AIM： To compare the results and complications of early pre-cutting technique with standard technique. METHODS： From January 2003 to December 2004, a total of 426 consecutive therapeutic biliary ERCP procedures were ...AIM： To compare the results and complications of early pre-cutting technique with standard technique. METHODS： From January 2003 to December 2004, a total of 426 consecutive therapeutic biliary ERCP procedures were performed by one endoscopist （T.A.）. Data were retrospectively collected according to procedure indication and results. Of these, 293 procedures （70.4%） were done with standard technique （group A） and 223 procedures （29.6%） with early pre-cutting technique in case of difficult cannulation （group B）. The results and complications of ERCP were compared. RESULTS： Success rate of first attempt cannulation was 98.0% in group A and 87.8% in group 13. The overall incidence of post-ERCP pancreatitis, hemorrhage, perforation and cholangitis was 0%, 0.2%, 0.5% and 0.5%, respectively. Morbidity rate was not significantly different. No procedure-related mortality was occurred. CONCLUSION： For an experienced hand, the early pre-cutting technique for biliary cannulation is safe and effective as standard technique.展开更多
In order to study the strength failure and crack coalescence characteristics of cracked rocks, uniaxial compression experiments were conducted on cylindrical sandstone specimens, sampled from Longyou Grottoes of Zheji...In order to study the strength failure and crack coalescence characteristics of cracked rocks, uniaxial compression experiments were conducted on cylindrical sandstone specimens, sampled from Longyou Grottoes of Zhejiang Province, China, with a single pre-cut crack soaking in different chemical solutions. Based on the results of uniaxial compressive test under different chemical solutions and velocities of flow, the effect of strength and deformation characteristics and main modes of crack coalescence for cracked rocks under chemical corrosion were analyzed. The results show that the pH value and velocity of the chemical solutions both have great influence on the sandstone sample's uniaxial compressive strength and deformation characteristics. Cracked sandstone samples are tension-destructed under uniaxial compression, and the crack propagation directions are consistent with the loading direction. The phenomena of crack initiation, propagation and coalescence of sandstone are well observed. Four different crack types are identified based on the crack propagation mechanism by analyzing the ultimate failure modes of sandstone containing a single pre-cut fissure. The failure process of specimen in air is similar with the specimen under chemical solutions, however, the initial time of crack occuring in specimen under chemical solutions is generally earlier than that in the natural specimen, and the crack propagation and coalescence process of specimen under chemical solutions are longer than those of the natural specimen due to softening of structure of rock caused by hydro-chemical action. Immersion velocity of flow and chemical solutions does not have influence on the ultimate modes of crack coalescence.展开更多
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
文摘AIM： To compare the results and complications of early pre-cutting technique with standard technique. METHODS： From January 2003 to December 2004, a total of 426 consecutive therapeutic biliary ERCP procedures were performed by one endoscopist （T.A.）. Data were retrospectively collected according to procedure indication and results. Of these, 293 procedures （70.4%） were done with standard technique （group A） and 223 procedures （29.6%） with early pre-cutting technique in case of difficult cannulation （group B）. The results and complications of ERCP were compared. RESULTS： Success rate of first attempt cannulation was 98.0% in group A and 87.8% in group 13. The overall incidence of post-ERCP pancreatitis, hemorrhage, perforation and cholangitis was 0%, 0.2%, 0.5% and 0.5%, respectively. Morbidity rate was not significantly different. No procedure-related mortality was occurred. CONCLUSION： For an experienced hand, the early pre-cutting technique for biliary cannulation is safe and effective as standard technique.
基金Projects(10472130,41202225) supported by the National Natural Science Foundation of China
文摘In order to study the strength failure and crack coalescence characteristics of cracked rocks, uniaxial compression experiments were conducted on cylindrical sandstone specimens, sampled from Longyou Grottoes of Zhejiang Province, China, with a single pre-cut crack soaking in different chemical solutions. Based on the results of uniaxial compressive test under different chemical solutions and velocities of flow, the effect of strength and deformation characteristics and main modes of crack coalescence for cracked rocks under chemical corrosion were analyzed. The results show that the pH value and velocity of the chemical solutions both have great influence on the sandstone sample's uniaxial compressive strength and deformation characteristics. Cracked sandstone samples are tension-destructed under uniaxial compression, and the crack propagation directions are consistent with the loading direction. The phenomena of crack initiation, propagation and coalescence of sandstone are well observed. Four different crack types are identified based on the crack propagation mechanism by analyzing the ultimate failure modes of sandstone containing a single pre-cut fissure. The failure process of specimen in air is similar with the specimen under chemical solutions, however, the initial time of crack occuring in specimen under chemical solutions is generally earlier than that in the natural specimen, and the crack propagation and coalescence process of specimen under chemical solutions are longer than those of the natural specimen due to softening of structure of rock caused by hydro-chemical action. Immersion velocity of flow and chemical solutions does not have influence on the ultimate modes of crack coalescence.
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。
