近年来,胆道子镜直视化系统为诊疗复杂胆胰管疾病打开了新的局面.但其在胆囊疾病诊治方面仍少有报道.现报道 1例通过内镜逆行胰胆管造影(ERCP)联合SpyGlass进入胆囊观察并取活检,从而确诊胆囊黏液腺瘤的患者,并就其临床资料及诊断过程等进行分析讨论.

Objective:To compare the efficacy and safety of stone extraction with a single peroral choledochoscopy system under direct visualization and conventional X-ray endoscopic retrograde cholangiopancreatography (ERCP) for non-difficult common bile duct stones.Methods:A total of 164 patients with common bile duct stones who underwent stone extraction by using the single peroral choledochoscopy system under direct visualization (the observation group, n=82) and conventional X-ray endoscopic retrograde cholangiopancreatography (ERCP) (the control group, n=82) from January 2018 to April 2022 in Dongfang Hospital, Beijing University of Chinese Medicine were enrolled. The observation group was directly selected from the database, while the control group was randomly matched by age stratification with baseline data validated. The success rates of intubation, stone removal, postoperative complication incidence, and radiation exposure between the two groups were compared. Results:There was no significant difference between the baseline data of the observation group and the control group ( P>0.05). The number of patients with detected stones≥2 in the observation group and the control group were 59 (71.95%) and 37 (45.12%) respectively with significant difference ( χ 2=12.16, P=0.001). The success rates of bile duct intubation in the observation group and the control group were both 100.00% (82/82). The success rates of stone extraction were 98.78% (81/82) and 100.00% (82/82) respectively with no significant difference ( P>0.05). The one-time stone removal rates of the two groups were 93.90% (77/82) and 92.68% (76/82) respectively with no significant difference ( χ2=0.10, P=0.755). There was no significant difference in the incidence of postoperative complications between the observation group and the control group ( P>0.05). The amount of intraoperative ray exposure volume in the observation group was significantly lower than that of the control group [10.20 (6.69, 18.94) mGy VS 15.41 (10.70, 22.77) mGy, U=2 462.00, P=0.003]. Conclusion:The efficacy and safety of stone extraction with single peroral choledochoscopy system under direct visualization are comparable to those of traditional X-ray ERCP for non-difficult common bile duct stones, but it can significantly reduce the intraoperative ray exposure volume during therapeutic ERCP stone extraction.

目的 探讨SpyGlassTM DS在 70 岁以上胆管疾病患者中的诊疗价值及安全性.方法 回顾性分析 2018 年 1 月至 2022 年4 月在北京中医药大学东方医院使用SpyGlassTM DS诊治的 178 例患者临床资料,根据年龄分为≥70 岁组和<70 岁组,观察诊治疾病的有效性,比较两组术中诊断的疾病谱、术中操作、术后并发症的差异性.结果 在不明原因胆道狭窄判断良恶性方面:≥70 岁组内镜下直视敏感度为 93.5%,特异度 83.3%,准确度 89.8%;活检诊断敏感度 94.7%,特异度 100%,准确度 95.7%.<70 岁组中内镜下直视下敏感度 89.3%,特异度 78.6%,准确度 83.9%.活检诊断敏感度 82.4%,特异度 100%,准确度 89.3%.整体内镜下直视敏感度91.5%,特异度 80.4%,准确度 86.7%;整体活检诊断敏感度 88.9%,特异度 100%,准确度 92.2%.在治疗困难性胆总管结石方面:取石成功率为 97.6%.安全性分析方面:≥70 岁组高血压、冠心病检出率高于<70 岁组(P<0.05).≥70 岁组留置支架概率(44.0%)高于<70 岁组(28.7%)(P<0.05),≥70 岁组并发症发生率与<70 岁组比较,差异无统计学意义(P>0.05).结论 SpyGlassTM DS系统能有效、准确地诊断治疗胆管疾病,对 70 岁以上人群术后不会增加并发症发生率,是一项安全、有效的技术.

目的 为了探讨大肠进展期腺瘤切除术后与血脂谱相关性及其他危险因素.方法 回顾性分析2018年1月至2020年12月在北京中医药大学东方医院行结肠镜检查患者病历资料及术后回访信息,根据大肠进展期腺瘤性息肉术后复发有无分为复发组和未复发组,分析两组人群的一般资料、血脂谱及大肠息肉的结肠镜下表现的差异.结果 复发组男性、吸烟、饮酒的比率均显著高于未复发组(P<0.05).复发组BMI、甘油三酯水平均显著高于未复发组(P<0.05).复发组HDL-C水平为(1.30±0.38)mmol/L,显著低于未复发组的(1.44±0.31)mmol/L(P<0.05).复发组中直肠部位检出率(12％)未复发组(20％),P<0.05.多因素logistic回归分析:甘油三酯水平升高(OR=1.626;95％CI=1.044～2.533;P=0.032)、年龄(OR=1.087;95％CI=1.043～1.133;P=0.001)、吸烟(OR=5.222;95％CI=1.674～16.289;P=0.004)、息肉数量≥3枚(OR=1.962;95％CI=1.373～2.803;P=0.001)、BMI高(OR=1.147;95％CI=1.020～1.291;P=0.022)是进展期腺瘤性息肉切除术后复发独立危险因素.回归模型预测概率(PRE)曲线=甘油三酯×0.606+数量≥3个×0.649+吸烟×0.663+年龄×0.617+BMI*0.627.最终模型的曲线下面积为0.811(95％CI:0.754～0.868,P<0.001)、最佳预测截断值为0.68、敏感度60.3％、特异性88.4％.结论 甘油三酯含量升高、年龄、吸烟、息肉数量≥3枚、BMI升高是大肠进展期腺瘤性息肉切除复发独立危险因素,且可以进行此类人群术后预测.

1 病例资料 患者女性,44岁,主因"右上腹胀满疼痛10 d"于2020年11月13日收入院.患者10 d前无明显诱因出现右上腹胀满,连及左侧后背,无疼痛,无寒战发热,无黄疸,无恶心呕吐,未予重视及诊疗.5d前右上腹胀满较前加重,后背及腹部均胀满不适,伴上腹部疼痛,全身皮肤、巩膜及小便黄染,小便如浓茶色,恶心呕吐,10次/d左右,呕吐物为胃内容物,无寒战发热,遂就诊于涿州市人民医院,查MRI示:胆总管结石,予抗感染等治疗后,上腹痛及恶心呕吐等症状明显好转,全身、巩膜、小便黄染颜色变浅.症状稍稳定后行内镜逆行胰胆管造影(ERCP),术中造影发现胆总管内可见一充盈缺损影不能移动,考虑为息肉或结石可能,未能取出,放置一枚鼻胆管,引流出黄绿色液体.为求进一步诊治,来本院就诊,门诊以"胆总管结石"收入本科.入院症见:患者上腹部无明显不适,饮食睡眠尚可,无恶心、呕吐,无发热,大便1周未行,小便如常.既往:体健.查体:未见明显阳性体征.