BACKGROUND:The Frey procedure(FP)is the treatment of choice for symptomatic chronic pancreatitis(CP).In cases of biliary stricture,biliary derivation can be performed by choledochoduodenostomy,Roux-en-Y choledochojeju...BACKGROUND:The Frey procedure(FP)is the treatment of choice for symptomatic chronic pancreatitis(CP).In cases of biliary stricture,biliary derivation can be performed by choledochoduodenostomy,Roux-en-Y choledochojejunostomy or,more recently,reinsertion of the common bile duct(CBD)into the resection cavity.The objective of the present study was to evaluate the outcomes associated with each of these three types of biliary derivation.METHODS:We retrospectively analyzed demographic,CPrelated,surgical and follow-up data for patients having undergone FP for CP with biliary derivation between 2004and 2012 in our university medical center.The primary efficacy endpoint was the rate of CBD stricture recurrence.The secondary endpoints were surgical parameters,postoperative complications,postoperative follow-up and the presence of risk factors for secondary CBD stricture.RESULTS:Eighty patients underwent surgery for CP during the study period.Of these,15 patients received biliary derivation with the FP.Eight of the FPs(53.3%)were combined with choledochoduodenostomy,4(26.7%)with choledochojejunostomy and 3(20.0%)with reinsertion of the CBD into the resection cavity.The mean operating time was 390minutes.Eleven complications(73.3%)were recorded,including one major complication(6.7%)that necessitated radiologicallyguided drainage of an abdominal collection.The mean(range)length of stay was 17 days(8-28)and the median(range)follow-up time was 35.2 months(7.2-95.4).Two patients presented stricture after CBD reinsertion into the resection cavity;one was treated with radiologically-guided dilatation and the other underwent revisional Roux-en-Y choledochojejunostomy.Three patients presented alkaline reflux gastritis(37.5%),one(12.5%)cholangitis and one CBD stricture after FP with choledochoduodenostomy.No risk factors for secondary CBD stricture were identified.CONCLUSIONS:As part of a biliary derivation,the FP gave good results.We did not observe any complications specifically related to surgical treatment of the biliary tract.Ho展开更多
目的探讨经皮经肝穿门静脉支架置入术(PTPS)+经皮经肝穿胆道支架植入术(PTBS)治疗肿瘤所致门静脉高压症并梗阻性黄疸的临床应用价值。方法选择2003年8月—2017年3月共收治门静脉狭窄伴梗阻性黄疸患者36例,其中炎症性狭窄6例,肿瘤侵犯性...目的探讨经皮经肝穿门静脉支架置入术(PTPS)+经皮经肝穿胆道支架植入术(PTBS)治疗肿瘤所致门静脉高压症并梗阻性黄疸的临床应用价值。方法选择2003年8月—2017年3月共收治门静脉狭窄伴梗阻性黄疸患者36例,其中炎症性狭窄6例,肿瘤侵犯性狭窄30例,在彩超引导下分别经皮经肝穿刺门静脉和胆道成功后,实施了门静脉支架及胆道支架置入术,观察术后门静脉压力、血流速及血流量、肝功变化、临床症状、并发症及患者存活情况。术后继续给予抗炎、利尿、抗凝、保肝及对症治疗,复查血常规、凝血系列、肝功、肾功、电解质。复检腹部增强CT,观察支架情况及门静脉、胆道通畅程度。结果 36例患者成功在彩超引导DSA下行门静脉造影术+支架置入成形术,再行胆道造影术+胆道狭窄支架置入成形术,置入门静脉支架及胆道支架各48枚,门静脉压力由术前的(38. 2±5. 1) cm H_2O(1 cm H_2O=0. 098 k Pa)降至术后(17. 0±2. 1) cm H_2O,患者门静脉高压及腹水症状完全缓解,肝功明显改善,手术过程中出现穿刺部位疼痛、胆心反射、胆道出血、胆汁性腹膜炎等并发症,对症处理后症状缓解,无手术相关的严重并发症。结论支架置入术治疗肿瘤所致门静脉狭窄及胆道狭窄引起的门静脉高压及梗阻性黄疸是安全有效的,可以应用于临床诊疗。展开更多
文摘BACKGROUND:The Frey procedure(FP)is the treatment of choice for symptomatic chronic pancreatitis(CP).In cases of biliary stricture,biliary derivation can be performed by choledochoduodenostomy,Roux-en-Y choledochojejunostomy or,more recently,reinsertion of the common bile duct(CBD)into the resection cavity.The objective of the present study was to evaluate the outcomes associated with each of these three types of biliary derivation.METHODS:We retrospectively analyzed demographic,CPrelated,surgical and follow-up data for patients having undergone FP for CP with biliary derivation between 2004and 2012 in our university medical center.The primary efficacy endpoint was the rate of CBD stricture recurrence.The secondary endpoints were surgical parameters,postoperative complications,postoperative follow-up and the presence of risk factors for secondary CBD stricture.RESULTS:Eighty patients underwent surgery for CP during the study period.Of these,15 patients received biliary derivation with the FP.Eight of the FPs(53.3%)were combined with choledochoduodenostomy,4(26.7%)with choledochojejunostomy and 3(20.0%)with reinsertion of the CBD into the resection cavity.The mean operating time was 390minutes.Eleven complications(73.3%)were recorded,including one major complication(6.7%)that necessitated radiologicallyguided drainage of an abdominal collection.The mean(range)length of stay was 17 days(8-28)and the median(range)follow-up time was 35.2 months(7.2-95.4).Two patients presented stricture after CBD reinsertion into the resection cavity;one was treated with radiologically-guided dilatation and the other underwent revisional Roux-en-Y choledochojejunostomy.Three patients presented alkaline reflux gastritis(37.5%),one(12.5%)cholangitis and one CBD stricture after FP with choledochoduodenostomy.No risk factors for secondary CBD stricture were identified.CONCLUSIONS:As part of a biliary derivation,the FP gave good results.We did not observe any complications specifically related to surgical treatment of the biliary tract.Ho
文摘目的探讨经皮经肝穿门静脉支架置入术(PTPS)+经皮经肝穿胆道支架植入术(PTBS)治疗肿瘤所致门静脉高压症并梗阻性黄疸的临床应用价值。方法选择2003年8月—2017年3月共收治门静脉狭窄伴梗阻性黄疸患者36例,其中炎症性狭窄6例,肿瘤侵犯性狭窄30例,在彩超引导下分别经皮经肝穿刺门静脉和胆道成功后,实施了门静脉支架及胆道支架置入术,观察术后门静脉压力、血流速及血流量、肝功变化、临床症状、并发症及患者存活情况。术后继续给予抗炎、利尿、抗凝、保肝及对症治疗,复查血常规、凝血系列、肝功、肾功、电解质。复检腹部增强CT,观察支架情况及门静脉、胆道通畅程度。结果 36例患者成功在彩超引导DSA下行门静脉造影术+支架置入成形术,再行胆道造影术+胆道狭窄支架置入成形术,置入门静脉支架及胆道支架各48枚,门静脉压力由术前的(38. 2±5. 1) cm H_2O(1 cm H_2O=0. 098 k Pa)降至术后(17. 0±2. 1) cm H_2O,患者门静脉高压及腹水症状完全缓解,肝功明显改善,手术过程中出现穿刺部位疼痛、胆心反射、胆道出血、胆汁性腹膜炎等并发症,对症处理后症状缓解,无手术相关的严重并发症。结论支架置入术治疗肿瘤所致门静脉狭窄及胆道狭窄引起的门静脉高压及梗阻性黄疸是安全有效的,可以应用于临床诊疗。
