BACKGROUND Percutaneous endoscopic lumbar discectomy(PTED)is a procedure that is commonly used to treat lumbar disc herniation and spinal stenosis.Despite its less invasiveness,this surgery is rarely used to treat spi...BACKGROUND Percutaneous endoscopic lumbar discectomy(PTED)is a procedure that is commonly used to treat lumbar disc herniation and spinal stenosis.Despite its less invasiveness,this surgery is rarely used to treat spinal metastases.Percutaneous vertebroplasty(PVP)has been utilized to treat lumbar vertebral body metastases but it has not proven useful in treating sciatic patients.CASE SUMMARY A 68-year-old woman presented with low back pain and radicular symptoms.She couldn't straighten her legs because of severe pain.Computed tomography(CT)showed a mass lesion in the lung and bone destruction in the L4 vertebrae.The biopsy of the lung lesion revealed adenocarcinoma and the biopsy for L4 vertebrae revealed metastatic adenocarcinoma.PTED paired with PVP was performed on the patient due to the patient's poor overall physical state and short survival time.Transcatheter arterial embolization of vertebral tumors was performed before surgical resection to reduce excessive blood loss during the operation.The incision was scaled up with the TESSY technology.The pain was obviously relieved following the operation and no serious complications occurred.Postoperative CT showed that the decompression around the nerve root was successful,polymethyl methacrylate filling was satisfactory and the tumor tissue around the nerve root was obviously removed.During the 1-year follow-up period,the patient was in a stable condition.CONCLUSION PTED in combination with PVP is an effective and safe treatment for Lumbar single-level Spinal Column metastases with radicular symptoms.Because of the small sample size and short followup time,the long-term clinical efficacy of this method needs to be further confirmed.展开更多
Objective To investigate the methods and effectiveness to treat Chiari malformation with surgical decompression of foramen magnum under endoscope. Methods 23 cases with Chiari malformation. (withoutatlanto-axial dislo...Objective To investigate the methods and effectiveness to treat Chiari malformation with surgical decompression of foramen magnum under endoscope. Methods 23 cases with Chiari malformation. (withoutatlanto-axial dislocation and basilar invagination) diagnosed by magnetic resonance imaging(MRI) were operated with the surgical decompression for foramen magnum under the endoscope. Results 23展开更多
Lumbar Disc Herniation and Lumbar Spine Stenosis are the most common spine diseases which are mainly due to age related Spine degeneration. Diagnosis of both Lumbar Disc Herniation and Lumbar Spine Stenosis depends on...Lumbar Disc Herniation and Lumbar Spine Stenosis are the most common spine diseases which are mainly due to age related Spine degeneration. Diagnosis of both Lumbar Disc Herniation and Lumbar Spine Stenosis depends on clinical findings as well as radiological investigations. Treatment of choice of these conditions is on the basis of the patient conditions. Surgical treatment is the option only when the conservative treatment does not improve the patient’s clinical condition. Advancement and improvement of the technology have resulted in the traditional open surgical treatment into minimal invasive surgery. Intervention of the different surgical instruments with expert spinal surgeons had made percutaneous endoscopic lumbar Spine surgery as one of the preferred choices of surgery for treating Lumbar Disc Herniation and Lumbar Spine Stenosis. The concept of percutaneous endoscopic surgery for lumbar region is to provide surgical options without producing iatrogenic morbidity associated with the open surgical procedures. Conventionally, there are different approaches/techniques for Percutaneous Endoscopic Lumbar Spine Surgery, but in this review we are mainly focusing on the Transforaminal Technique. Regarding the Lumbar Disc Herniation treatment with transforaminal approach, a number of articles have been published due to which we mainly focused on those articles which were published after 2009 onwards. While fewer articles related to Lumbar Spine Stenosis treatment with Transforaminal approach were found, we tried to brief out all those articles. On the basis of comparative study of different surgeries done for Lumbar Disc Herniation and Lumbar Spine Stenosis, Percutaneous Transforaminal endoscopic Lumbar Surgery provides a substantial benefit. Transforaminal approach for treating Lumbar Disc Herniation and Lumbar Spine Stenosis is safe and effective. The Percutaneous Transforaminal Endoscopic Lumbar Surgery has advantage as it is performed under local anesthesia with shorter length of hospitalization and early return to normal life. The clinical outcome of the patient that underwent Percutaneous Transforaminal Endoscopic Lumbar Surgery for Lumbar Disc Herniation and Lumbar Spine Stenosis is quite good in regard of its fewer complication and more benefits.展开更多
Percutaneous endoscopic gastrostomy tube placement is an invaluable tool in clinical practice that has an important role in the palliative care of patients with gastrointestinal cancer. While there is no extensive dat...Percutaneous endoscopic gastrostomy tube placement is an invaluable tool in clinical practice that has an important role in the palliative care of patients with gastrointestinal cancer. While there is no extensive data regarding the use of this procedure in patients with gastrointestinal malignancy, inferences can be made from the available information derived from studies of similar or mixed populations. Percutaneous endoscopic gastrostomy tubes can be used to provide enteral nutrition for terminal malignancies of the upper gastrointestinal tract as well as for decompression of malignant obstructions. The rates of successful placement for cancer patients with either of these indications are high, similar to those in mixed populations. There is no conclusive evidence that the procedure will help patients reach nutritional goals for those needing alimental supplementation. However, it is effective at relieving symptoms caused by malignant obstruction. A high American Society of Anesthesiologist physical status score and an advanced tumor stage have been shown to be independent predictors of poor outcomes following placement in cancer patients. This suggests the potential for similar outcomes in the palliative care of patients with advanced stage gastrointestinal cancer who may be in relatively poor physiologic condition. However, this potential should not preclude its use in patients with terminal gastrointestinal cancer considering the high rate of successful tube placement, the possible benefits and the ultimate goal of comfort in palliative care.展开更多
Severe acute cholangitis(AC)exacerbates the risk of death because of the rapid progression of the disease.The optimal timing of biliary decompression(BD)as a necessary intervention in patients with severe AC is contro...Severe acute cholangitis(AC)exacerbates the risk of death because of the rapid progression of the disease.The optimal timing of biliary decompression(BD)as a necessary intervention in patients with severe AC is controversial.A recently report titled“Timing of endoscopic retrograde cholangiopancreatography in the treatment of acute cholangitis of different severity”in the World Journal of Gastroenterology that the optimal time of endoscopic retrograde cholangiopancreatography for treating patients with severe AC is≤48 but not≤24 h,providing clinical evidence for selecting the optimal time for implementation of BD.Here,we discuss the controversy over the optimal timing of BD for AC based on guidelines and clinical evidence,and consider that more high-level clinical researches are urgent needed to benefit the management of patients with different severity of AC.展开更多
Background: The authors present the results of a four surgeon, multicenter study of endoscopic decompression for the treatment of Civinini-Morton’s entrapment of 193 interspaces. Methods: A retrospective review of 19...Background: The authors present the results of a four surgeon, multicenter study of endoscopic decompression for the treatment of Civinini-Morton’s entrapment of 193 interspaces. Methods: A retrospective review of 193 interspaces, which were decompressed by four different surgeons. Results: The overall success rate was high, with 92% of patients reporting a good or fair outcome. Higher success rates were reported in the 3rd interspace decompression group (95%) compared to the 2nd interspace decompression group (85%). Complications reported were minimal, with only seven cases requiring a revision with traditional neurectomy. No revisions were required in the 3rd interspace decompression group. Five of the revisions were in the 2nd interspace decompression group, with the remaining two revisions in the combined 2nd/3rd interspace decompression group. Conclusions: Endoscopic decompression for the treatment of Civinnini-Morton’s entrapment is a safe and efficacious method of treatment of this nerve entrapment, with very low complication rates and rapid return to normal activity.展开更多
BACKGROUND This reported procedure combines the orthopedic surgical robot with the unilateral biportal endoscopy-lumbar interbody fusion(UBE-LIF),utilizing the UBE's wide viewing field and operating space to perfo...BACKGROUND This reported procedure combines the orthopedic surgical robot with the unilateral biportal endoscopy-lumbar interbody fusion(UBE-LIF),utilizing the UBE's wide viewing field and operating space to perform minimally invasive decompressive fusion of the lesioned segment,and the orthopedic surgical robot's intelligence and precision to perform percutaneous pedicle screw placement.The advancement of this procedure lies in the superposition of advantages and offsetting disadvantages of the two new technologies,and the maximum effect of treatment is achieved with maximum minimization of invasiveness and precision under the monitoring of imaging instruments to maximize the benefit of patients,and this review reports a case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE for reference.CASE SUMMARY A 44-year-old patient presented to our hospital.Combining various clinical data,we diagnosed the patient with lumbar disc herniation with radiculopathy,lumbar spondylolisthesis,and lumbar spinal stenosis.We developed a surgical plan of"UBE decompression+UBE-LIF+orthopedic surgery robot-assisted percutaneous pedicle screw implantation for internal fixation".The results were satisfactory.CONCLUSION We present an extremely rare case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE and achieved good results.Therefore,the technique is worthy of clinical promotion.展开更多
Background:To describe the surgical technique and assess the clinical efficacy and safety of modified endoscopic transnasal orbital apex decompression in the treatment of dysthyroid optic neuropathy.Methods:In this re...Background:To describe the surgical technique and assess the clinical efficacy and safety of modified endoscopic transnasal orbital apex decompression in the treatment of dysthyroid optic neuropathy.Methods:In this retrospective research,forty-two subjects(74 orbits)who underwent modified endoscopic transnasal orbital apex decompression for the treatment of dysthyroid optic neuropathy were enrolled.Preoperative and postoperative best-corrected visual acuity(BCVA),visual field mean deviation(MD),Hertel exophthalmometry,and new onset diplopia were assessed before and after the intervention.The Wilcoxon test was used for differential analysis.Linear mixed-models’analyses were conducted to assess the potential predictors for BCVA change.Results:Postoperatively,the mean BCVA improved from 0.70±0.62 logMAR to 0.22±0.33 logMAR.BCVA significantly improved in 69 eyes(93%),remained stable in 4 eyes(5%)and deteriorated in 1 eye(1%).MD of visual fields improved from−13.73±9.22 dB to−7.23±7.04 dB.Proptosis decreased from 19.57±3.38mm to 16.35±3.01mm.Preoperative BCVA,MD of visual fields and medical rectus diameter were independent factors associated with improvements in BCVA(P<0.05)by linear mixed-models’analyses.Eighteen patients(42.9%)developed new diplopia postoperatively.Conclusion:Modified endoscopic transnasal orbital apex decompression effectively restores vision in dysthyroid optic neuropathy.展开更多
Objective: The management of traumatic facial nerve paralysis(FNP) has remained a controversial issue with conflicting findings arguing between surgical decompression and conservative management.However, recent advanc...Objective: The management of traumatic facial nerve paralysis(FNP) has remained a controversial issue with conflicting findings arguing between surgical decompression and conservative management.However, recent advances in endoscopic surgery may consolidate the management plan for this condition.Methods: This prospective clinical study included patients with posttraumatic FNP at a tertiary referral center. Patients were categorized in two main groups: surgical and conservative. Indications for surgery included patients with immediate and complete FNP, no improvement in facial function on medical treatment, with electroneurography showing >90% degeneration or electromyography showing fibrillation potential. Patients who did not satisfy this criterion received the conservative approach. The transcanal endoscopic approach(TEA) or endoscopic assisted transmastoid approach was performed for facial nerve decompression in the surgical group.Outcome: The main outcome was facial function improvement, assessed using the House Brackmann grading scale(HBGS) 6 months after surgery, and hearing state assessed using the air bone gap(ABG).Results: The study included 38 patients, of whom 15 underwent had surgical decompression and 23underwent conservative therapy. A significant improvement in facial nerve function from a mean of4.66 ± 0.97 to 1.71 ± 0.69(P = 0.001) and ABG from a median of 30(10-40) to 20(10-25)(P = 0.002)was observed.Conclusion: Decision-making in cases of traumatic FNP is critical. The geniculate ganglion and tympanic segment were the most commonly affected areas in FNP cases. The TEA represents the most direct and least invasive approach for this area.展开更多
Background:Post-ERCP pancreatitis(PEP)is significantly influenced by the reflux of duodenal fluid.While gastrointestinal decompression represents a fundamental approach in acute pancreatitis management,the effectivene...Background:Post-ERCP pancreatitis(PEP)is significantly influenced by the reflux of duodenal fluid.While gastrointestinal decompression represents a fundamental approach in acute pancreatitis management,the effectiveness of immediate duodenal decompression following ERCP to prevent PEP remains uncertain.This study aimed to investigate the impact of immediate duodenal decompression after ERCP on reducing the incidence of hyperamylasemia and PEP.Methods:This retrospective study encompassed patients with native papilla who underwent therapeutic ERCP for choledocholithiasis at the Department of Gastroenterology,Chun’an Branch of Zhejiang Provincial People’s Hospital(Zhejiang,China)between January 2020 and June 2023.Based on the immediate placement of a duodenal decompression tube post-ERCP,patients were categorized into two groups:the duodenal decompression group and the conventional procedure group.Primary outcomes included the incidence of PEP and hyperamylasemia.Results:A total of 195 patients were enrolled(94 in the duodenal decompression group and 101 in the conventional procedure group).Baseline clinical and procedural characteristics exhibited no significant differences between the two groups.PEP occurred in 2 patients(2.1%)in the duodenal decompression group,in contrast to 11 patients(10.9%)in the conventional procedure group(Risk difference[RD]8.8%;95%confidence interval[CI]1.7%-16.5%,P=0.014).Hyperamylasemia was observed in 8 patients(8.5%)in the duodenal decompression group,compared to 20 patients(19.8%)in the conventional procedure group(RD 11.3%;95%CI 1.4%-21.0%;P=0.025).Patients with PEP in both groups showed improvement after receiving active treatment.No severe cases of PEP occurred in either group,and no serious adverse events related to duodenal catheter decompression were reported.Conclusion:Immediate duodenal decompression following ERCP demonstrates an effective reduction in the incidence of hyperamylasemia and PEP.展开更多
文摘BACKGROUND Percutaneous endoscopic lumbar discectomy(PTED)is a procedure that is commonly used to treat lumbar disc herniation and spinal stenosis.Despite its less invasiveness,this surgery is rarely used to treat spinal metastases.Percutaneous vertebroplasty(PVP)has been utilized to treat lumbar vertebral body metastases but it has not proven useful in treating sciatic patients.CASE SUMMARY A 68-year-old woman presented with low back pain and radicular symptoms.She couldn't straighten her legs because of severe pain.Computed tomography(CT)showed a mass lesion in the lung and bone destruction in the L4 vertebrae.The biopsy of the lung lesion revealed adenocarcinoma and the biopsy for L4 vertebrae revealed metastatic adenocarcinoma.PTED paired with PVP was performed on the patient due to the patient's poor overall physical state and short survival time.Transcatheter arterial embolization of vertebral tumors was performed before surgical resection to reduce excessive blood loss during the operation.The incision was scaled up with the TESSY technology.The pain was obviously relieved following the operation and no serious complications occurred.Postoperative CT showed that the decompression around the nerve root was successful,polymethyl methacrylate filling was satisfactory and the tumor tissue around the nerve root was obviously removed.During the 1-year follow-up period,the patient was in a stable condition.CONCLUSION PTED in combination with PVP is an effective and safe treatment for Lumbar single-level Spinal Column metastases with radicular symptoms.Because of the small sample size and short followup time,the long-term clinical efficacy of this method needs to be further confirmed.
文摘Objective To investigate the methods and effectiveness to treat Chiari malformation with surgical decompression of foramen magnum under endoscope. Methods 23 cases with Chiari malformation. (withoutatlanto-axial dislocation and basilar invagination) diagnosed by magnetic resonance imaging(MRI) were operated with the surgical decompression for foramen magnum under the endoscope. Results 23
文摘Lumbar Disc Herniation and Lumbar Spine Stenosis are the most common spine diseases which are mainly due to age related Spine degeneration. Diagnosis of both Lumbar Disc Herniation and Lumbar Spine Stenosis depends on clinical findings as well as radiological investigations. Treatment of choice of these conditions is on the basis of the patient conditions. Surgical treatment is the option only when the conservative treatment does not improve the patient’s clinical condition. Advancement and improvement of the technology have resulted in the traditional open surgical treatment into minimal invasive surgery. Intervention of the different surgical instruments with expert spinal surgeons had made percutaneous endoscopic lumbar Spine surgery as one of the preferred choices of surgery for treating Lumbar Disc Herniation and Lumbar Spine Stenosis. The concept of percutaneous endoscopic surgery for lumbar region is to provide surgical options without producing iatrogenic morbidity associated with the open surgical procedures. Conventionally, there are different approaches/techniques for Percutaneous Endoscopic Lumbar Spine Surgery, but in this review we are mainly focusing on the Transforaminal Technique. Regarding the Lumbar Disc Herniation treatment with transforaminal approach, a number of articles have been published due to which we mainly focused on those articles which were published after 2009 onwards. While fewer articles related to Lumbar Spine Stenosis treatment with Transforaminal approach were found, we tried to brief out all those articles. On the basis of comparative study of different surgeries done for Lumbar Disc Herniation and Lumbar Spine Stenosis, Percutaneous Transforaminal endoscopic Lumbar Surgery provides a substantial benefit. Transforaminal approach for treating Lumbar Disc Herniation and Lumbar Spine Stenosis is safe and effective. The Percutaneous Transforaminal Endoscopic Lumbar Surgery has advantage as it is performed under local anesthesia with shorter length of hospitalization and early return to normal life. The clinical outcome of the patient that underwent Percutaneous Transforaminal Endoscopic Lumbar Surgery for Lumbar Disc Herniation and Lumbar Spine Stenosis is quite good in regard of its fewer complication and more benefits.
文摘Percutaneous endoscopic gastrostomy tube placement is an invaluable tool in clinical practice that has an important role in the palliative care of patients with gastrointestinal cancer. While there is no extensive data regarding the use of this procedure in patients with gastrointestinal malignancy, inferences can be made from the available information derived from studies of similar or mixed populations. Percutaneous endoscopic gastrostomy tubes can be used to provide enteral nutrition for terminal malignancies of the upper gastrointestinal tract as well as for decompression of malignant obstructions. The rates of successful placement for cancer patients with either of these indications are high, similar to those in mixed populations. There is no conclusive evidence that the procedure will help patients reach nutritional goals for those needing alimental supplementation. However, it is effective at relieving symptoms caused by malignant obstruction. A high American Society of Anesthesiologist physical status score and an advanced tumor stage have been shown to be independent predictors of poor outcomes following placement in cancer patients. This suggests the potential for similar outcomes in the palliative care of patients with advanced stage gastrointestinal cancer who may be in relatively poor physiologic condition. However, this potential should not preclude its use in patients with terminal gastrointestinal cancer considering the high rate of successful tube placement, the possible benefits and the ultimate goal of comfort in palliative care.
文摘Severe acute cholangitis(AC)exacerbates the risk of death because of the rapid progression of the disease.The optimal timing of biliary decompression(BD)as a necessary intervention in patients with severe AC is controversial.A recently report titled“Timing of endoscopic retrograde cholangiopancreatography in the treatment of acute cholangitis of different severity”in the World Journal of Gastroenterology that the optimal time of endoscopic retrograde cholangiopancreatography for treating patients with severe AC is≤48 but not≤24 h,providing clinical evidence for selecting the optimal time for implementation of BD.Here,we discuss the controversy over the optimal timing of BD for AC based on guidelines and clinical evidence,and consider that more high-level clinical researches are urgent needed to benefit the management of patients with different severity of AC.
文摘Background: The authors present the results of a four surgeon, multicenter study of endoscopic decompression for the treatment of Civinini-Morton’s entrapment of 193 interspaces. Methods: A retrospective review of 193 interspaces, which were decompressed by four different surgeons. Results: The overall success rate was high, with 92% of patients reporting a good or fair outcome. Higher success rates were reported in the 3rd interspace decompression group (95%) compared to the 2nd interspace decompression group (85%). Complications reported were minimal, with only seven cases requiring a revision with traditional neurectomy. No revisions were required in the 3rd interspace decompression group. Five of the revisions were in the 2nd interspace decompression group, with the remaining two revisions in the combined 2nd/3rd interspace decompression group. Conclusions: Endoscopic decompression for the treatment of Civinnini-Morton’s entrapment is a safe and efficacious method of treatment of this nerve entrapment, with very low complication rates and rapid return to normal activity.
基金Supported by National Natural Science Foundation of China(Regional Program),No.82060879,No.82360947Gansu Province Key Talent Project,No.2024-4+2 种基金Natural Science Foundation of Gansu Province,No.20JR10RA356Gansu Provincial Joint Research Fund,No.23JRRA1534National Administration of Traditional Chinese Medicine High Level Key Discipline Construction Project of Traditional Chinese Medicine(Traditional Chinese Orthopedics and Traumatology Science),No.203.
文摘BACKGROUND This reported procedure combines the orthopedic surgical robot with the unilateral biportal endoscopy-lumbar interbody fusion(UBE-LIF),utilizing the UBE's wide viewing field and operating space to perform minimally invasive decompressive fusion of the lesioned segment,and the orthopedic surgical robot's intelligence and precision to perform percutaneous pedicle screw placement.The advancement of this procedure lies in the superposition of advantages and offsetting disadvantages of the two new technologies,and the maximum effect of treatment is achieved with maximum minimization of invasiveness and precision under the monitoring of imaging instruments to maximize the benefit of patients,and this review reports a case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE for reference.CASE SUMMARY A 44-year-old patient presented to our hospital.Combining various clinical data,we diagnosed the patient with lumbar disc herniation with radiculopathy,lumbar spondylolisthesis,and lumbar spinal stenosis.We developed a surgical plan of"UBE decompression+UBE-LIF+orthopedic surgery robot-assisted percutaneous pedicle screw implantation for internal fixation".The results were satisfactory.CONCLUSION We present an extremely rare case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE and achieved good results.Therefore,the technique is worthy of clinical promotion.
基金supported by the Natural Key Research and Development Program of China(2016YFC1101200).
文摘Background:To describe the surgical technique and assess the clinical efficacy and safety of modified endoscopic transnasal orbital apex decompression in the treatment of dysthyroid optic neuropathy.Methods:In this retrospective research,forty-two subjects(74 orbits)who underwent modified endoscopic transnasal orbital apex decompression for the treatment of dysthyroid optic neuropathy were enrolled.Preoperative and postoperative best-corrected visual acuity(BCVA),visual field mean deviation(MD),Hertel exophthalmometry,and new onset diplopia were assessed before and after the intervention.The Wilcoxon test was used for differential analysis.Linear mixed-models’analyses were conducted to assess the potential predictors for BCVA change.Results:Postoperatively,the mean BCVA improved from 0.70±0.62 logMAR to 0.22±0.33 logMAR.BCVA significantly improved in 69 eyes(93%),remained stable in 4 eyes(5%)and deteriorated in 1 eye(1%).MD of visual fields improved from−13.73±9.22 dB to−7.23±7.04 dB.Proptosis decreased from 19.57±3.38mm to 16.35±3.01mm.Preoperative BCVA,MD of visual fields and medical rectus diameter were independent factors associated with improvements in BCVA(P<0.05)by linear mixed-models’analyses.Eighteen patients(42.9%)developed new diplopia postoperatively.Conclusion:Modified endoscopic transnasal orbital apex decompression effectively restores vision in dysthyroid optic neuropathy.
文摘Objective: The management of traumatic facial nerve paralysis(FNP) has remained a controversial issue with conflicting findings arguing between surgical decompression and conservative management.However, recent advances in endoscopic surgery may consolidate the management plan for this condition.Methods: This prospective clinical study included patients with posttraumatic FNP at a tertiary referral center. Patients were categorized in two main groups: surgical and conservative. Indications for surgery included patients with immediate and complete FNP, no improvement in facial function on medical treatment, with electroneurography showing >90% degeneration or electromyography showing fibrillation potential. Patients who did not satisfy this criterion received the conservative approach. The transcanal endoscopic approach(TEA) or endoscopic assisted transmastoid approach was performed for facial nerve decompression in the surgical group.Outcome: The main outcome was facial function improvement, assessed using the House Brackmann grading scale(HBGS) 6 months after surgery, and hearing state assessed using the air bone gap(ABG).Results: The study included 38 patients, of whom 15 underwent had surgical decompression and 23underwent conservative therapy. A significant improvement in facial nerve function from a mean of4.66 ± 0.97 to 1.71 ± 0.69(P = 0.001) and ABG from a median of 30(10-40) to 20(10-25)(P = 0.002)was observed.Conclusion: Decision-making in cases of traumatic FNP is critical. The geniculate ganglion and tympanic segment were the most commonly affected areas in FNP cases. The TEA represents the most direct and least invasive approach for this area.
基金Zhejiang Province Traditional Chinese Medicine Science and Technology Plan Project(No.2023ZL266).
文摘Background:Post-ERCP pancreatitis(PEP)is significantly influenced by the reflux of duodenal fluid.While gastrointestinal decompression represents a fundamental approach in acute pancreatitis management,the effectiveness of immediate duodenal decompression following ERCP to prevent PEP remains uncertain.This study aimed to investigate the impact of immediate duodenal decompression after ERCP on reducing the incidence of hyperamylasemia and PEP.Methods:This retrospective study encompassed patients with native papilla who underwent therapeutic ERCP for choledocholithiasis at the Department of Gastroenterology,Chun’an Branch of Zhejiang Provincial People’s Hospital(Zhejiang,China)between January 2020 and June 2023.Based on the immediate placement of a duodenal decompression tube post-ERCP,patients were categorized into two groups:the duodenal decompression group and the conventional procedure group.Primary outcomes included the incidence of PEP and hyperamylasemia.Results:A total of 195 patients were enrolled(94 in the duodenal decompression group and 101 in the conventional procedure group).Baseline clinical and procedural characteristics exhibited no significant differences between the two groups.PEP occurred in 2 patients(2.1%)in the duodenal decompression group,in contrast to 11 patients(10.9%)in the conventional procedure group(Risk difference[RD]8.8%;95%confidence interval[CI]1.7%-16.5%,P=0.014).Hyperamylasemia was observed in 8 patients(8.5%)in the duodenal decompression group,compared to 20 patients(19.8%)in the conventional procedure group(RD 11.3%;95%CI 1.4%-21.0%;P=0.025).Patients with PEP in both groups showed improvement after receiving active treatment.No severe cases of PEP occurred in either group,and no serious adverse events related to duodenal catheter decompression were reported.Conclusion:Immediate duodenal decompression following ERCP demonstrates an effective reduction in the incidence of hyperamylasemia and PEP.
