BACKGROUND Choledochal cyst is a rare biliary tract disorder with five subtypes categorized based on the anatomical location of cystic dilatation.Type IV(which affects the intrahepatic and extrahepatic ducts)is the mo...BACKGROUND Choledochal cyst is a rare biliary tract disorder with five subtypes categorized based on the anatomical location of cystic dilatation.Type IV(which affects the intrahepatic and extrahepatic ducts)is the most common subtype in adults.Its clinical manifestations are diverse and the disease can potentially become malignant.Currently,the mainstay treatment is surgical excision which is used as a definitive treatment to prevent complications and avoid carcinogenesis.However,the surgical operation for giant choledochal cysts is technically challenging.CASE SUMMARY Here,we present a case of a giant choledochal cyst in an 18-year-old female.The diagnosis of patient was confirmed through magnetic resonance cholangiopancreatography.The patient developed acute cholangitis,and was treated with percutaneous transhepatic cholangial drainage to alleviate symptoms.The final treatment approach was cyst excision followed by Roux-en-Y hepaticojejunostomy,which successfully achieved excellent postoperative recovery.CONCLUSION Ultrasonography and magnetic resonance cholangiopancreatography can effectively diagnose choledochal cysts.Combined percutaneous transhepatic cholangial drainage surgery for giant choledochal cysts is safe and effective.展开更多
BACKGROUND Difficult bile duct intubation is a big challenge for endoscopists during endoscopic retrograde cholangiopancreatography(ERCP)procedure.We report a case of percutaneous transhepatic cholangial drainage(PTCD...BACKGROUND Difficult bile duct intubation is a big challenge for endoscopists during endoscopic retrograde cholangiopancreatography(ERCP)procedure.We report a case of percutaneous transhepatic cholangial drainage(PTCD)-guided methylene blue for fistulotomy using dual-knife for bile duct intubation.CASE SUMMARY A 50-year-old male patient had developed obstructive jaundice,and ERCP procedure need to be performed to treat the obstructive jaundice.But intubation cannot be performed if the duodenal papilla cannot be identified because of previous surgery for a perforated descending duodenal diverticulum.We used PTCD-guided methylene blue to identify the intramural common bile duct before dual-knife fistulotomy,and bile duct intubation was successfully completed.CONCLUSION The method that combing methylene blue and dual-knife fistulotomy to achieve bile duct intubation during difficult ERCP is safe and effective.展开更多
Background and aims:Biliary thermal injury caused by microwave ablation(MWA)for a hepatocellular carcinoma(HCC)close to the central bile ducts always results in severe complications and leads to mortality.Some studies...Background and aims:Biliary thermal injury caused by microwave ablation(MWA)for a hepatocellular carcinoma(HCC)close to the central bile ducts always results in severe complications and leads to mortality.Some studies have demonstrated that intraductal cooling of the biliary tract with chilled saline during thermal ablation can successfully prevent these complications.In this study,we present a novel bile duct cooling technique through a percutaneous transhepatic cholangial drainage(PTCD)tube for preventing biliary thermal injury caused by MWA,and compare the feasibility and safety of the intraductal cooling technique when performed with a PTCD tube and with an endoscopic nasobiliary drainage(ENBD)tube.Methods:Participants were randomly assigned to undergo MWA of HCC with intraductal chilled saline perfusion through a PTCD tube or an ENBD tube.The main study outcomes were bile duct complications related to MWA and local tumor recurrence,p value<0.05 was considered to indicate a statistically significant difference.Results:A total of 23 patients with an HCC(23 nodules)close to a central bile duct were enrolled in this study.Of these patients,12 had a PTCD tube and 11 had an ENBD tube placed into the hepatic duct close to the lesions.There were no PTCD-and ENBD-related mortality cases.There was no complication related to the PTCD procedure;however,3 patients(27.27%)developed acute pancreatitis and 1 patient(9.09%)had hemorrhage in the ENBD group(p=0.037).One patient(8.33%)in the PTCD group had bile leakage and 2 patients(18.18%)in the ENBD group developed a biloma.Within 5 years,1 patient in the PTCD group and 2 patients in the ENBD group had local recurrence.There was no significant difference in local recurrence,nonlocal hepatic recurrence,mortality rate,or median cumulative overall survival between the 2 groups.Conclusions:The intraductal cooling technique using a PTCD tube is a feasible and effective method for preventing bile duct thermal injury caused by MWA for an HCC close to the central bile ducts.It does not increase local recurrence and may be safer than intraductal cooling through an ENBD tube.展开更多
目的:分析集束化护理策略对经皮肝穿刺胆道引流术(PTCD)置管患者自我管理能力的影响。方法:根据随机数表法将2024年1月—2025年1月无锡市人民医院接收的120例PTCD置管患者分为对照组(60例,常规护理)和观察组(60例,常规护理+集束化护理策...目的:分析集束化护理策略对经皮肝穿刺胆道引流术(PTCD)置管患者自我管理能力的影响。方法:根据随机数表法将2024年1月—2025年1月无锡市人民医院接收的120例PTCD置管患者分为对照组(60例,常规护理)和观察组(60例,常规护理+集束化护理策略)。对比分析两组的疾病健康知识掌握程度评分(伤口、引流液、引流管、并发症观察及护理知识、健康饮食知识、适度运动知识评分),自护能力评分[Self-care Ability Measurement Scale(ESCA)评分],生活质量评分[Generic Quality of Life Inventory-74(GQOLI-74)评分],不良事件总发生率。结果:观察组各项疾病健康知识掌握程度评分明显高于对照组,差异有统计学意义(P<0.05)。护理前,两组ESCA量表各维度评分及GQOLI-74量表总分比较,差异无统计学意义(P>0.05),护理后,观察组高于对照组,差异有统计学意义(P<0.05)。观察组不良事件发生率显著低于对照组,差异有统计学意义(P<0.05)。结论:集束化护理策略在PTCD置管患者中的应用效果良好,在促进患者理解、掌握、应用疾病健康知识,提高患者自我护理管理能力,改善患者生活状况,降低不良事件发生风险几个方面有显著的积极作用。展开更多
Malignant obstructive jaundice(MOJ)encompasses a range of diseases stemming from malignant tumors such as cholangiocarcinoma,pancreatic cancer,and primary liver cancer,among others,which cause obstruction in both intr...Malignant obstructive jaundice(MOJ)encompasses a range of diseases stemming from malignant tumors such as cholangiocarcinoma,pancreatic cancer,and primary liver cancer,among others,which cause obstruction in both intra-and extra-hepatic bile ducts.This obstruction may lead to elevated bilirubin levels,hepatic function impairment,and a low rate of successful surgical resection in clinical settings.There are various minimally invasive treatment options for MOJ,including endoscopic biliary drainage,ultrasound-guided procedures,and percutaneous biliary tract puncture drainage.展开更多
基金Supported by Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital,No.CY2024-MS-B04Gansu Provincial Natural Science Foundation Project,No.24JRRA331the Traditional Chinese Medicine Research Project of Gansu Province,No.GZKZ-2024-26.
文摘BACKGROUND Choledochal cyst is a rare biliary tract disorder with five subtypes categorized based on the anatomical location of cystic dilatation.Type IV(which affects the intrahepatic and extrahepatic ducts)is the most common subtype in adults.Its clinical manifestations are diverse and the disease can potentially become malignant.Currently,the mainstay treatment is surgical excision which is used as a definitive treatment to prevent complications and avoid carcinogenesis.However,the surgical operation for giant choledochal cysts is technically challenging.CASE SUMMARY Here,we present a case of a giant choledochal cyst in an 18-year-old female.The diagnosis of patient was confirmed through magnetic resonance cholangiopancreatography.The patient developed acute cholangitis,and was treated with percutaneous transhepatic cholangial drainage to alleviate symptoms.The final treatment approach was cyst excision followed by Roux-en-Y hepaticojejunostomy,which successfully achieved excellent postoperative recovery.CONCLUSION Ultrasonography and magnetic resonance cholangiopancreatography can effectively diagnose choledochal cysts.Combined percutaneous transhepatic cholangial drainage surgery for giant choledochal cysts is safe and effective.
文摘BACKGROUND Difficult bile duct intubation is a big challenge for endoscopists during endoscopic retrograde cholangiopancreatography(ERCP)procedure.We report a case of percutaneous transhepatic cholangial drainage(PTCD)-guided methylene blue for fistulotomy using dual-knife for bile duct intubation.CASE SUMMARY A 50-year-old male patient had developed obstructive jaundice,and ERCP procedure need to be performed to treat the obstructive jaundice.But intubation cannot be performed if the duodenal papilla cannot be identified because of previous surgery for a perforated descending duodenal diverticulum.We used PTCD-guided methylene blue to identify the intramural common bile duct before dual-knife fistulotomy,and bile duct intubation was successfully completed.CONCLUSION The method that combing methylene blue and dual-knife fistulotomy to achieve bile duct intubation during difficult ERCP is safe and effective.
基金Financial support from the Municipal Hospital Joint Research Project of Emerging Frontier Technology(Project SHDC12014112)Shanghai City,Shen Kang Group,and medical guided technology project of Shanghai Committee of Science and Technology,China(project 14411967500).
文摘Background and aims:Biliary thermal injury caused by microwave ablation(MWA)for a hepatocellular carcinoma(HCC)close to the central bile ducts always results in severe complications and leads to mortality.Some studies have demonstrated that intraductal cooling of the biliary tract with chilled saline during thermal ablation can successfully prevent these complications.In this study,we present a novel bile duct cooling technique through a percutaneous transhepatic cholangial drainage(PTCD)tube for preventing biliary thermal injury caused by MWA,and compare the feasibility and safety of the intraductal cooling technique when performed with a PTCD tube and with an endoscopic nasobiliary drainage(ENBD)tube.Methods:Participants were randomly assigned to undergo MWA of HCC with intraductal chilled saline perfusion through a PTCD tube or an ENBD tube.The main study outcomes were bile duct complications related to MWA and local tumor recurrence,p value<0.05 was considered to indicate a statistically significant difference.Results:A total of 23 patients with an HCC(23 nodules)close to a central bile duct were enrolled in this study.Of these patients,12 had a PTCD tube and 11 had an ENBD tube placed into the hepatic duct close to the lesions.There were no PTCD-and ENBD-related mortality cases.There was no complication related to the PTCD procedure;however,3 patients(27.27%)developed acute pancreatitis and 1 patient(9.09%)had hemorrhage in the ENBD group(p=0.037).One patient(8.33%)in the PTCD group had bile leakage and 2 patients(18.18%)in the ENBD group developed a biloma.Within 5 years,1 patient in the PTCD group and 2 patients in the ENBD group had local recurrence.There was no significant difference in local recurrence,nonlocal hepatic recurrence,mortality rate,or median cumulative overall survival between the 2 groups.Conclusions:The intraductal cooling technique using a PTCD tube is a feasible and effective method for preventing bile duct thermal injury caused by MWA for an HCC close to the central bile ducts.It does not increase local recurrence and may be safer than intraductal cooling through an ENBD tube.
文摘目的:分析集束化护理策略对经皮肝穿刺胆道引流术(PTCD)置管患者自我管理能力的影响。方法:根据随机数表法将2024年1月—2025年1月无锡市人民医院接收的120例PTCD置管患者分为对照组(60例,常规护理)和观察组(60例,常规护理+集束化护理策略)。对比分析两组的疾病健康知识掌握程度评分(伤口、引流液、引流管、并发症观察及护理知识、健康饮食知识、适度运动知识评分),自护能力评分[Self-care Ability Measurement Scale(ESCA)评分],生活质量评分[Generic Quality of Life Inventory-74(GQOLI-74)评分],不良事件总发生率。结果:观察组各项疾病健康知识掌握程度评分明显高于对照组,差异有统计学意义(P<0.05)。护理前,两组ESCA量表各维度评分及GQOLI-74量表总分比较,差异无统计学意义(P>0.05),护理后,观察组高于对照组,差异有统计学意义(P<0.05)。观察组不良事件发生率显著低于对照组,差异有统计学意义(P<0.05)。结论:集束化护理策略在PTCD置管患者中的应用效果良好,在促进患者理解、掌握、应用疾病健康知识,提高患者自我护理管理能力,改善患者生活状况,降低不良事件发生风险几个方面有显著的积极作用。
文摘Malignant obstructive jaundice(MOJ)encompasses a range of diseases stemming from malignant tumors such as cholangiocarcinoma,pancreatic cancer,and primary liver cancer,among others,which cause obstruction in both intra-and extra-hepatic bile ducts.This obstruction may lead to elevated bilirubin levels,hepatic function impairment,and a low rate of successful surgical resection in clinical settings.There are various minimally invasive treatment options for MOJ,including endoscopic biliary drainage,ultrasound-guided procedures,and percutaneous biliary tract puncture drainage.
