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LC联合术中ERCP与LC联合LTCBDE治疗胆囊结石合并非扩张型胆总管结石的效果比较:一项倾向性评分匹配研究 认领 引用 被引量：1
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作者 张洪战 刘珊珊 +3 位作者 张明 张锎 郭景龙 牛帅 《肝胆胰外科杂志》 CAS 2026年第1期31-38,共8页
目的分析腹腔镜胆囊切除术(LC)联合术中内镜逆行胰胆管造影(ERCP)对比LC联合腹腔镜下经胆囊管胆总管探查取石术(LTCBDE)治疗胆囊结石合并非扩张型胆总管结石的安全性和有效性。方法回顾性收集2022年10月至2024年10月于山东省立第三医院... 目的分析腹腔镜胆囊切除术(LC)联合术中内镜逆行胰胆管造影(ERCP)对比LC联合腹腔镜下经胆囊管胆总管探查取石术(LTCBDE)治疗胆囊结石合并非扩张型胆总管结石的安全性和有效性。方法回顾性收集2022年10月至2024年10月于山东省立第三医院诊断为胆囊结石合并非扩张型胆总管结石并接受LC联合术中ERCP或LC联合LTCBDE的312例患者临床资料,按手术方式分为LC+术中ERCP组(n=160)和LC+LTCBDE组(n=152),采用倾向性评分匹配(PSM)进行1∶1匹配,卡钳值设为0.1。观察并比较匹配后两组患者术中和术后各项指标及并发症等情况。结果PSM后,两组各纳入131例。LC+术中ERCP组与LC+LTCBDE组手术成功率(99.2%vs 98.5%,P=1.000)和结石清除率(100.0%vs 99.2%,P=1.000)差异均无统计学意义。LC+术中ERCP组较LC+LTCBDE组手术时间更长[(99.1±28.9)min vs(84.2±24.8)min,t=4.492,P0.05)。结论LC联合术中ERCP或LC联合LTCBDE治疗胆囊结石合并非扩张型胆总管结石均安全有效。建议结合患者自身状况,医疗单位条件和医师手术水平综合评估,选择最佳治疗方案。 展开更多
关键词 胆总管结石 胆囊结石 非扩张型胆总管 腹腔镜胆囊切除术 内镜逆行胰胆管造影 腹腔镜经胆囊管胆总管探查取石术
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超微创钳辅助微单孔腹腔镜胆囊切除术的临床实践 认领 引用 被引量：1
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作者 宋兴超 许安之 +3 位作者 马啸 田春艳 李文锦 何子凡 《肝胆胰外科杂志》 CAS 2026年第1期11-15,共5页
目的分析超微创钳辅助微单孔腹腔镜胆囊切除术(MSILC)治疗胆囊良性疾病的可行性和安全性。方法回顾性收集2024年10月至2025年6月徐州医科大学附属徐州市立医院肝胆胰外科开展的76胆囊良性疾病患者临床资料。所有患者均接受超微创钳辅助M... 目的分析超微创钳辅助微单孔腹腔镜胆囊切除术(MSILC)治疗胆囊良性疾病的可行性和安全性。方法回顾性收集2024年10月至2025年6月徐州医科大学附属徐州市立医院肝胆胰外科开展的76胆囊良性疾病患者临床资料。所有患者均接受超微创钳辅助MSILC治疗,其中3例患者术中辅以吲哚菁绿(ICG)荧光胆道显像技术。结果MSILC手术中,73例患者术中使用1把超微创钳,2例使用2把超微创钳;1例患者中转传统三孔LC。无中转开腹病例,无死亡病例。中位手术时间65(50,90)min,中位术中出血量10(10,20)mL;手术过程ICG荧光胆道清晰显影。28例患者因炎症较重、渗出较多术后留置引流管,引流管放置中位时间48(40,80)h。术后患者首次下床中位时间6(5,6)h,术后住院中位时间5(4,6)d。切口一期愈合,恢复良好,术中及术后住院期间未出现胆管损伤、腹腔内出血等并发症。术后随访1~8个月,未见胆漏、脐疝、术后胰腺炎、肺部感染等并发症,手术瘢痕愈合隐蔽,患者满意。结论超微创钳辅助MSILC用于治疗胆囊良性疾病安全可行;该方法对腹壁损伤小,术后伤口隐匿,美容效果好。术中ICG荧光胆道显影可充分显露胆囊三角,提升术中胆道结构的可视化。 展开更多
关键词 超微创钳 微单孔 腹腔镜胆囊切除术 胆道结构可视化 腹壁损伤
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腹腔镜胆总管探查术在有上腹部手术史胆总管结石患者中的临床应用 认领 引用 被引量：2
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作者 冯之文 张文君 陈晓鹏 《肝胆胰外科杂志》 CAS 2026年第1期44-48,共5页
目的评估腹腔镜胆总管探查术(LCBDE)在有上腹部手术史的胆总管结石患者中应用的安全性和可行性。方法采用回顾性队列研究设计,纳入2021年1月至2022年12月期间于皖南医学院第一附属医院接受LCBDE治疗的胆总管结石患者96例。根据既往是否... 目的评估腹腔镜胆总管探查术(LCBDE)在有上腹部手术史的胆总管结石患者中应用的安全性和可行性。方法采用回顾性队列研究设计,纳入2021年1月至2022年12月期间于皖南医学院第一附属医院接受LCBDE治疗的胆总管结石患者96例。根据既往是否有上腹部手术史分为两组:观察组(有上腹部手术史,n=36)和对照组(无上腹部手术史,n=60)。比较两组患者的气腹建立方式、胆总管缝合方式、手术时间、术中出血量、中转开腹率、结石清除率、住院时间、术后并发症发生率及其处理方法、术后实验室指标,评估手术效果及安全性。结果与对照组比较,观察组采用Hasson技术建立气腹的比例更高[38.9%(14/36)vs 1.7%(1/60)],且手术时间更长[150.0(120.0,180.0)min vs 120.0(100.0,145.0)min],差异均有统计学意义(P0.05)。结论LCBDE在既往有上腹部手术史的胆总管结石患者中的临床应用具有较高的安全性和可行性。 展开更多
关键词 胆总管结石 腹腔镜胆总管探查术 上腹部手术史
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超声引导下经皮经肝胆囊穿刺置管引流术在治疗老年急性胆囊炎中的应用价值 认领 引用 被引量：1
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作者 王娟娟 侯庆兵 +2 位作者 袁中旭 陆启芳 张宏伟 《中华老年多器官疾病杂志》 2026年第3期161-165,共5页
目的探讨超声引导下经皮经肝胆囊穿刺置管引流术(PTGD)在治疗老年急性胆囊炎及序贯腹腔镜胆囊切除术(LC)中的应用。方法选取2020年6月至2025年1月在安徽省第二人民医院行PTGD序贯LC手术的老年急性胆囊炎(AC)患者41例为观察组,对比PTGD... 目的探讨超声引导下经皮经肝胆囊穿刺置管引流术(PTGD)在治疗老年急性胆囊炎及序贯腹腔镜胆囊切除术(LC)中的应用。方法选取2020年6月至2025年1月在安徽省第二人民医院行PTGD序贯LC手术的老年急性胆囊炎(AC)患者41例为观察组,对比PTGD前后的临床资料、炎症指标[白细胞(WBC)、中性粒细胞(NEU)、C反应蛋白(CRP)]及肝功能指标[白蛋白(ALB)、总胆红素(TBIL)、血淀粉酶(AMS)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷氨酰转肽酶(GGT)];另随机选择行直接LC手术的老年AC患者45例纳入对照组,对比观察组和对照组患者治疗前的一般资料,以及LC术中、术后的临床资料。采用SPSS 25.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、Mann-Whitney U检验、χ2检验或Fisher确切概率法。结果治疗前,观察组患者WBC、NEU、ALT及治疗费用均高于对照组(P0.05)。结论PTGD能快速缓解老年患者急性胆囊炎症状,减轻炎症反应、降低肝功能指标;同时可以为后期LC术创造良好的手术条件,减少手术损伤,促进患者更快恢复。 展开更多
关键词 老年人 急性胆囊炎 经皮经肝胆囊穿刺置管引流术 腹腔镜 胆囊切除术
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内镜下液电碎石术取石治疗Bouveret综合征一例 认领 引用 被引量：1
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作者 李作安 沈伟明 +2 位作者 朱纯 徐晓东 刘利敏 《肝胆胰外科杂志》 CAS 2026年第4期292-296,共5页
Bouveret综合征,即胆囊-十二指肠瘘伴高位胆石性肠梗阻(gallstone ileus,GSI),是胆囊结石从胆胃或胆肠瘘管进入胃或十二指肠导致的一种罕见的高位胆石性肠梗阻,约占小肠梗阻的1%~4%[1-2],好发于基础病多的老年患者,易漏诊误治,死亡率高... Bouveret综合征,即胆囊-十二指肠瘘伴高位胆石性肠梗阻(gallstone ileus,GSI),是胆囊结石从胆胃或胆肠瘘管进入胃或十二指肠导致的一种罕见的高位胆石性肠梗阻,约占小肠梗阻的1%~4%[1-2],好发于基础病多的老年患者,易漏诊误治,死亡率高达33%[3]。Bouveret综合征内镜治疗成功率低[4],治疗程序复杂,因此,探讨其术前评估、诊断和治疗方式的选择有重要意义。现将我院1例Bouveret综合征患者行内镜下液电碎石取石术的诊治经过总结报道如下。 展开更多
关键词 Bouveret综合征 胆石性肠梗阻 胆囊-肠瘘 内镜下液电碎石取石术
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单中心955例常规器械单孔腹腔镜胆囊切除术的临床应用 认领 引用 被引量：2
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作者 刘达人 查刘凡 +6 位作者 李超 吴锦洪 朱焕兵 叶丹 侯阳明 陈治泉 潘翔 《肝胆胰外科杂志》 CAS 2026年第1期16-21,共6页
目的探讨常规器械单孔腹腔镜胆囊切除术(SILC)治疗胆囊良性疾病的安全性与有效性。方法回顾性收集2023年1月至2025年1月在浙江大学医学院附属第二医院肝胆胰外科由同一手术团队均使用常规腹腔镜手术器械行SILC的955例及行传统腹腔镜胆... 目的探讨常规器械单孔腹腔镜胆囊切除术(SILC)治疗胆囊良性疾病的安全性与有效性。方法回顾性收集2023年1月至2025年1月在浙江大学医学院附属第二医院肝胆胰外科由同一手术团队均使用常规腹腔镜手术器械行SILC的955例及行传统腹腔镜胆囊切除术(CLC)的985例胆囊良性疾病患者临床资料,比较两组患者手术时间、总住院时间、总住院费用、术后疼痛评分、术后Clavien-DindoⅡ级及以上并发症发生率、术后瘢痕评分及术后生活质量等指标。结果SILC组患者在手术时间、总住院时间、总住院费用、术后疼痛评分及术后Clavien-DindoⅡ级以上并发症发生率等方面与CLC组差异无统计学意义(P>0.05)。SILC组患者术后1个月瘢痕评分明显低于CLC组(P<0.05);在术后6个月生活质量评分上,SILC组在情感职能、躯体疼痛及精力三个维度的评分高于CLC组,差异具有统计学意义(P<0.05)。结论在胆囊良性疾病治疗中,常规器械SILC的安全性及有效性与CLC相当;同时SILC能减少术后瘢痕并发症发生率,提升患者术后生活质量。 展开更多
关键词 常规器械 腹腔镜胆囊切除术 单孔腹腔镜手术 胆囊结石 胆囊良性疾病
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基于胆囊三角解剖特点设计的“两点提拉法”经脐单孔腹腔镜胆囊切除术的临床应用 认领 引用 被引量：1
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作者 康利民 何小龙 +1 位作者 王阿勇 许磊 《肝胆胰外科杂志》 CAS 2026年第1期27-30,共4页
目的根据胆囊三角解剖特点设计一种“两点提拉法”经脐单孔腹腔镜胆囊切除术(SILC),并探讨其临床应用可行性。方法回顾性分析普洱市人民医院肝胆胰外科2023年6月至2024年6月采用在右侧肋缘上锁骨中线8~9肋间穿刺置入3-0可吸收缝合线向... 目的根据胆囊三角解剖特点设计一种“两点提拉法”经脐单孔腹腔镜胆囊切除术(SILC),并探讨其临床应用可行性。方法回顾性分析普洱市人民医院肝胆胰外科2023年6月至2024年6月采用在右侧肋缘上锁骨中线8~9肋间穿刺置入3-0可吸收缝合线向上“提”起胆囊底部,再于右侧肋缘下5~10 cm腋中线穿刺置入3-0可吸收缝合线向右下“拉”开胆囊壶腹部的“两点提拉法”经脐SILC的103例患者临床资料;其中胆囊结石合并慢性胆囊炎82例,胆囊结石合并急性胆囊炎6例,胆囊息肉11例,胆囊腺肌病4例。结果所有SILC均使用常规腹腔镜器械。103例患者中,98例行“两点提拉法”SILC获得成功,术中胆囊三角均暴露良好,手术成功率为95.14%。手术时间35~70 min,术中出血量2~10 mL。其余5例中,3例因胆囊局部组织粘连严重而在剑突下增加1个操作孔,2例因胆囊急性炎症期中转行传统三孔腹腔镜胆囊切除术。“两点提拉法”SILC术后未出现发热、胆漏、出血或切口感染等并发症。术后2周复查时未观察到明显的手术瘢痕。术后3个月随访均恢复良好,未见特殊不适。结论基于胆囊三角解剖特点设计的“两点提拉法”SILC能够在术中良好地暴露胆囊三角,该方法操作简单、安全可行。 展开更多
关键词 胆囊三角 两点提拉法 经脐单孔手术 腹腔镜胆囊切除术
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Percutaneous transhepatic cholangioscopy-assisted procedures for the management of postoperative benign bilioenteric anastomotic strictures with or without biliary stones 认领 引用
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作者 Xu Ren Chen Wang +4 位作者 Yong-Ping Qu Xiu-Fen Tang Tian Xia Yi-Xia Lu Xiao-Mei Sun 《World Journal of Gastroenterology》 SCIE CAS 2026年第10期67-81,共15页
BACKGROUND Postoperative benign bilioenteric anastomotic stricture(BBAS)is a serious complication of biliary surgeries.AIM To determine the efficacy and safety of percutaneous transhepatic cholangioscopy(PTCS)-assiste... BACKGROUND Postoperative benign bilioenteric anastomotic stricture(BBAS)is a serious complication of biliary surgeries.AIM To determine the efficacy and safety of percutaneous transhepatic cholangioscopy(PTCS)-assisted procedures,including stricture dilation and recanalization for BBAS and biliary stone therapy for concomitant stones.METHODS Patients with BBAS who received PTCS-assisted procedures were included.Primary outcomes were anastomotic patency(including initial anastomotic patency after stricture dilation and cumulative anastomotic patency after PTCS catheter removal)and treatment success(i.e.,negative clinical clamping trial and removable indwelling PTCS catheter).Secondary outcomes were technical success for the three PTCS-assisted procedures,duration of the indwelling PTCS catheter,and adverse events.RESULTS Forty patients were included;32 underwent PTCS-assisted stricture dilationecanalization and 36 underwent biliary stone therapy.The initial patency rates were 58.1%and 41.9%at 1 and 2 years,respectively,and the cumulative patency rates were 74.3%,59.7,49.8%,and 34.8%at 1,3,5,and 7 years,respectively.The treatment success rate was 90.6%(29/32)for PTCS-assisted stricture procedures.The technical success rates were 100%(31/31),87.5%(7/8),and 94.5%(34/36)for PTCS-assisted stricture dilation,recanalization,and biliary stone therapy,respectively.The median duration of the indwelling PTCS catheter in the 29 patients with treatment success was 6(range:2-109)months.Only one patient experienced acute bleeding,which was manageable.CONCLUSION PTCS-assisted procedures are efficacious and safe for the management of BBAS and concomitant biliary stones.Placement of an indwelling PTCS catheter across the anastomosis after stricture dilation improves the anastomotic patency. 展开更多
关键词 Benign bilioenteric anastomotic stricture Percutaneous transhepatic cholangioscopy Anastomotic patency Stricture dilation Anastomotic recanalization Biliary stone Indwelling percutaneous transhepatic cholangioscopy catheter
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Artificial intelligence-assisted biliary stent length selection for common bile duct strictures in endoscopic retrograde cholangiopancreatography:Model development and validation 认领 引用
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作者 Wen-Lin Zhang Xue-Jun Shao +5 位作者 Xuan-Yuan Dong Hong-Ting Shao Guang-Chao Li Zhen Li Ning Zhong Rui Ji 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2026年第1期76-82,共7页
Background:Biliary stent placement during endoscopic retrograde cholangiopancreatography(ERCP)is important for drainage in common bile duct(CBD)strictures,while the stent length is associated with many stent-related c... Background:Biliary stent placement during endoscopic retrograde cholangiopancreatography(ERCP)is important for drainage in common bile duct(CBD)strictures,while the stent length is associated with many stent-related complications.We aimed to develop an artificial intelligence(AI)model for stent length selection during ERCP.Methods:Images of the patients who underwent ERCP and were diagnosed with CBD strictures were collected.Training involved identifying and delineating the duodenoscope,CBD and guidewire,calculating the pixel distance of the target guidewire and determining the required biliary stent length based on the diameter of the duodenoscope.The performance of the model,accuracy for length calculation and the assistance for endoscopists were validated using the testing set.Results:A total of 794 images from 431 patients were included and data augmentation was conducted.The mean intersection over union(mIoU)for duodenoscope,CBD and guidewire were 90.46%,84.79%and 84.64%,respectively.The accuracy in identifying the strictures was 97.58%(121/124).The accuracy for stent length calculation achieved 85.95%(104/121)with an error margin of±1 cm.The mean absolute error(MAE)and mean relative error(MRE)of the AI model was 0.81 cm and 0.13,respectively.The AI model could reduce approximately 202 mGycm2of the radiation exposure for each patient.It significantly improved both MAE and MRE for less experienced endoscopists(P=0.01 and P=0.02,respectively).Conclusions:The AI model could accurately identify duodenoscope,CBD and guidewire,enabling accurate strictures identification and stent length selection. 展开更多
关键词 Endoscopic retrograde cholangiopancreatography Artificial intelligence Common bile duct stricture Stent placement
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Endoscopic ultrasound-guided transhepatic antegrade stone removal for choledocholithiasis after pancreaticoduodenectomy:A case report and review of literature 认领 引用
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作者 Yu-Ming Li Aimaiti Yasen +4 位作者 Si-Fang Chen Jian Fan Xiao-Bing Huang Guo-Hua Zuo Lu Zheng 《World Journal of Gastroenterology》 SCIE CAS 2026年第8期146-153,共8页
BACKGROUND The special choledocholithiasis(common hepatic duct stone)proximal to hepaticojejunostomy anastomosis following pancreaticoduodenectomy(PD)presents significant therapeutic challenges because of surgically a... BACKGROUND The special choledocholithiasis(common hepatic duct stone)proximal to hepaticojejunostomy anastomosis following pancreaticoduodenectomy(PD)presents significant therapeutic challenges because of surgically altered anatomy,which precludes the use of conventional endoscopic retrograde cholangiopancreatography.Endoscopic ultrasound(EUS)offers a minimally invasive alternative for antegrade stone extraction.Here,we report a rare case of EUS-guided transhepatic antegrade stone removal(EUS-TASR)in a patient with choledocholithiasis occurring eleven years after PD.CASE SUMMARY A 58-year-old male with a history of PD for a duodenal tumor eleven years prior presented with a three-month history of intermittent upper abdominal discomfort.Imaging revealed a nodular filling defect in the common hepatic duct and mild intrahepatic biliary dilatation,confirming choledocholithiasis.Given the altered anatomy,endoscopic retrograde cholangiopancreatography was deemed unfeasible;thus,EUS-TASR with endoscopic nasobiliary drainage was successfully performed.The endoscopic nasobiliary drainage tube was removed on postoperative day 7,and the patient was discharged in stable condition on postoperative day 8.At the ten-month follow-up,the patient remained asymptomatic without complications.CONCLUSION EUS-TASR is a viable,minimally invasive approach for managing choledocholithiasis in post-PD patients with altered anatomy where conventional endoscopic access is restricted. 展开更多
关键词 Choledocholithiasis Pancreaticoduodenectomy Endoscopic ultrasound Endoscopic ultrasound-guided transhepatic antegrade stone removal Case report
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单孔与三孔腹腔镜胆总管探查术的临床疗效比较及单孔术式学习曲线分析 认领 引用
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作者 孙爱学 高良荣 +4 位作者 汪东 黄朝君 田开亮 魏晓明 牛小行 《中国普通外科杂志》 CAS CSCD 北大核心 2026年第2期397-402,共6页
背景与目的:在微创与加速康复理念推动下,减孔腹腔镜技术逐渐应用于胆总管结石治疗,但单孔腹腔镜-胆道镜胆总管探查术的临床价值及其学习过程仍缺乏系统评估。本研究基于倾向评分匹配,比较单孔与三孔腹腔镜-胆道镜胆总管探查术的临床疗... 背景与目的:在微创与加速康复理念推动下,减孔腹腔镜技术逐渐应用于胆总管结石治疗,但单孔腹腔镜-胆道镜胆总管探查术的临床价值及其学习过程仍缺乏系统评估。本研究基于倾向评分匹配,比较单孔与三孔腹腔镜-胆道镜胆总管探查术的临床疗效,并分析单孔术式的学习曲线特征。方法:回顾性纳入2022年3月—2025年8月中国人民解放军联勤保障部队第九〇一医院行腹腔镜-胆道镜胆总管探查术的患者,按手术方式分为单孔组与三孔组。采用1∶2倾向评分匹配平衡基线差异。比较两组围手术期指标,包括手术时间、术中出血、术后恢复情况、并发症及住院费用等。以手术时间为评价指标,采用累积求和分析法(CUSUM)分析单孔术式学习曲线。结果:匹配后两组基线资料基本均衡。与三孔组相比,单孔组术后排气时间更短、术后24 h疼痛评分更低、腹腔引流管留置时间更短(均P0.05)。CUSUM分析显示,单孔腹腔镜-胆道镜胆总管探查术在完成约20例后达到学习曲线拐点,术者操作逐渐稳定。结论:单孔腹腔镜-胆道镜胆总管探查术在保证安全性的前提下,可减轻术后早期疼痛并促进胃肠功能恢复,但以手术时间延长及费用增加为代价。该术式存在一定学习曲线,建议在规范培训及病例选择基础上逐步开展,并优化手术方案。 展开更多
关键词 胆总管结石病 腹腔镜 胆道镜 胆总管探查术
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Technical overview of difficult biliary cannulation in endoscopic retrograde cholangiopancreatography:A guide for the endoscopist 认领 引用
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作者 Shubhra Mishra Jahnvi Dhar +1 位作者 Stefano F Crinò Jayanta Samanta 《World Journal of Gastroenterology》 SCIE CAS 2026年第26期41-58,共18页
Endoscopic retrograde cholangiopancreatography(ERCP)is one of the most technically challenging procedures in the field of therapeutic endoscopy and remains the standard of care for the management of extrahepatic bilia... Endoscopic retrograde cholangiopancreatography(ERCP)is one of the most technically challenging procedures in the field of therapeutic endoscopy and remains the standard of care for the management of extrahepatic biliary obstruction(both benign and malignant causes).The prerequisite for defining the success of this procedure is to achieve deep biliary cannulation and the guidewire assisted technique is the most commonly performed procedure.A latest meta-analysis of 15 randomized controlled trials in 4426 patients reported the unweighted pooled primary cannulation success rate(using this technique)of 85.4%(at the hands of experienced endoscopists),with a failure of approximately 5%-20%overall,and in less than 5%at high volume centers.As a result,achieving deep cannulation is a substantial barrier to success of ERCP,both for experts and novices alike.Despite improvements in endoscopic technologies and accessories,development of advanced endoscopy fellowship programs,and advances in ancillary imaging techniques,biliary cannulation in ERCP can still be unsuccessful in up to 20%of patients,even in referral centers.Once cannulation has been deemed to be difficult,the risk of post-ERCP pancreatitis and technical failure inherently increases.A number of factors,including endoscopist experience and patient anatomy,have been associated with difficult biliary cannulation(DBC),but predicting a case of difficult cannulation a priori is often not possible.Numerous techniques such as pancreatic guidewire and stenting,early pre-cut,and endoscopic ultrasound-guided rendezvous may be employed when standard approaches fail.Data regarding the rate of success and adverse events of these techniques have been variable,though most studies suggest that pancreatic duct stenting generally reduces the rate of post-ERCP pancreatitis in instances of DBC.Here we provide a technical review on DBC(with images)and discuss how the choice of which techniques to employ and how to best employ them should be individualized and take into account the skill of the endoscopist,the disorder being treated,the anatomy of the patient,and the available biomedical literature. 展开更多
关键词 Endoscopic retrograde cholangiopancreatography Bile duct Needle knife Double guidewire Rendezvous Transpancreatic sphincterotomy Pancreatitis
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Essential strategies for the management of challenging laparoscopic cholecystectomy procedures 认领 引用
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作者 Efstathios T Pavlidis Theodoros E Pavlidis +3 位作者 Christina Mouratidou Alexandra G Marneri Athanasios Kofinas Kalliopi E Stavrati 《World Journal of Gastrointestinal Surgery》 SCIE 2026年第6期36-49,共14页
Laparoscopic cholecystectomy(LC)represents the most frequently conducted surgical intervention for managing symptomatic cholelithiasis.However,in the contemporary context of laparoscopic and robotic cholecystectomy pr... Laparoscopic cholecystectomy(LC)represents the most frequently conducted surgical intervention for managing symptomatic cholelithiasis.However,in the contemporary context of laparoscopic and robotic cholecystectomy procedures,open cholecystectomy remains a relevant surgical approach that minimizes the risk of severe complications.LC is considered to be a straightforward procedure in approximately 60%of cases and presents no significant challenges for most surgeons.However,in 20%-30%of cases,the procedure involves a moderate level of difficulty,and in 10%-15%of cases,the complexity is substantial,thus potentially requiring conversion to an open cholecystectomy approach and the involvement of a highly experienced surgeon who is proficient in both laparoscopic and open techniques.Existing scoring systems have the potential to predict procedural difficulty.Obesity,cirrhosis,elevated American Society of Anesthesiologists scores,prior abdominal surgeries,and the presence of acute cholecystitis or common bile duct stones have been identified as factors contributing to the complexity of cholecystectomy procedures.Radiological findings such as gallbladder wall thickening,pericholecystic fluid accumulation,and impacted gallstones are also correlated with increased surgical difficulty.Elevated body mass index and increased C-reactive protein levels were identified as significant independent predictors of surgical difficulty during LC in patients with acute cholecystitis.For cases in which the operation is anticipated to be challenging,the utilization of intraoperative imaging techniques(including intraoperative cholangiography,intraoperative ultrasound,and near-infrared cholangiography)is advised.When the safe attainment of the critical view of the hepatocystic triangle is not feasible,alternative surgical strategies[such as subtotal cholecystectomy(STC)or an anterograde approach]should be considered.Conversion to open surgery is recommended in instances of significant hemorrhage,cholecystoenteric fistula,Mirizzi syndrome,or suspected malignancy.Furthermore,consultation with or assistance from an additional surgeon is advised under complex operative conditions.The body-first approach and STC represent significant surgical approaches in cases of severe inflammation and fibrosis(including cholecystitis,choledocholithiasis,and biliary pancreatitis)and anatomical variations.Laparoscopic STC encompasses both fenestrating and reconstituting techniques.Moreover,robotic subtotal fenestrating cholecystectomy is the prevailing technique due to the three-dimensional view.Thus,failure to appropriately manage challenging cases may result in severe complications,given the demanding nature of biliary surgery. 展开更多
关键词 Gallbladder diseases Cholelithiasis Laparoscopic cholecystectomy Biliary surgery Complications Common bile duct injury Difficult cholecystectomy Bailout techniques
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Biliary drainage in patients with altered anatomy:Literature review of different endoscopic approaches 认领 引用
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作者 Silvia Cocca Gianmaria Casoni Pattacini +11 位作者 Alessandro Grova Sofia Esposito Marinella Lupo Mario Ferrante Giuseppe Grande Chiara Guidotti Flavia Pigò Tancredi Vincenzo Li Cavoli Alessandro Mussetto Micaela Piccoli Rita Conigliaro Helga Bertani 《World Journal of Gastroenterology》 SCIE CAS 2026年第2期90-103,共14页
Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to t... Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to the biliary tree.Over the past two decades,device-assisted enteroscopy(DAE),including singleballoon,double-balloon,and motorized spiral enteroscopy,has expanded the feasibility of ERCP in this population,with overall technical success rates generally reported between 70%and 90%.Nevertheless,these techniques are technically demanding,time-consuming,and frequently affected by limited reach and unstable positioning.More recently,interventional endoscopic ultrasound(EUS)-guided procedures have emerged as highly effective alternatives,significantly improving clinical outcomes in selected patients,particularly in those with long-limb Roux-en-Y reconstructions where conventional methods are less effective.Percutaneous transhepatic biliary drainage continues to represent a valuable salvage option when endoscopic approaches fail,though it is associated with a greater burden of reinterventions and adverse events.This minireview provides a comprehensive overview of the main endoscopic strategies for biliary drainage in altered anatomy,focusing on technical considerations,efficacy,and safety profiles of DAE-assisted ERCP,EUS-guided interventions,and motorized systems.The evolving landscape of biliary drainage in this setting highlights the need for tailored treatment strategies,multidisciplinary collaboration,referral to high-volume centers,and further prospective studies to refine patient selection and optimize clinical outcomes. 展开更多
关键词 Surgical altered anatomy Enteroscopy Endoscopic ultrasound Biliary drainage Endoscopic retrograde cholangiopancreatography
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单孔机器人辅助腹腔镜胆囊切开取石术的应用分析 认领 引用
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作者 王波 黄安华 +5 位作者 徐安安 张诚 张凯 蔡景理 杨玉龙 胡海 《中国内镜杂志》 CAS 2026年第5期83-88,共6页
目的探讨单孔机器人辅助腹腔镜胆囊切开取石术治疗单发胆囊结石的可行性、安全性及近期疗效。方法回顾性分析2025年1月-2025年6月于该院接受单孔机器人辅助腹腔镜胆囊切开取石术的50例单发胆囊结石患者的临床资料。记录手术相关情况、... 目的探讨单孔机器人辅助腹腔镜胆囊切开取石术治疗单发胆囊结石的可行性、安全性及近期疗效。方法回顾性分析2025年1月-2025年6月于该院接受单孔机器人辅助腹腔镜胆囊切开取石术的50例单发胆囊结石患者的临床资料。记录手术相关情况、术后并发症和术后恢复情况。结果所有患者均顺利完成手术,无中转多孔腹腔镜和开腹者。手术时间为25~66 min,平均(41.5±10.7)min;胆囊切口缝合时间为10~25 min,平均(16.0±4.0)min;术中出血量为3~15 mL,平均(7.0±2.9)mL;术后住院时间为2~5 d,平均(3.1±0.7)d。并发症发生率较低,为8.0%(4/50),包括:发热2例、切口轻度红肿2例,均为轻微并发症,经对症处理后痊愈,未发生严重并发症。脐部切口愈合良好,温哥华瘢痕量表(VSS)评分提示瘢痕质量良好,患者总体美容满意度高。术后4个月复查B超,无结石残留。结论单孔机器人辅助腹腔镜胆囊切开取石术在严格选择适应证的前提下是安全、可行的,其操作灵活度高,缝合精确,美容效果佳,短期并发症少,为保胆取石治疗提供了新的选择。 展开更多
关键词 单孔手术 机器人辅助手术 胆囊结石 腹腔镜 胆囊切开取石术
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达芬奇机器人下胆道生理重建术治疗胆道损伤后胆道狭窄的疗效 认领 引用
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作者 陈军周 叶进冬 +4 位作者 牛强 段伟宏 戴景兴 雷磊 王三贵 《中国临床解剖学杂志》 CSCD 北大核心 2026年第4期481-485,共5页
目的回顾分析达芬奇机器人下胆道生理重建术在治疗胆道损伤后胆道狭窄方面的疗效。方法2014年10月年至2025年10月间我中心收治的胆道损伤后出现胆道狭窄的患者,其中17例接受了达芬奇机器人下胆道生理重建术,将此17例作为机器人手术组;... 目的回顾分析达芬奇机器人下胆道生理重建术在治疗胆道损伤后胆道狭窄方面的疗效。方法2014年10月年至2025年10月间我中心收治的胆道损伤后出现胆道狭窄的患者,其中17例接受了达芬奇机器人下胆道生理重建术,将此17例作为机器人手术组;另选取同时期同手术组相同病例开腹行胆道重建术17例作为对照组,对手术过程、术后并发症、术后恢复情况以及随访结果进行对比、分析。结果机器人手术组平均胆道重建时间长于开腹组(P0.05),两组病例3年内胆道再狭窄率均为0。结论达芬奇机器人下胆道生理重建术是一种安全、有效、可行的手术方式,能够缩短整体手术时间、较少腹壁创伤、加速术后康复。 展开更多
关键词 胆道重建 胆道损伤 胆管狭窄 达芬奇机器人手术系统
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Advances in biliary stone management:Latest-generation extracorporeal shock wave lithotripsy vs laser lithotripsy for difficult bile duct stones 认领 引用
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作者 Neeraj Singla Katrevula Anudeep Venkata +12 位作者 Pradev Inavolu Sana Fathima Memon Krithi Krishna Koduri Aniruddha Pratap Singh Thejesh Katamareddy Santosh Darisetty Vinod Koppoju Nitin Jagtap Rakesh Kalpala Sundeep Lakhtakia Mohan Ramchandani Manu Tandan Duvvur Nageshwar Reddy 《World Journal of Hepatology》 2026年第2期126-132,共7页
BACKGROUND Extracorporeal shock wave lithotripsy(ESWL)and laser lithotripsy(LL)are established alternatives for the management of difficult common bile duct(CBD)stones.However,there is limited evidence regarding the e... BACKGROUND Extracorporeal shock wave lithotripsy(ESWL)and laser lithotripsy(LL)are established alternatives for the management of difficult common bile duct(CBD)stones.However,there is limited evidence regarding the efficacy and safety of the latest-generation Dornier Delta Ⅲ lithotripter.In particular,evidence on the clinical performance of the Dornier Delta Ⅲ lithotripter is scarce.AIM To evaluate and compare the efficacy and safety of ESWL performed with the Dornier Delta Ⅲ and of LL using a single-operator cholangioscope with specific focus on stone clearance rates,number of treatment sessions,and procedurerelated adverse events in a large patient cohort.METHODS We conducted a retrospective analysis of a prospectively maintained database at AIG Hospitals,Hyderabad,covering the period from January 2019 to December 2022.A total of 458 patients with difficult bile duct stones underwent either ESWL or LL based on clinical discretion.ESWL was performed using the Dornier Delta III lithotripter,whereas LL was carried out with a singleoperator cholangioscope in combination with an yttrium-aluminum-garnet laser.RESULTS The 387 patients with difficult bile duct stones(mean age 53.8±15.7 years,58.7% male)underwent ESWL.A single CBD stone was noted in 46.8% of patients while 53.2% patients had multiple stones.Complete duct clearance was achieved in 95.1% of patients,with 68.7% requiring two or more ESWL sessions.Adverse events included cholangitis in 3 patients and post-sphincterotomy bleeding in 4 patients;All were managed conservatively.Seventyone patients(mean age 55±15.4 years,64.8%male)underwent LL.Complete duct clearance was achieved in 97.2% of patients with single-session clearance in 58(81.7%)patients.The remaining 18.3% of patients required two or three sessions for fragmented stone removal.Adverse events included cholangitis in 2 patients and mild pancreatitis in 1 patient;all were managed conservatively.Patients with incomplete clearance were referred for surgery.There was no significant difference in efficacy between ESWL and LL(95.1%vs 97.2%,P=0.4).CONCLUSION ESWL using the latest generation lithotripter and LL provide equally effective and safe alternatives for managing difficult CBD stones,minimizing the need for surgery. 展开更多
关键词 Extracorporeal shock wave lithotripsy Laser lithotripsy Difficult bile duct stone Endoscopic retrograde cholangiopancreatography Choledocholithiasis
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Clinical characteristics of and risk factors for hepatolithiasis developed after surgery for congenital biliary dilatation 认领 引用
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作者 Fumio Asano Ryusei Matsuyama +4 位作者 Takafumi Kumamoto Masato Shinkai Daisuke Morioka Satoru Shinoda Itaru Endo 《World Journal of Gastrointestinal Surgery》 SCIE 2026年第1期174-184,共11页
BACKGROUND Pancreaticobiliary maljunction(PBM)is a congenital disease in which the pancreatic and bile ducts fuse outside the duodenal wall.Congenital biliary dilatation(CBD)involves PBM and dilatation of the extrahep... BACKGROUND Pancreaticobiliary maljunction(PBM)is a congenital disease in which the pancreatic and bile ducts fuse outside the duodenal wall.Congenital biliary dilatation(CBD)involves PBM and dilatation of the extrahepatic bile duct.The lack of Oddi sphincter action at the confluence results in the retrograde flow of pancreatic juice into the bile duct,placing patients with CBD at high risk of biliary carcinoma.The standard treatment for CBD is complete extrahepatic bile duct resection(EHBR).Hepatolithiasis(HL),a late complication following CBD surgery,has a deleterious clinical impact;further research is necessary to elu-cidate its risk factors.AIM To clarify the clinical impact of and risk factors for HL after CBD surgery.METHODS A retrospective study was conducted with 223 CBD patients who underwent EHBR across three tertiary hospitals to investigate postoperative complications.An exploratory analysis was performed to identify factors associated with HL development.Risk factors were subsequently identified using least absolute shrinkage and selection operator(LASSO)analysis.RESULTS HL was observed in 15/223(6.7%)patients.Two of those patients developed liver failure owing to biliary cirrhosis;one died, and the other received liver transplantation. Two patients requiredmajor hepatectomy. The majority of the remaining patients required repeated enteroscopic and/or percutaneouslithotomy procedures. LASSO analysis revealed older age at surgery as an independent risk factor for HL;the timedependentreceiver operating characteristic analysis at 6 years after surgery revealed a cutoff age of 31 years.CONCLUSIONHL following CBD surgery has a markedly deleterious clinical impact. Advanced age at the time of CBD surgerywas identified as an independent risk factor for HL. 展开更多
关键词 Congenital biliary dilatation Pancreaticobiliary maljunction Postoperative complications Hepatolithiasis Least absolute shrinkage and selection operator regulation
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经皮肝穿刺胆囊引流后择期行腹腔镜胆囊切除术在亚急性期急性胆囊炎中的临床疗效 认领 引用
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作者 邢冰琛 许英晨 +4 位作者 张立军 徐一凡 付建柱 梁熙虹 计嘉军 《肝胆胰外科杂志》 CAS 2026年第7期478-483,共6页
目的探讨CT引导下经皮肝穿刺胆囊引流(PTGD)后择期行腹腔镜胆囊切除术(LC)在亚急性期急性胆囊炎(AC)中的临床疗效。方法本研究采用回顾性分析方法,选取2021年3月至2025年1月首都医科大学附属北京同仁医院普外科收治的中重度亚急性期AC患... 目的探讨CT引导下经皮肝穿刺胆囊引流(PTGD)后择期行腹腔镜胆囊切除术(LC)在亚急性期急性胆囊炎(AC)中的临床疗效。方法本研究采用回顾性分析方法,选取2021年3月至2025年1月首都医科大学附属北京同仁医院普外科收治的中重度亚急性期AC患者180例。根据治疗方式不同,将入组患者分为观察组(n=98)和对照组(n=82),观察组先在CT引导下行PTGD、后择期行LC手术,对照组确诊后即接受一期LC手术。对比分析两组患者围手术期临床指标、术后恢复情况、炎症控制水平及并发症发生情况。结果分析表明,观察组中转开腹率、手术时间、术中出血量、腹腔引流量、总住院时间、总住院费用均较对照组明显更低(均P0.05)。结论针对亚急性期AC,先在CT引导下行PTGD、后择期行LC手术的治疗方案较一期行LC手术的方案可显著降低术中出血量,缩短手术时间和住院时间,有效降低围手术期并发症发生率,促进患者机体功能康复,这为临床手术时机选择和优化个体化治疗方案提供了循证依据。 展开更多
关键词 急性胆囊炎 亚急性期 经皮肝穿刺胆囊引流 腹腔镜胆囊切除术
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内镜下乳头球囊扩张对比十二指肠乳头括约肌小切开联合球囊扩张治疗中等大小胆总管结石的效果分析 认领 引用
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作者 周国超 付华 +3 位作者 蔡融民 杨定华 宋新 杨康 《肝胆胰外科杂志》 CAS 2026年第3期195-200,共6页
目的比较内镜下乳头球囊扩张(EPBD)与十二指肠乳头括约肌小切开联合球囊扩张(ESBD)治疗中等大小胆总管结石的临床效果。方法回顾性分析2020年1月至2024年1月在湘西自治州人民医院(n=398)和张家界市人民医院(n=408)接受治疗的806例单纯... 目的比较内镜下乳头球囊扩张(EPBD)与十二指肠乳头括约肌小切开联合球囊扩张(ESBD)治疗中等大小胆总管结石的临床效果。方法回顾性分析2020年1月至2024年1月在湘西自治州人民医院(n=398)和张家界市人民医院(n=408)接受治疗的806例单纯性胆总管结石患者的临床资料。806例患者胆总管结石直径均在8~12 mm;根据治疗方式的不同,患者被分为EPBD组(n=401)和ESBD组(n=405)。比较两组患者的一次性结石取净率、取石成功率、住院时间、住院费用及术后并发症发生率。结果EPBD组和ESBD组在一次性结石取净率(99.3%vs 97.5%)和取石成功率(99.8%vs 99.3%)方面的差异无统计学意义(P>0.05)。EPBD组在住院时间[(14.5±3.5)d vs(15.5±4.5)d,t=-3.519,P0.05)。与ESBD组相比,EPBD组术后高淀粉酶血症发生率更高(14.7%vs 9.9%,χ2=3.938,P=0.047),但术后出血发生率更低(0 vs 1.5%,P=0.031)。EPBD组和ESBD组术后胰腺炎发生率(4.7%vs 4.4%,χ2=0.001,P=0.975)以及总并发症发生率(19.7%vs 16.5%,χ2=1.150,P=0.284)差异均无统计学意义。两组均未发现严重并发症或死亡病例。结论EPBD治疗中等大小胆总管结石的效果与ESBD相当,且患者术后出血更少、住院时间更短、治疗费用更低。 展开更多
关键词 胆总管结石 内镜逆行胰胆管造影 内镜下乳头球囊扩张 内镜下十二指肠乳头括约肌切开
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