BACKGROUND Surgery and percutaneous radiological methods[puncture,aspiration,injection,re-aspiration(PAIR)]are the current invasive treatment strategies for patients with hepatic hydatid cyst(HHC).Biliary leak is a co...BACKGROUND Surgery and percutaneous radiological methods[puncture,aspiration,injection,re-aspiration(PAIR)]are the current invasive treatment strategies for patients with hepatic hydatid cyst(HHC).Biliary leak is a common complication in patients who underwent these treatments of HHC.Bile leak should be treated effectively as uncontrolled biliary fistula may lead to life-treating conditions such as severe cholangitis,intraabdominal abscesses and septicemia.Endoscopic retrograde cholangiopancreatography(ERCP)has become the main treatment of post-interventional biliary fistula.AIM To evaluate the efficacy and safety of ERCP in the management of biliary fistula following HHC-related surgery or PAIR.METHODS We evaluated data of patients who developed bile leakage following HHC-related interventions from endemic area during the period of March 2017 and February 2025.We included 88 patients(50 female,57%)with a median age of 33 years(range:8-83 years)at the time of ERCP.Bile leak occurred following surgery in 72(82%)patients and after PAIR in 16(18%)patients.Low-grade leakage(<400 mL/day)was identified in 46(52%)patients.RESULTS Initial mode of ERCP was endoscopic sphincterotomy(ES)with biliary drainage(plastic stent or nasobiliary drain)in 73(83%)patients and ES alone in remaining 15(17%)patients.Six patients who initially treated by ES alone had persistent fistula and underwent repeat ERCP with stent placement.ERCP type(ES+biliary stenting)and fistula flow rate(<400 mL/day)were significantly associated with 20-days complete closure of the fistula[P=0.020;odds ratio(OR)=5.27,95%confidence interval(95%CI):1.30-21.37]and(P=0.008;OR=3.43,95%CI:1.37-8.55),respectively.ERCP-related complications were mild pancreatitis in 5(5.9%)patients and minor bleeding in 4(4.7%)patients and mild-moderate cholangitis in 4(4.7%)patients.CONCLUSION This case based-study from endemic area demonstrates that ERCP is highly effective and safe for managing bile leakage following both surgery and PAIR.ES+biliary stenting seems better mode of ERCP procedure.展开更多
Liver hydatidosis is the most common clinical presentation of cystic echinococcosis(CE).Ultrasonographic mass surveys have demonstrated the true prevalence,including the asymptomatic characteristic of the majority of ...Liver hydatidosis is the most common clinical presentation of cystic echinococcosis(CE).Ultrasonographic mass surveys have demonstrated the true prevalence,including the asymptomatic characteristic of the majority of cases,providing new insight into the natural history of the disease.This raises the question of whether to treat or not to treat these patients,due to the high and unsuspected prevalence of CE.The high rate of liver/lung frequencies of cyst localization,the autopsy findings,and the involution of cysts demonstrated in long time follow-up of asymptomatic carriers contribute to this discussion.The decision to treat an asymptomatic patient by surgery,albendazole,or puncture aspiration injection and reaspiration or to wait and watch,is based on conflicting reports in the literature,the lack of complications in untreated patients over time,and the spontaneous disappearance and involution of cysts.All these points contribute to difficulties of individual clinical decisions.The patients should be informed of the reasons and the risks of watchful/waiting without treatment,the possibility of complications,and the risks of the other options.As more information on the natural history of liver hydatidosis is acquired,selection of the best treatment will be come easier.Without this knowledge it would be very difficult to establish definitive rules of treatment.At present,it is possible to manage these patients over time and to wait for the best moment for treatment.Followup studies must be conducted to achieve this objective.展开更多
Objective To study the effect of modified Tongqiao Huoxue Decoction on cerebral oedema and patient prognosis after stereotactic puncture for cerebral haemorrhage in the basal ganglia.Methods Forty-seven patients with ...Objective To study the effect of modified Tongqiao Huoxue Decoction on cerebral oedema and patient prognosis after stereotactic puncture for cerebral haemorrhage in the basal ganglia.Methods Forty-seven patients with basal ganglia hemorrhage who underwent stereotactic hematoma puncture and aspiration at the Xiaoshan Hospital in Zhejiang from November 2019 to November 2023 were enrolled in this study.展开更多
文摘BACKGROUND Surgery and percutaneous radiological methods[puncture,aspiration,injection,re-aspiration(PAIR)]are the current invasive treatment strategies for patients with hepatic hydatid cyst(HHC).Biliary leak is a common complication in patients who underwent these treatments of HHC.Bile leak should be treated effectively as uncontrolled biliary fistula may lead to life-treating conditions such as severe cholangitis,intraabdominal abscesses and septicemia.Endoscopic retrograde cholangiopancreatography(ERCP)has become the main treatment of post-interventional biliary fistula.AIM To evaluate the efficacy and safety of ERCP in the management of biliary fistula following HHC-related surgery or PAIR.METHODS We evaluated data of patients who developed bile leakage following HHC-related interventions from endemic area during the period of March 2017 and February 2025.We included 88 patients(50 female,57%)with a median age of 33 years(range:8-83 years)at the time of ERCP.Bile leak occurred following surgery in 72(82%)patients and after PAIR in 16(18%)patients.Low-grade leakage(<400 mL/day)was identified in 46(52%)patients.RESULTS Initial mode of ERCP was endoscopic sphincterotomy(ES)with biliary drainage(plastic stent or nasobiliary drain)in 73(83%)patients and ES alone in remaining 15(17%)patients.Six patients who initially treated by ES alone had persistent fistula and underwent repeat ERCP with stent placement.ERCP type(ES+biliary stenting)and fistula flow rate(<400 mL/day)were significantly associated with 20-days complete closure of the fistula[P=0.020;odds ratio(OR)=5.27,95%confidence interval(95%CI):1.30-21.37]and(P=0.008;OR=3.43,95%CI:1.37-8.55),respectively.ERCP-related complications were mild pancreatitis in 5(5.9%)patients and minor bleeding in 4(4.7%)patients and mild-moderate cholangitis in 4(4.7%)patients.CONCLUSION This case based-study from endemic area demonstrates that ERCP is highly effective and safe for managing bile leakage following both surgery and PAIR.ES+biliary stenting seems better mode of ERCP procedure.
文摘Liver hydatidosis is the most common clinical presentation of cystic echinococcosis(CE).Ultrasonographic mass surveys have demonstrated the true prevalence,including the asymptomatic characteristic of the majority of cases,providing new insight into the natural history of the disease.This raises the question of whether to treat or not to treat these patients,due to the high and unsuspected prevalence of CE.The high rate of liver/lung frequencies of cyst localization,the autopsy findings,and the involution of cysts demonstrated in long time follow-up of asymptomatic carriers contribute to this discussion.The decision to treat an asymptomatic patient by surgery,albendazole,or puncture aspiration injection and reaspiration or to wait and watch,is based on conflicting reports in the literature,the lack of complications in untreated patients over time,and the spontaneous disappearance and involution of cysts.All these points contribute to difficulties of individual clinical decisions.The patients should be informed of the reasons and the risks of watchful/waiting without treatment,the possibility of complications,and the risks of the other options.As more information on the natural history of liver hydatidosis is acquired,selection of the best treatment will be come easier.Without this knowledge it would be very difficult to establish definitive rules of treatment.At present,it is possible to manage these patients over time and to wait for the best moment for treatment.Followup studies must be conducted to achieve this objective.
文摘Objective To study the effect of modified Tongqiao Huoxue Decoction on cerebral oedema and patient prognosis after stereotactic puncture for cerebral haemorrhage in the basal ganglia.Methods Forty-seven patients with basal ganglia hemorrhage who underwent stereotactic hematoma puncture and aspiration at the Xiaoshan Hospital in Zhejiang from November 2019 to November 2023 were enrolled in this study.
