BACKGROUND Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide.Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional mul...BACKGROUND Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide.Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional multisession percutaneous transhepatic cholangioscopic lithotripsy(PTCSL).AIM To study one-step PTCSL using the percutaneous transhepatic one-step biliary fistulation(PTOBF)technique guided by three-dimensional(3D)visualization.METHODS This was a retrospective,single-center study analyzing,140 patients who,between October 2016 and October 2023,underwent one-step PTCSL for hepatolithiasis.The patients were divided into two groups:The 3D-PTOBF group and the PTOBF group.Stone clearance on choledochoscopy,complications,and long-term clearance and recurrence rates were assessed.RESULTS Age,total bilirubin,direct bilirubin,Child-Pugh class,and stone location were similar between the 2 groups,but there was a significant difference in bile duct strictures,with biliary strictures more common in the 3D-PTOBF group(P=0.001).The median follow-up time was 55.0(55.0,512.0)days.The immediate stone clearance ratio(88.6%vs 27.1%,P=0.000)and stricture resolution ratio(97.1%vs 78.6%,P=0.001)in the 3D-PTOBF group were significantly greater than those in the PTOBF group.Postoperative complication(8.6%vs 41.4%,P=0.000)and stone recurrence rates(7.1%vs 38.6%,P=0.000)were significantly lower in the 3D-PTOBF group.CONCLUSION Three-dimensional visualization helps make one-step PTCSL a safe,effective,and promising treatment for patients with complicated primary hepatolithiasis.The perioperative and long-term outcomes are satisfactory for patients with complicated primary hepatolithiasis.This minimally invasive method has the potential to be used as a substitute for hepatobiliary surgery.展开更多
BACKGROUND Primary pancreatic paraganglioma is exceedingly rare.Most patients with pancreatic paraganglioma lack a typical clinical presentation,and the tumor is difficult to accurately differentiate from other pancre...BACKGROUND Primary pancreatic paraganglioma is exceedingly rare.Most patients with pancreatic paraganglioma lack a typical clinical presentation,and the tumor is difficult to accurately differentiate from other pancreatic neuroendocrine tumors,making the misdiagnosis rate extremely high.Surgical excision is the primary treatment modality but is considered high risk.Because of its rich vascularity,the tumor easily bleeds during surgery,especially malignant paragangliomas invading large blood vessels.Thus,a thorough preoperative evaluation of the tumor is necessary.Here,we report a primary malignant pancreatic paraganglioma,the second such case in a young patient that was successfully resected surgically.CASE SUMMARY A 26-year-old female patient was admitted to the hospital with unexplained abdominal pain.Dual-layer spectral-detector computed tomography(DLCT)revealed a mixed density mass in the pancreatic body and tail.The patient was transferred to our hospital after previous failed surgical resection at other hospitals.The patient and her family strongly desired surgery.After a thorough preoperative evaluation and adequate preparation,a large mass with the greatest dimension of 8.0 cm was successfully resected.The final pathological diagnosis was malignant paraganglioma.The patient was discharged in good condition 2 wk postoperatively.CONCLUSION The rare malignant pancreatic paraganglioma reported here was difficult to diagnose preoperatively.Early filling of the draining vein may be a crucial diagnostic imaging feature.DLCT can provide more precise information for surgical resection through dual-energy imaging.展开更多
基金Supported by The Key Medical Specialty Nurturing Program of Foshan During The 14th Five-Year Plan Period,No.FSPY145205The Medical Research Project of Foshan Health Bureau,No.20230814A010024+1 种基金The Guangzhou Science and Technology Plan Project,No.202102010251the Guangdong Science and Technology Program,No.2017ZC0222.
文摘BACKGROUND Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide.Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional multisession percutaneous transhepatic cholangioscopic lithotripsy(PTCSL).AIM To study one-step PTCSL using the percutaneous transhepatic one-step biliary fistulation(PTOBF)technique guided by three-dimensional(3D)visualization.METHODS This was a retrospective,single-center study analyzing,140 patients who,between October 2016 and October 2023,underwent one-step PTCSL for hepatolithiasis.The patients were divided into two groups:The 3D-PTOBF group and the PTOBF group.Stone clearance on choledochoscopy,complications,and long-term clearance and recurrence rates were assessed.RESULTS Age,total bilirubin,direct bilirubin,Child-Pugh class,and stone location were similar between the 2 groups,but there was a significant difference in bile duct strictures,with biliary strictures more common in the 3D-PTOBF group(P=0.001).The median follow-up time was 55.0(55.0,512.0)days.The immediate stone clearance ratio(88.6%vs 27.1%,P=0.000)and stricture resolution ratio(97.1%vs 78.6%,P=0.001)in the 3D-PTOBF group were significantly greater than those in the PTOBF group.Postoperative complication(8.6%vs 41.4%,P=0.000)and stone recurrence rates(7.1%vs 38.6%,P=0.000)were significantly lower in the 3D-PTOBF group.CONCLUSION Three-dimensional visualization helps make one-step PTCSL a safe,effective,and promising treatment for patients with complicated primary hepatolithiasis.The perioperative and long-term outcomes are satisfactory for patients with complicated primary hepatolithiasis.This minimally invasive method has the potential to be used as a substitute for hepatobiliary surgery.
文摘BACKGROUND Primary pancreatic paraganglioma is exceedingly rare.Most patients with pancreatic paraganglioma lack a typical clinical presentation,and the tumor is difficult to accurately differentiate from other pancreatic neuroendocrine tumors,making the misdiagnosis rate extremely high.Surgical excision is the primary treatment modality but is considered high risk.Because of its rich vascularity,the tumor easily bleeds during surgery,especially malignant paragangliomas invading large blood vessels.Thus,a thorough preoperative evaluation of the tumor is necessary.Here,we report a primary malignant pancreatic paraganglioma,the second such case in a young patient that was successfully resected surgically.CASE SUMMARY A 26-year-old female patient was admitted to the hospital with unexplained abdominal pain.Dual-layer spectral-detector computed tomography(DLCT)revealed a mixed density mass in the pancreatic body and tail.The patient was transferred to our hospital after previous failed surgical resection at other hospitals.The patient and her family strongly desired surgery.After a thorough preoperative evaluation and adequate preparation,a large mass with the greatest dimension of 8.0 cm was successfully resected.The final pathological diagnosis was malignant paraganglioma.The patient was discharged in good condition 2 wk postoperatively.CONCLUSION The rare malignant pancreatic paraganglioma reported here was difficult to diagnose preoperatively.Early filling of the draining vein may be a crucial diagnostic imaging feature.DLCT can provide more precise information for surgical resection through dual-energy imaging.
