背景与目的:临床中复杂的结石性胆管炎常合并Vater壶腹部狭窄,从而增加治疗的难度和复杂性。若只取除胆管内结石而不处理壶腹部狭窄问题,后期疾病容易反复发作。既往大多采取的方法主要是经内镜逆行胆胰管造影(ERCP)入路导丝顺向引导十...背景与目的:临床中复杂的结石性胆管炎常合并Vater壶腹部狭窄,从而增加治疗的难度和复杂性。若只取除胆管内结石而不处理壶腹部狭窄问题,后期疾病容易反复发作。既往大多采取的方法主要是经内镜逆行胆胰管造影(ERCP)入路导丝顺向引导十二指肠乳头括约肌切开、取石术联合后期腹腔镜胆囊切除的方式处理。然而,ERCP在处理复杂情况时仍有一定局限性。为此,笔者团队首创了一种新型经腹腔入路治疗结石性胆管炎合并Vater壶腹部狭窄的方法。本研究探讨该方法的可行性与疗效,以期为临床提供新的治疗选择。方法:采用随机对照研究的方法,将2021—2023年因胆囊结石、胆管结石伴Vater壶腹部狭窄于成都市第二人民医院治疗的120例患者分为观察组和对照组,每组各60例,观察组行腹腔镜胆囊切除+胆管切开取石,并顺势从切开的胆管中插入导管逆向引导十二指肠乳头切开,同时处理胆囊、胆管结石及Vater壶腹部狭窄;对照组行传统ERCP入路乳头切开、胆管取石+腹腔镜胆囊切除术。收集两组患者围手术期相关指标,比较两组手术效果。结果:120例患者中,男性54例,女性66例。两组在胆道取石成功率、术中出血量、术后24 h总胆红素、直接胆红素、转氨酶、白细胞计数、黄疸缓解时间及胆汁漏、腹膜后出血/感染、重症胰腺炎发生率等方面,差异无统计学意义(均P>0.05)。观察组平均手术时间、术后住院时间均明显短于对照组(98.67 min vs. 110.8 min,P<0.05;3.81 d vs. 5.61 d,P<0.05),并且观察组术后高淀粉酶血症和(或)高脂肪酶血症、轻型胰腺炎发生率均明显更低(1.67%vs. 25.00%,P<0.001;0 vs. 10%,P=0.027)。结论:新型经腹腔入路在缩短手术时间、住院时间方面明显优于ERCP入路,术后发生轻症胰腺炎及高淀粉酶血症和(或)高脂肪酶血症的风险更低,并且胆管取石成功率不劣于ERCP入路,是一种可选择的治疗方式。展开更多
BACKGROUND Currently,there is no standard adjuvant therapy for patients with resected ampulla of Vater(AoV)cancer.AIM To evaluate the effectiveness of adjuvant concurrent chemoradiotherapy(CCRT)in patients with advanc...BACKGROUND Currently,there is no standard adjuvant therapy for patients with resected ampulla of Vater(AoV)cancer.AIM To evaluate the effectiveness of adjuvant concurrent chemoradiotherapy(CCRT)in patients with advanced AoV cancer who underwent curative resection.METHODS This single-centered,retrospective study included 29 patients with advanced AoV cancer who underwent pancreaticoduodenectomy between 2006 and 2018.The impact of CCRT on advanced AoV cancer was analyzed.RESULTS The 1-,3-,and 5-yr recurrence-free survival(RFS)rates for patients with advanced AoV cancer were 82.8%,48.3%,and 40.8%,respectively,and the overall survival(OS)rates were 89.7%,62.1%,and 51.7%,respectively.Lymphovas-cular invasion was found to be a significant risk factor for RFS and OS in patients with advanced AoV cancer in the univariate analysis,whereas T stage and lymph node metastasis were significantly associated with OS in the multivariate analysis.Compared to the patients who did not receive adjuvant CCRT,those who received adjuvant CCRT did not show statistically significant improvements in the RFS and OS,although they had a significantly lower average age and significantly higher platelet-to-lymphocyte ratio.CONCLUSION Adjuvant CCRT did not improve survival outcomes in patients with advanced AoV cancer.These findings contribute to existing knowledge on the effectiveness of CCRT in this patient population and provide important insights for clinical decision-making.展开更多
文摘背景与目的:临床中复杂的结石性胆管炎常合并Vater壶腹部狭窄,从而增加治疗的难度和复杂性。若只取除胆管内结石而不处理壶腹部狭窄问题,后期疾病容易反复发作。既往大多采取的方法主要是经内镜逆行胆胰管造影(ERCP)入路导丝顺向引导十二指肠乳头括约肌切开、取石术联合后期腹腔镜胆囊切除的方式处理。然而,ERCP在处理复杂情况时仍有一定局限性。为此,笔者团队首创了一种新型经腹腔入路治疗结石性胆管炎合并Vater壶腹部狭窄的方法。本研究探讨该方法的可行性与疗效,以期为临床提供新的治疗选择。方法:采用随机对照研究的方法,将2021—2023年因胆囊结石、胆管结石伴Vater壶腹部狭窄于成都市第二人民医院治疗的120例患者分为观察组和对照组,每组各60例,观察组行腹腔镜胆囊切除+胆管切开取石,并顺势从切开的胆管中插入导管逆向引导十二指肠乳头切开,同时处理胆囊、胆管结石及Vater壶腹部狭窄;对照组行传统ERCP入路乳头切开、胆管取石+腹腔镜胆囊切除术。收集两组患者围手术期相关指标,比较两组手术效果。结果:120例患者中,男性54例,女性66例。两组在胆道取石成功率、术中出血量、术后24 h总胆红素、直接胆红素、转氨酶、白细胞计数、黄疸缓解时间及胆汁漏、腹膜后出血/感染、重症胰腺炎发生率等方面,差异无统计学意义(均P>0.05)。观察组平均手术时间、术后住院时间均明显短于对照组(98.67 min vs. 110.8 min,P<0.05;3.81 d vs. 5.61 d,P<0.05),并且观察组术后高淀粉酶血症和(或)高脂肪酶血症、轻型胰腺炎发生率均明显更低(1.67%vs. 25.00%,P<0.001;0 vs. 10%,P=0.027)。结论:新型经腹腔入路在缩短手术时间、住院时间方面明显优于ERCP入路,术后发生轻症胰腺炎及高淀粉酶血症和(或)高脂肪酶血症的风险更低,并且胆管取石成功率不劣于ERCP入路,是一种可选择的治疗方式。
基金This study was approved by the Institutional Review Board of Clinical Trial Center in Pusan National University hospital(IRB No.2303-007-124).
文摘BACKGROUND Currently,there is no standard adjuvant therapy for patients with resected ampulla of Vater(AoV)cancer.AIM To evaluate the effectiveness of adjuvant concurrent chemoradiotherapy(CCRT)in patients with advanced AoV cancer who underwent curative resection.METHODS This single-centered,retrospective study included 29 patients with advanced AoV cancer who underwent pancreaticoduodenectomy between 2006 and 2018.The impact of CCRT on advanced AoV cancer was analyzed.RESULTS The 1-,3-,and 5-yr recurrence-free survival(RFS)rates for patients with advanced AoV cancer were 82.8%,48.3%,and 40.8%,respectively,and the overall survival(OS)rates were 89.7%,62.1%,and 51.7%,respectively.Lymphovas-cular invasion was found to be a significant risk factor for RFS and OS in patients with advanced AoV cancer in the univariate analysis,whereas T stage and lymph node metastasis were significantly associated with OS in the multivariate analysis.Compared to the patients who did not receive adjuvant CCRT,those who received adjuvant CCRT did not show statistically significant improvements in the RFS and OS,although they had a significantly lower average age and significantly higher platelet-to-lymphocyte ratio.CONCLUSION Adjuvant CCRT did not improve survival outcomes in patients with advanced AoV cancer.These findings contribute to existing knowledge on the effectiveness of CCRT in this patient population and provide important insights for clinical decision-making.
