Sub capsular hepatic haematoma is a rare complication after endoscopic retrograde cholangiopancreatography (ERCP). Exact pathological mechanism is still unclear and few reports are nowadays available in literature. We...Sub capsular hepatic haematoma is a rare complication after endoscopic retrograde cholangiopancreatography (ERCP). Exact pathological mechanism is still unclear and few reports are nowadays available in literature. We report the case of a 58-year-old woman with recurrent episodes of upper abdominal pain, nausea and vomiting. On the basis of laboratory exams, abdomen ultrasound and magnetic resonance imaging she was diagnosed with a common bile duct stone. Endoscopic biliary sphincterotomy was performed. On the following day the patient complaint severe abdominal pain with rebound and hemodynamic instability. A computed tomography scan reveal a 14 cm × 6 cm × 19 cm sub-capsular hepatic haematoma on the right lobe that was successfully managed via percutaneous embolization. Sub capsular liver haematoma is a rare life threatening complication after ERCP that should be managed according to patients’ haemodynamic and clinic.展开更多
AIM To assess the diagnostic value of a laparoscopic finding of a hepatic subcapsular spider-like telangiectasis (HSST) sign in biliary atresia. METHODS A retrospective study was conducted first and then a validation ...AIM To assess the diagnostic value of a laparoscopic finding of a hepatic subcapsular spider-like telangiectasis (HSST) sign in biliary atresia. METHODS A retrospective study was conducted first and then a validation set was used to investigate the value of an HSST sign in predicting biliary atresia (BA). In the retrospective study, laparoscopic images of the liver surface were reviewed in 126 patients with infantile cholestasis (72 BA patients and 54 non-BA cholestasis patients) and a control group of 38 patients with nonhepatic conditions. Analysis was first made by two observers separately and finally, a consensus conclusion was achieved. Then, the diagnostic value of the HSST sign was validated in an independent cohort including 45 BA and 45 non-BA patients. RESULTS In the retrospective investigation, an ampli.ed HSST sign was found in all BA patients, while we were unable to detect the HSST sign in 98.1% of the 54 non-BA patients. There was no HSST sign in any of the control subjects. In the first review, the sensitivity and specificity from one reviewer were 100% and 98.1%, respectively, and the results from the other reviewer were both 100%. The consensus sensitivity and specificity were 100% and 98.1%, respectively. The HSST sign was defined as being composed of several enlarged tortuous spider-like vascular plexuses with two to eight branches distributed on all over the liver surface, which presented as either a concentrated type or a dispersed type. In the independent validation group, the sensitivity, specificity, positive predictive value and negative predictive value of the HSST sign were 100%, 97.8%, 97.8% and 100%, respectively. CONCLUSION The HSST sign is characteristic in BA, and laparoscopic exploration for the HSST sign is valuable in the diagnosis of BA.展开更多
Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive procedure for diagnosis and treatment of biliary and pancreatic diseases. Even in the best hands, complications may occur. Cl...Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive procedure for diagnosis and treatment of biliary and pancreatic diseases. Even in the best hands, complications may occur. Clinically significant hemorrhagic complications associated usually to previous papillotomy are uncommon. Subcapsular hepatic hematoma is excepcional, with only twenty cases described. We present a case of a 52-year-old man who developed a large subcapsular liver hematoma following a therapeutic ERCP. Due to serious anemization and hemodynamic instability, arterial embolization and finally urgent surgical evacuation of the hematoma were performed. In the postoperative period the patient presented infection of the collection, which indicated colocation of percutaneous drainage and broad-spectrum intravenous antibiotics, and gradually recovered.展开更多
BACKGROUND Endoscopic ultrasonography(EUS)has evolved in the last years making it not only a diagnostic modality but a therapeutic procedure.EUS is now used as an alternative technique to percutaneous and surgical dra...BACKGROUND Endoscopic ultrasonography(EUS)has evolved in the last years making it not only a diagnostic modality but a therapeutic procedure.EUS is now used as an alternative technique to percutaneous and surgical drainage.Even though EUS is a challenging procedure and not always suitable compared to percutaneous drainage,there is a need for developing new therapeutic approaches to the liver for when percutaneous drainage is not feasible.CASE SUMMARY We present the case of a 82 years old male who developed an infected subcapsular hepatic hematoma(SHH)of the left lobe following percutaneous biliary drainage.After 2 failed attempts of percutaneous drainage of the SHH and because the patients couldn’t withstand surgery,we conducted a EUS drainage and debridement of the SHH.Using a lumen apposing metal stent(LAMS)by a transgastric approach,we were able to gain endoscopic access to the SHH.With our experience in the debridement of walled off pancreatic necrosis using this technique,we were confident it was the right approach.After four debridement sessions,the computed tomography scan showed a clear regression of the SHH.CONCLUSION To our knowledge,this is the first case of successful endoscopic debridement of a SHH using a LAMS which appear to be feasible and safe in this specific case.展开更多
目的:比较不同人工晶状体(IOL)固定术治疗缺少囊膜支撑的无晶状体患者的疗效。方法:回顾性研究。选取2019年6月至2024年6月本院收治的缺少囊膜支撑的无晶状体患者120例120眼,根据治疗方式分为两组:A组60眼采用巩膜瓣下IOL深层巩膜固定...目的:比较不同人工晶状体(IOL)固定术治疗缺少囊膜支撑的无晶状体患者的疗效。方法:回顾性研究。选取2019年6月至2024年6月本院收治的缺少囊膜支撑的无晶状体患者120例120眼,根据治疗方式分为两组:A组60眼采用巩膜瓣下IOL深层巩膜固定术治疗;B组60眼采用睫状沟IOL缝线悬吊固定术治疗。比较两组患者手术时间,术前,术后1、3、6 mo裸眼视力(UCVA)、最佳矫正视力(BCVA)、眼压(IOP)、角膜内皮细胞密度(CECD)、角膜内皮细胞丢失率和术后并发症。结果:A组患者手术时间小于B组(24.69±2.69 vs 32.75±3.75 min,t=11.937,P<0.05)。两组患者术后UCVA和BCVA均较术前改善,且A组优于B组(均P<0.05);A组角膜内皮细胞丢失率在术后1、3、6 mo均小于B组,术后1 mo A组的IOP小于B组,CECD高于B组(均P<0.05);A组患者术后IOL异位3眼(5.0%)小于B组11眼(18.3%,P=0.023)。结论:巩膜瓣下IOL深层巩膜固定术治疗缺少囊膜支撑的无晶状体患者的疗效显著,有助于改善患者视力,手术时间较少,且术后并发症少。展开更多
目的:探讨基质金属蛋白酶-3(mat ri xmet al lopro-teinase-3,MMP-3)在前囊下性白内障患者的晶状体上皮细胞(lensepithelialcells,LECs)中的表达及意义。方法:采用SP免疫组织化学染色法,测定21例前囊下性白内障、18例核性白内障和10例...目的:探讨基质金属蛋白酶-3(mat ri xmet al lopro-teinase-3,MMP-3)在前囊下性白内障患者的晶状体上皮细胞(lensepithelialcells,LECs)中的表达及意义。方法:采用SP免疫组织化学染色法,测定21例前囊下性白内障、18例核性白内障和10例正常晶状体上皮细胞中MMP-3的表达情况,并进行阳性细胞细胞计数。结果:MMP-3在前囊下性白内障晶状体上皮细胞中有表达,而在核性白内障和正常晶状体上皮细胞中均无表达。结论:MMP-3可能是调节细胞外基质(extracellulamatrix,ECM)降解的重要因素而参与前囊膜下性白内障的形成。展开更多
文摘Sub capsular hepatic haematoma is a rare complication after endoscopic retrograde cholangiopancreatography (ERCP). Exact pathological mechanism is still unclear and few reports are nowadays available in literature. We report the case of a 58-year-old woman with recurrent episodes of upper abdominal pain, nausea and vomiting. On the basis of laboratory exams, abdomen ultrasound and magnetic resonance imaging she was diagnosed with a common bile duct stone. Endoscopic biliary sphincterotomy was performed. On the following day the patient complaint severe abdominal pain with rebound and hemodynamic instability. A computed tomography scan reveal a 14 cm × 6 cm × 19 cm sub-capsular hepatic haematoma on the right lobe that was successfully managed via percutaneous embolization. Sub capsular liver haematoma is a rare life threatening complication after ERCP that should be managed according to patients’ haemodynamic and clinic.
基金Supported by the Public Welfare Research Special Fund of the National Health and Family Planning of China,No.201402007
文摘AIM To assess the diagnostic value of a laparoscopic finding of a hepatic subcapsular spider-like telangiectasis (HSST) sign in biliary atresia. METHODS A retrospective study was conducted first and then a validation set was used to investigate the value of an HSST sign in predicting biliary atresia (BA). In the retrospective study, laparoscopic images of the liver surface were reviewed in 126 patients with infantile cholestasis (72 BA patients and 54 non-BA cholestasis patients) and a control group of 38 patients with nonhepatic conditions. Analysis was first made by two observers separately and finally, a consensus conclusion was achieved. Then, the diagnostic value of the HSST sign was validated in an independent cohort including 45 BA and 45 non-BA patients. RESULTS In the retrospective investigation, an ampli.ed HSST sign was found in all BA patients, while we were unable to detect the HSST sign in 98.1% of the 54 non-BA patients. There was no HSST sign in any of the control subjects. In the first review, the sensitivity and specificity from one reviewer were 100% and 98.1%, respectively, and the results from the other reviewer were both 100%. The consensus sensitivity and specificity were 100% and 98.1%, respectively. The HSST sign was defined as being composed of several enlarged tortuous spider-like vascular plexuses with two to eight branches distributed on all over the liver surface, which presented as either a concentrated type or a dispersed type. In the independent validation group, the sensitivity, specificity, positive predictive value and negative predictive value of the HSST sign were 100%, 97.8%, 97.8% and 100%, respectively. CONCLUSION The HSST sign is characteristic in BA, and laparoscopic exploration for the HSST sign is valuable in the diagnosis of BA.
文摘Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive procedure for diagnosis and treatment of biliary and pancreatic diseases. Even in the best hands, complications may occur. Clinically significant hemorrhagic complications associated usually to previous papillotomy are uncommon. Subcapsular hepatic hematoma is excepcional, with only twenty cases described. We present a case of a 52-year-old man who developed a large subcapsular liver hematoma following a therapeutic ERCP. Due to serious anemization and hemodynamic instability, arterial embolization and finally urgent surgical evacuation of the hematoma were performed. In the postoperative period the patient presented infection of the collection, which indicated colocation of percutaneous drainage and broad-spectrum intravenous antibiotics, and gradually recovered.
文摘BACKGROUND Endoscopic ultrasonography(EUS)has evolved in the last years making it not only a diagnostic modality but a therapeutic procedure.EUS is now used as an alternative technique to percutaneous and surgical drainage.Even though EUS is a challenging procedure and not always suitable compared to percutaneous drainage,there is a need for developing new therapeutic approaches to the liver for when percutaneous drainage is not feasible.CASE SUMMARY We present the case of a 82 years old male who developed an infected subcapsular hepatic hematoma(SHH)of the left lobe following percutaneous biliary drainage.After 2 failed attempts of percutaneous drainage of the SHH and because the patients couldn’t withstand surgery,we conducted a EUS drainage and debridement of the SHH.Using a lumen apposing metal stent(LAMS)by a transgastric approach,we were able to gain endoscopic access to the SHH.With our experience in the debridement of walled off pancreatic necrosis using this technique,we were confident it was the right approach.After four debridement sessions,the computed tomography scan showed a clear regression of the SHH.CONCLUSION To our knowledge,this is the first case of successful endoscopic debridement of a SHH using a LAMS which appear to be feasible and safe in this specific case.
文摘目的:比较不同人工晶状体(IOL)固定术治疗缺少囊膜支撑的无晶状体患者的疗效。方法:回顾性研究。选取2019年6月至2024年6月本院收治的缺少囊膜支撑的无晶状体患者120例120眼,根据治疗方式分为两组:A组60眼采用巩膜瓣下IOL深层巩膜固定术治疗;B组60眼采用睫状沟IOL缝线悬吊固定术治疗。比较两组患者手术时间,术前,术后1、3、6 mo裸眼视力(UCVA)、最佳矫正视力(BCVA)、眼压(IOP)、角膜内皮细胞密度(CECD)、角膜内皮细胞丢失率和术后并发症。结果:A组患者手术时间小于B组(24.69±2.69 vs 32.75±3.75 min,t=11.937,P<0.05)。两组患者术后UCVA和BCVA均较术前改善,且A组优于B组(均P<0.05);A组角膜内皮细胞丢失率在术后1、3、6 mo均小于B组,术后1 mo A组的IOP小于B组,CECD高于B组(均P<0.05);A组患者术后IOL异位3眼(5.0%)小于B组11眼(18.3%,P=0.023)。结论:巩膜瓣下IOL深层巩膜固定术治疗缺少囊膜支撑的无晶状体患者的疗效显著,有助于改善患者视力,手术时间较少,且术后并发症少。
文摘目的:探讨基质金属蛋白酶-3(mat ri xmet al lopro-teinase-3,MMP-3)在前囊下性白内障患者的晶状体上皮细胞(lensepithelialcells,LECs)中的表达及意义。方法:采用SP免疫组织化学染色法,测定21例前囊下性白内障、18例核性白内障和10例正常晶状体上皮细胞中MMP-3的表达情况,并进行阳性细胞细胞计数。结果:MMP-3在前囊下性白内障晶状体上皮细胞中有表达,而在核性白内障和正常晶状体上皮细胞中均无表达。结论:MMP-3可能是调节细胞外基质(extracellulamatrix,ECM)降解的重要因素而参与前囊膜下性白内障的形成。
