity of 92% (24/26), a specificity of 94% (17/18), and an accuracy of 93% (41/44), and SpyBite biopsy had a diagnostic sensitivity of 71% (15/21), a specificity of 92% (11/12), and an accuracy of 79% (26/33). SpyGlass was used for the treatment of bile duct stones in 8 patients (14%), with a lithotripsy success rate of 83% (5/6) and a stone clearance rate of 88% (7/8). A guide wire under the SpyGlass system was to superselect the cystic duct in 5 patients (9%), with a procedure success rate of 80% (4/5). In one patient (1%), SpyGlass was used to assist the removal of common bile duct stones after liver transplantation and the treatment of bile duct anastomotic stricture. A total of 5 patients (9%) experienced complications after surgery. Conclusion The SpyGlass choledochoscopy system is accurate, safe, and effective in the diagnosis and treatment of unexplained biliary stricture, complex bile duct stones, and other biliary tract diseases.
RESUMO
Objective To observe clinical curative effect of the external application of Wentong Paste plus local block therapy for the treatment of stenosing tendovaginitis at radial styloid. Methods A total of 108 cases of patients with stenosing tendovaginitis at the radial styloid were randomly divided into local block therapy group, combination group and Wentong Paste group, 36 cases in each group. The local block therapy group was given injection of blocking liquid into the tendon sheath, combination group was given external application of Wentong Paste(mainly composed of Radix Angelicae Sinensis, Fructus Psoraleae, Radix Angelicae Pubescentis, and Rhizoma et Radix Notopterygii) plus local block therapy, and Wentong Paste group was only given external application of Wentong Paste. Before treatment and after treatment for one and 2 week(s), visual analogue scale (VAS) scores of pain and range of motion (ROM) of wrist joint were observed for the evaluation of clinical effectiveness and safety. The patients were followed up for 3 months for the assay of recurrence rate. Results (1) After treatment for one week, the total effective rate of local block therapy group, combination group and Wentong Paste group was 77.8%, 100.0%, 72.2%respectively, and the total effective rate after treatment for 2weeks was 86.1%, 100.0%, 86.1% respectively. The combination group had better clinical efficacy than local block therapy group and Wentong Paste group (P < 0.05). (2) After treatment for one and 2 week (s), VAS scores of the 3 groups were obviously increased while ROM was much increased (P < 0.05 compared with those before treatment). The combination group had the lowest VAS scores and highest ROM(P < 0.05).(3) No adverse reaction was found in the 3 groups during the treatment. (4) The 3 month follow-up results showed that the recurrence rate of the three groups was 30.61%, 10.20%, 20.41% respectively, and the combination group had the lower rate than local block therapy group and Wentong Paste group(P<0.05). Conclusion The external application of Wentong Paste plus local block therapy is effective for the treatment of stenosing tendovaginitis at radial styloid by relieving pain, increasing the ROM, and reducing the recurrence rate. The one-week efficacy of Wentong Paste alone was inferior to that of local block therapy alone, but their two-week efficacy showed no obvious difference. Moreover, Wentong Paste has an obvious advantage in reducing the recurrence rate.