目的探讨经胰管预切开技术联合双导丝法在胆管恶性肿瘤困难插管中的应用。方法选取2022年4月—2025年3月河北省沧州市中心医院收治的胆管恶性肿瘤行ERCP的患者104例,按照随机数字表法将其分成常规组与预切开组,每组52例。患者接受常规...目的探讨经胰管预切开技术联合双导丝法在胆管恶性肿瘤困难插管中的应用。方法选取2022年4月—2025年3月河北省沧州市中心医院收治的胆管恶性肿瘤行ERCP的患者104例,按照随机数字表法将其分成常规组与预切开组,每组52例。患者接受常规插管操作,导丝误入胰管>2次,困难插管时,导丝误入胰管即保留胰管导丝,常规组再次进行胆管超选插管,预切开组应用乳头切开刀沿胆管方向进行乳头预切开,再次进行胆管超选,对比2组临床指标、血气指标、炎症指标、医疗恐惧、并发症发生率。结果预切开组首次插管成功率(96.15%)高于常规组首次插管成功率(82.69%),差异有统计学意义(χ^(2)=4.981,P=0.026);插管时间、排气时间、住院时间均短于常规组(t=2.956、2.183、2.471,均P<0.05)。插管后,预切开组pH值、动脉血氧分压(partial pressure of oxygen in arterial blood,PaO_(2))高于常规组(t=2.884、2.324,均P<0.05),PaCO_(2)低于常规组(t=2.388,P=0.019)。插管后,预切开组C反应蛋白(C-reactive protein,CRP)、白细胞介素6(interleukin-6,IL-6)、血淀粉酶水平低于常规组(t=2.494、2.438、2.188,均P<0.05)。插管后,预切开组医疗恐惧评分低于常规组(P<0.05)。预切开组患者的并发症发生率(1.92%)低于常规组并发症发生率(13.46%),差异有统计学意义(χ^(2)=4.875,P=0.027)。结论经胰管预切开技术联合双导丝法能通过“预开窗+双导向”提高胆管恶性肿瘤困难插管首次成功率、缩短操作与康复时间;还可减轻血气失衡、炎症反应及医疗恐惧,降低并发症发生率,充分体现“精准微创”优势,为该类患者提供更可靠的治疗方案。展开更多
目的探讨胆囊神经内分泌肿瘤(neuroendocrine tumor of gallbladder,GB-NET)与胆囊腺癌(gallbladder adenocarcinoma,GB-ADC)MRI征象特征,为临床诊疗提供参考。方法回顾性分析经病理证实的21例GB-NET和42例GB-ADC患者的临床、病理及影...目的探讨胆囊神经内分泌肿瘤(neuroendocrine tumor of gallbladder,GB-NET)与胆囊腺癌(gallbladder adenocarcinoma,GB-ADC)MRI征象特征,为临床诊疗提供参考。方法回顾性分析经病理证实的21例GB-NET和42例GB-ADC患者的临床、病理及影像学资料,分析MRI特征。结果与GB-ADC组相比,GB-NET组患者MRI影像学表现肿瘤边缘清晰者比例更高(P=0.036),黏膜完整者比例更高(P=0.001),且在增强扫描与扩散加权成像中更多表现为厚环状强化及扩散受限(P<0.001)。此外,GB-NET组肝转移发生率显著高于GB-ADC组(P<0.001),其肝转移灶亦多表现为环形强化与扩散受限。GB-NET患者肿块与脾的表观扩散系数比值显著低于GB-ADC患者(P<0.001)。结论GB-NET和GB-ADC的MRI表现存在差异,对临床诊断GB-NET和GB-ADC具有积极参考价值。展开更多
Based on the Bismuth-Corlette classification of hilar cholangiocarcinoma,the patients with types I,II,and III can undergo radical resection in the absence of extensive intrahepatic metastasis and vascular invasion[1]....Based on the Bismuth-Corlette classification of hilar cholangiocarcinoma,the patients with types I,II,and III can undergo radical resection in the absence of extensive intrahepatic metastasis and vascular invasion[1].Depending on the scope of tumor invasion in bile duct,a combined resection of parts of the liver,hepatic ducts,common bile ducts,regional lymph nodes,and even parts of the duodenum and pancreas is necessary,along with biliary and gastrointestinal reconstructions[2].The surgical plan is complex,involving a large resection area and significant trauma.In recent years,laparoscopic or robot assisted radical resection of hilar cholangiocarcinoma has been applied clinically[3,4].With the advanced laparoscopic equipment,many patients undergo hepatopancreatoduodenectomy successfully[5].The limitations of traditional laparoscopic techniques restrict their wide application in clinical practice.However,the Da Vinci robot has been widely applied due to its clear field of vision and flexible manipulation.However,its utilization in hepato-pancreatoduodenectomy for hilar cholangiocarcinoma is still relatively rare.Here,we report a case with hilar cholangiocarcinoma at clinical stage IIIb who underwent robot-assisted hepato-pancreatoduodenectomy.展开更多
Perihilar cholangiocarcinoma(pCCA)and intrahepatic cholangiocarcinoma(iCCA)are highly malignant neoplasms with a 5-year overall survival rate of approximately 30%[1,2].Surgical resection remains the only potentially c...Perihilar cholangiocarcinoma(pCCA)and intrahepatic cholangiocarcinoma(iCCA)are highly malignant neoplasms with a 5-year overall survival rate of approximately 30%[1,2].Surgical resection remains the only potentially curative treatment,yet only one-fifth of patients are eligible for resection at initial diagnosis[3].Threedimensional(3D)reconstruction technology provides precise preoperative visualization of complex hilar anatomy,significantly enhancing surgical planning and outcomes[4].Recent advances in 3D reconstruction technology have enhanced preoperative planning by providing precise anatomical mapping of tumor-vessel relationships and biliary variations[4,5].Therefore,this report describes a case of left iCCA successfully resected with biliary reconstruction guided by 3D visualization.展开更多
文摘目的探讨经胰管预切开技术联合双导丝法在胆管恶性肿瘤困难插管中的应用。方法选取2022年4月—2025年3月河北省沧州市中心医院收治的胆管恶性肿瘤行ERCP的患者104例,按照随机数字表法将其分成常规组与预切开组,每组52例。患者接受常规插管操作,导丝误入胰管>2次,困难插管时,导丝误入胰管即保留胰管导丝,常规组再次进行胆管超选插管,预切开组应用乳头切开刀沿胆管方向进行乳头预切开,再次进行胆管超选,对比2组临床指标、血气指标、炎症指标、医疗恐惧、并发症发生率。结果预切开组首次插管成功率(96.15%)高于常规组首次插管成功率(82.69%),差异有统计学意义(χ^(2)=4.981,P=0.026);插管时间、排气时间、住院时间均短于常规组(t=2.956、2.183、2.471,均P<0.05)。插管后,预切开组pH值、动脉血氧分压(partial pressure of oxygen in arterial blood,PaO_(2))高于常规组(t=2.884、2.324,均P<0.05),PaCO_(2)低于常规组(t=2.388,P=0.019)。插管后,预切开组C反应蛋白(C-reactive protein,CRP)、白细胞介素6(interleukin-6,IL-6)、血淀粉酶水平低于常规组(t=2.494、2.438、2.188,均P<0.05)。插管后,预切开组医疗恐惧评分低于常规组(P<0.05)。预切开组患者的并发症发生率(1.92%)低于常规组并发症发生率(13.46%),差异有统计学意义(χ^(2)=4.875,P=0.027)。结论经胰管预切开技术联合双导丝法能通过“预开窗+双导向”提高胆管恶性肿瘤困难插管首次成功率、缩短操作与康复时间;还可减轻血气失衡、炎症反应及医疗恐惧,降低并发症发生率,充分体现“精准微创”优势,为该类患者提供更可靠的治疗方案。
文摘目的探讨胆囊神经内分泌肿瘤(neuroendocrine tumor of gallbladder,GB-NET)与胆囊腺癌(gallbladder adenocarcinoma,GB-ADC)MRI征象特征,为临床诊疗提供参考。方法回顾性分析经病理证实的21例GB-NET和42例GB-ADC患者的临床、病理及影像学资料,分析MRI特征。结果与GB-ADC组相比,GB-NET组患者MRI影像学表现肿瘤边缘清晰者比例更高(P=0.036),黏膜完整者比例更高(P=0.001),且在增强扫描与扩散加权成像中更多表现为厚环状强化及扩散受限(P<0.001)。此外,GB-NET组肝转移发生率显著高于GB-ADC组(P<0.001),其肝转移灶亦多表现为环形强化与扩散受限。GB-NET患者肿块与脾的表观扩散系数比值显著低于GB-ADC患者(P<0.001)。结论GB-NET和GB-ADC的MRI表现存在差异,对临床诊断GB-NET和GB-ADC具有积极参考价值。
文摘Based on the Bismuth-Corlette classification of hilar cholangiocarcinoma,the patients with types I,II,and III can undergo radical resection in the absence of extensive intrahepatic metastasis and vascular invasion[1].Depending on the scope of tumor invasion in bile duct,a combined resection of parts of the liver,hepatic ducts,common bile ducts,regional lymph nodes,and even parts of the duodenum and pancreas is necessary,along with biliary and gastrointestinal reconstructions[2].The surgical plan is complex,involving a large resection area and significant trauma.In recent years,laparoscopic or robot assisted radical resection of hilar cholangiocarcinoma has been applied clinically[3,4].With the advanced laparoscopic equipment,many patients undergo hepatopancreatoduodenectomy successfully[5].The limitations of traditional laparoscopic techniques restrict their wide application in clinical practice.However,the Da Vinci robot has been widely applied due to its clear field of vision and flexible manipulation.However,its utilization in hepato-pancreatoduodenectomy for hilar cholangiocarcinoma is still relatively rare.Here,we report a case with hilar cholangiocarcinoma at clinical stage IIIb who underwent robot-assisted hepato-pancreatoduodenectomy.
基金supported by grants from the National Natural Science Foundation of China(82170412)Shanghai Municipal Science and Technology Commission Clinical Innovation Research Special Project(23Y11905400).
文摘Perihilar cholangiocarcinoma(pCCA)and intrahepatic cholangiocarcinoma(iCCA)are highly malignant neoplasms with a 5-year overall survival rate of approximately 30%[1,2].Surgical resection remains the only potentially curative treatment,yet only one-fifth of patients are eligible for resection at initial diagnosis[3].Threedimensional(3D)reconstruction technology provides precise preoperative visualization of complex hilar anatomy,significantly enhancing surgical planning and outcomes[4].Recent advances in 3D reconstruction technology have enhanced preoperative planning by providing precise anatomical mapping of tumor-vessel relationships and biliary variations[4,5].Therefore,this report describes a case of left iCCA successfully resected with biliary reconstruction guided by 3D visualization.
