目的探讨胆囊切除术后再次手术的原因及其防治措施。方法对近6年我院收治的胆囊切除术后仍有症状，经B超、ERCP、MRCP、腹部X线平片及十二指肠低张造影等检查发现需再次手术的81例患者的临床资料进行回顾性分析，并结合文献，对其常见原因及其预防治疗措施进行了讨论。结果81例患者根据不同病因予以了相应的手术，如残株胆囊切除术、胆总管切开取石术、十二指肠憩室手术等。再次手术均取得良好效果，无手术死亡。结论对胆囊切除术后仍有症状者应作全面检查，部分患者可找出原因进行相应治疗，能取得良好效果； 而且绝大部分的再次手术，通过术前评估及术中各种技巧的应用是可以防范的。
目的 观察内镜治疗急性胆源性胰腺炎（ABP）的疗效及其并发症。方法 30例ABP患者在抗炎、抑酶等综合治疗基础上，经内镜（1～3 d 内）逆行胰胆管造影（ERCP）及经内镜十二指肠乳头括约肌切开（EST）或鼻胆管引流（ENBD）等治疗。结果 内镜治疗后22 例（73.3%）轻症急性胆源性胰腺炎（MABP）患者3～5 d 体温恢复正常； 8例（26.7%） 重症急性胆源性胰腺炎（SABP）患者3～8 d 腹部体征好转，血常规、淀粉酶及血生化1~2周内基本恢复，平均住院18.7 d，3例死亡（10.0%）。内镜治疗过程中5例出现十二指肠乳头括约肌切口少量出血，经简单治疗止血，未再出现其他并发症。与同期开腹手术治疗相比较，症状体征缓解、血常规、淀粉酶、血生化恢复正常及住院的时间更短，死亡率无明显差异。结论 ABP早期ERCP 及内镜治疗安全有效。
Objective To explore the operation methods and indications of the transabdominal reverse guided-laparoscopic endoscopic sphincterotomy in treatment of duodenal papilla stenosis during the course of laparoscopic common bile duct exploration. Methods The clinical data of 501 cases of duodenal papilla stenosis who underwent laparoscopic endoscopic sphincterotomy with the transabdominal reverse guide technique from March 2003 to July 2015 in the Second People’s Hospital of Chengdu city were analyzed retrospectively. Results All operation of the 501 cases were successful, no death happened. The operation time were 60-190 min (average of 107 min), the blood loss were 5-100 mL (average of 21.8 mL), and postoperative hospitalization time were 4-9 days (average of 6.7 days). It was successful in 501 cases that removed the gallbladder, and successful in 493 cases (98.4%) that removed the common bile duct stones out of 501 cases. Six cases (1.2%) had residual stones in T tube drainage and received treatment with postoperative choledochoscope and electrohydraulic lithotripsy. Two cases (0.4%) of primary suture had residual stones. In the 501 cases, 364 cases (72.7%) underwent directly implementation of primary suture after the success of papillary stenosis cutting, 9 cases (1.8%) underwent primary suture after indwelling ureteral catheter, 118 cases (23.5%) underwent primary suture after detaining nasobiliary drainage, 4 cases (0.8%) failed in cutting the papillary stenosis and 6 cases (1.2%) had residual stones, all the 10 cases turned into the T tube drainage. After the operation, 9 cases (1.8%) suffered from mild pancreatitis and 23 cases (4.6%) suffered from bile leakage, no perforation of intestine and bile duct, bleeding, severe pancreatitis, and other complications happened. The overall incidence of postoperative complication was 6.8% (34/501). Conclusion If patients are suitable, transabdominal reverse guided-laparoscopic endoscopic sphincterotomy in treatment of duodenal papilla stenosis is safe and effective.
ObjectiveTo summarize the diagnosis and treatment process of a patient who underwent laparoscopic local excision of duodenal papillary tumor, and to explore the safety and feasibility of this surgery. MethodThe clinicopathologic characteristics and surgical procedure of the patient with duodenal papillary neuroendocrine tumor admitted to the West China Hospital of Sichuan University in June 2021 were retrospectively analyzed. ResultsThe patient underwent the laparoscopic local excision of duodenal papillary tumor + in situ cholangiojejunostomy and pancreaticojejunostomy. The operation lasted about 3 hours, the blood loss was about 20 mL, and the patient exhausted on the 3rd day after the operation. On the 7th postoperative day, the gastric tube was pulled out and oral feeding was started. On the 8th day, the plasma drainage tube was pulled out and the patient was discharged smoothly. There was no duodenal fistula, bleeding, wound infection, and other complications. After 6 months of follow-up, the general condition of this patient was good, and no tumor recurrence or metastasis was found. ConclusionLaparoscopic local excision is an appropriate option for benign or low-grade malignancies involving the duodenal papillary tumor.
目的:探讨MRI不同检查方法对十二指肠乳头旁憩室(periampullary diverticulum,PAD)的诊断价值。方法:应用MRI多序列检查方法诊断PAD23例,并进行分析。结果:T1WI显示为囊状低信号影,与十二指肠相通者1例,其余22例表现为不均匀略低及高低混杂信号,均未明确诊断;横断位压脂T2WI显示含气液平面囊性病灶15例;冠状位FIESTA序列表现为混杂高信号或高信号影15例;呼吸触发3D MRCP表现为高或混杂高信号影16例;冠状位屏气3DCE LAVA动态增强扫描均清晰显示。其中合并胆系结石13例,胆系炎症及感染13例,胰腺炎3例,胆胰管扩张3例,十二指肠炎症3例。结论:MRI能多序列、多方位、直观、无创的清晰显示PAD的部位、大小、范围及与邻近结构的关系,同时显示胆胰疾病形态学改变。故MRI多序列检查非常必要,是PAD诊断及鉴别诊断的重要方法。
ObjectiveTo investigate the value of endoscopic sphincterotomy (EST) on treating sphincter of Oddi dysfunction (SOD). MethodsForty-two patients with SOD according to Rome Ⅱ diagnostic criteria were retrospectively summarized. Bile duct residual stone, tumor or biliopancreatic duct obstruction diseases were excluded by B ultrasound, CT, and MRCP examination. Total 42 patients underwent EST. ResultsEST was done successfully in 42 cases, success rate was 100%. Postoperative acute pancreatitis occurred in 5 patients (11.90%), which were cured by 3－7 d conservative treatment. There were no complications of severe acute pancreatitis, digestive tract perforation, hemorrhage, and cholangitis. Follow-up 12-45 months (mean 23.8 months), symptoms of abdominal pain in all cases were improved or relieved, the effective rate was 100%. There were 2 cases treated conservatively because of hyperlipemic pancreatitis. ConclusionEST has become the primary treatment procedure for SOD because of definite outcome, less suffering, safety, less complications, and reproducibility, which are concordant with the requirements of minimally invasive surgery.
Objective To investigate the early diagnosis and treatment methods of primary duodenal papilla carcinoma. Methods The medical records of 54 patients with primary duodenal papilla adenocarcinoma underwent operation between January 2002 and December 2008 were reviewed. Results Thirty seven cases received fiberduodenoscopy and 35 cases received ERCP, and the accuracy of them were both 100%. Forty four patients received duodenopancreatectomy and 10 patients received jaundice-reducing operation. The 1-, 3-, and 5-year cumulation survival rate was 68%, 50%, and 29%, respectively. Conclusions Fiberduodenoscopy and ERCP are the effective diagnostic methods for duodenal papilla carcinoma. Early diagnosis and early rational radical operation are essential for successful treatment of duodenal papilla carcinoma.
Objective To investigate the severe complications recently after endoscopic sphincterotomy (EST) and related risk factors. Methods Two thousands one hundred and twenty patients after EST in People’s Hospital of Leshan city in recent 15 years were collected to be analyzed. The incidence rates of severe complications were observed and related risk factors were analyzed. Results Thirty four cases (1.60%) in 2 120 patients presented severe complications in 72 h after EST: Nine were with hemorrhage, 23 with acute pancreatitis, 1 with duodenum perforation and 1 with septicemia. Acute pancreatitis was the most remarkable severe complication. The duodenal papilla with tumor or inflammation, and oddi dysfunction were the primary risk factors of hemorrhage or acute pancreatitis, respectively. The rate of oddi dysfunction patients with acute pancreatitis reached up to 44.68% (21/47). Conclusions Acute pancreatitis is the most common severe complications recently after EST and sphincter of oddi dysfunction is the most remarkable risk factor.