目的总结急性胆源性胰腺炎(ABP)的治疗经验。方法我院2005年2月至2009年10月期间收治89例ABP患者，梗阻型ABP 29例，其中2例胆总管下端结石梗阻致坏死型胰腺炎患者，24 h内行开腹或腹腔镜胆囊切除（LC）、胆总管切开取石、T管引流、胰腺被膜切开减压、胰腺坏死组织清除; 8例肝外胆管结石患者急诊(24～48 h)行内镜逆行胰胆管造影术(ERCP)+内镜下括约肌切开术(EST)+内镜下鼻胆管引流(ENBD); 17例胆囊结石伴胆总管结石及2例胆总管下端占位患者先行内科保守治疗病情得到控制，7 d后行CT、EST或ENBD，择期行LC、胆总管切开取石术、限期内镜胆管内支架放置术或开放根治术。非梗阻型ABP 60例，均为胆囊结石、胆囊炎所致，在入院后3～14 d急性胰腺炎控制后42例行胆囊切除术，18例行保守治疗。结果29例梗阻型ABP在及时或限时行胆道引流解除梗阻后均使胰腺炎得到控制，病情稳定后行手术治疗，均治愈出院; 60例非梗阻型ABP患者中，42例住院行一期胆囊切除术，治愈率达100%，18例保守治疗患者，1个月至1年胰腺炎复发9例，均再次入院，3例保守治疗好转后出院； 6例行胆囊切除术，其中LC 4例，开腹胆囊切除术2例，其中5例治愈，1例出现急性呼吸窘迫综合征抢救无效死亡。结论ABP应根据胆管有无梗阻分型治疗，梗阻型应尽早引流解除胆管梗阻，EST+ENBD能有效解除胆管梗阻控制胰腺炎症； 非梗阻型宜积极保守治疗，病情缓解后手术治疗，能有效降低并发症发生率和病死率。
Esophageal diseases include esophageal malignant diseases and benign diseases, with a high incidence in our country. Along with the development of the endoscopic technique, many of them which required medical treatment or surgery in the past can now be cured by endoscopic surgery. This article is an overview of long-term follow-up of endoscopic surgery for the common esophageal disease, such as early squamous cell carcinoma, esophageal stricture, achalasia and submucosal tumor of the esophagus.
Objective To evaluate the therapeutic effects of endoscopic treatment on biliary tract complications after liver transplantation. Methods The clinical data of 55 patients with biliary tract complications after liver transplantation undergoing endoscopic treatment from January 2006 to June 2009 were analyzed retrospectively. Results Ninety-eight times of endoscopic treatment were performed in 55 patients. There were 11 cases of biliary fistula, 4 cases of bile duct stricture with biliary fistula, 21 cases of bile duct stricture, 12 cases of bile duct stricture with biliary sludge or stones, 3 cases of biliary sludge or stones, 2 cases of angular distortion of the bile duct and papilla duodeni stenosis in 2 cases. Different procedures including biliary tract dilation, endoscopic nasobiliary drainage, endoscopic sphincterotomy, stone extraction technique and biliary stent placement were performed in different biliary tract complications. The endoscopic treatments were successful in 46 cases (83.6%). The procedure related complications were found in 13 times (13.3%). Conclusion Endoscopy may serve as the primary modality for treating biliary tract complications after liver transplantation with safety and effectiveness.
ObjectiveThe aim of this paper is to summarize the advantages and disadvantages of non-surgical treatments of the enterocutaneous fistula, in order to give some advice.MethodsPubmed, EMBASE, Medline, CNKI, and Wanfang databases were retrieved for the published article addressing the non-surgical treatments of enterocutaneous fistula between 2004 to 2018. The keywords were " enterocutaneous fistula” in English and Chinese, respectively. The non-surgical treatments of enterocutaneous fistula were reviewed.ResultsThe results of this search suggested that non-surgical treatments of the enterocutaneous fistula mainly include fibrin glue, endoscopic treatment, laser ablation, and somatostatin. Fibrin glue was widely used at domestic and abroad, but it needed repeated operations. Endoscopic treatment of enterocutaneous fistula required a certain professional foundation; laser ablation technology was still immature and required theoretical data support. Now, the use of somatostatin was controversial.ConclusionEach of measures have its advantages and disadvantages, we should determine according to the patient’s condition and economic situation.
ObjectiveTo explore the safety and effectiveness of endoscopic treatment for biliary tract complications after liver transplantation.MethodsPatients who underwent endoscopic treatment for biliary tract complications after liver transplantation from January 2009 to December 2018 in West China Hospital were enrolled. Characteristics of patients, types of biliary tract complications, effectiveness of endoscopic treatment and endoscopic related complications were collected and analyzed.ResultsAmong the 57 patients with biliary tract complications, 37 patients had biliary stricture alone, 4 patients had bile leak alone, 15 patients had biliary stricture plus biliary stones or sludge, and 1 patient had biliary stricture combined with biliary leakage. A total of 112 treatments of endoscopic retrograde cholangiopancreatography (ERCP) were performed, among which 100 treatments were accomplished successfully (89.3%), including the improvement of bile duct stenosis, the cure of bile leak and the successful removal of common bile duct stones. The number of total ERCP related complications was 15 (13.4%), among which post ERCP pancreatitis was the most common (9.8%).ConclusionEndoscopic therapy can be considered as an initial treatment for biliary tract complications after liver transplantation as its safety and effectiveness.
Objective To systematically review the efficacy and safety of cap-assisted endoscopy in the treatment of esophageal foreign bodies. Methods PubMed, Web of Science, The Cochrane Library, EMbase, CNKI and Wanfang databases were searched by computer for relevant literatures on cap-assisted endoscopy and traditional endoscopy for esophageal foreign bodies from inception to November 2022. The quality assessment of the literature was conducted using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan 5.4.1. Results Finally, 27 studies were collected, including 17 randomized controlled trials, 2 cohort studies and 8 case-control studies, with a total of 3 619 patients. NOS scores of all studies were ≥7 points. Meta-analysis results showed that compared with traditional endoscopic treatment, the success rate of removing esophageal foreign bodies in the cap-assisted endoscopy group was higher (OR=14.43, 95%CI 10.64 to 19.55, P<0.000 1), postoperative complications were fewer (OR=0.30, 95%CI 0.23 to 0.38, P<0.000 1), patients' tolerance was better (OR=4.07, 95%CI 2.95 to 5.60, P<0.000 1), intraoperative visual field clarity was better (OR=12.00, 95%CI 7.29 to 19.76, P<0.000 1) and operative time was shorter (SMD=−1.83, 95%CI −2.31 to −1.34, P<0.000 1). Conclusion Cap-assisted endoscopy for esophageal foreign bodies is an effective and safe method, worthy of further promotion and application in clinical practice.
目的探讨肝移植术后胆道并发症的病因及内镜在肝移植并发症中的治疗。 方法笔者所在单位1995年9月至2010年3月期间共施行尸体肝移植516例，将其分为2个阶段，即1995～2001年的技术摸索阶段和2001～2010年的技术成熟阶段。第1阶段125例，有17例（13.60%）发生胆道并发症；第2阶段391例，有15例（3.84%）发生胆道并发症。对这32例患者行内镜诊治的相关临床资料进行回顾性分析。 结果32例中单纯胆瘘5例，单纯胆管结石2例，单纯胆管狭窄11例，胆管狭窄伴结石9例，胆管狭窄合并胆瘘2例，胆管扭曲2例，十二指肠乳头狭窄1例。针对不同的胆道并发症，采取了胆管扩张、乳头切开取石、胆道支架置放、鼻胆管引流等不同的治疗方式，32例患者共行内镜治疗56例次，治疗成功27例（84.38%）；发生内镜相关并发症4例（12.50%）。 结论内镜治疗肝移植术后胆道并发症的疗效是值得肯定的。
Objective To evaluate the efficacy and safety of traditional Chinese medicine (TCM) in treating Chronic Rhinosinusitis (CRS) after Functional Endoscopic Sinus Surgery (FESS). Methods The following databases and periodicals such as PubMed (Jan. 1980 to Jan. 2009), MEDLINE (1980 to 2009), EBSCOhost (Jan. 1975 to Jan. 2009), CALIS (1984 to 2009), CNKI (1979 to 2007), VIP (1989 to 2009), CBM (1978 to 2009); Chinese Journal of Otorhinolaryngology Head and Neck Surgery (1990 to 2008), Journal of Clinical Otorhinolaryngology Head and Neck Surgery (1988 to 2008), Otorhinolaryngology Head and Neck Surgery (1990 to 2008), and Chinese Journal of Otorhinolaryngology of Integrated Traditional and Western Medicine (1996 to 2008) were searched by computer and handwork for randomized controlled trials (RCTs) about TCM to treat CRS after ESS. The trial screening, quality assessment, and the data extraction of the included trials were conducted before performing statistical analyses by using RevMan 4.2.10 software. Results A total of 32 RCTs in three sub-groups in Chinese literatures were identified with meta-analyses in comparisons of the cure rate (OR=1.99, 95%CI 1.78 to 2.23), total effective rate (OR=2.66, 95%CI 2.20 to 3.22), degree I postoperative improvement rate (OR=2.22, 95%CI 1.60 to 3.06), total postoperative improvement rate (OR=8.77, 95%CI 1.09 to 70.64), postoperative clean time (OR=2.54, 95%CI 1.70 to 3.79), postoperative epithelization time (OR= –29.46, 95%CI –37.73 to –21.18), and mucociliary transport rate (OR=1.14, 95%CI 0.22 to 2.06). A total of 4 RCTs were meta-analyzed to evaluate the safety in comparisons of gastrointestinal reaction (OR=0.25, 95%CI 0.00 to 33.78) and local reaction (OR=0.03, 95%CI 0.01 to 0.12). Conclusion The current evidence shows TCM in treating CRS after ESS tends to improve the clinical efficacy and reduce the cure time without obvious adverse reaction. Due to the low methodological quality of included trials, more RCTs with high quality and large scale are required.