Clinical Analysis Of Common Duct Stones Treated By None-X-ray ERCP

Research background and objectiveBile stone syndrome is a common disease, in China incidence high, its occurred rate can up to 10%-20%, and bile duct stones in bile stone syndrome in the accounted for up 30%, bile duct stones traditional treatment is surgical opened abdominal surgery, opened abdominal bile duct exploration take stone +T tube drainage, for simple bile duct stones, and by operation Qian check or operation in the biliary contrast confirmed no bile duct system narrow and liver within bile duct more sent stones of, feasible celiac mirror Xia take stone, but traditional surgical opened abdominal surgery, Trauma patients with larger, slower recovery, the high cost of hospitalization, for recurrence of biliary calculi, recurring, poor heart and lung function of secondary laparotomy surgery in patients with poor compliance and the second open difficult. ERCP:that by within mirror retrograde pancreatic bile duct contrast of English first wrote letters (Encoscopic Retrograde Cholangio-Pancreatography, ERCP), is in within mirror Xia by duodenal nipples intubation injected contrast agent, thus retrograde displayed pancreatic bile duct of contrast technology, its image clear, has is high of resolution, has continuous, and dynamic, and open, and easily by intestinal gas interference, series advantages, x line Xia observation whole bile pancreatic tube form And clearly show dilatation of biliary and pancreatic duct lumen has any, stenosis, filling defects, pressure changes, gallstones can be observed directly, such as the size, location, number, while for Endoscopic biliary pathology organization under direct vision can still be biopsy and brush biopsy and cytology, and ERCP is now recognized as the gold standard for diagnosis of pancreaticobiliary diseases. Endoscopic Retrograde Cholangiopancreatography (Endoscopic Retrograde Cholangiopancreatography, ERCP) was mainly used in biliary and pancreatic disease diagnosis system. Along with improvements in equipment and endoscopic operations technology improved, expanding the scope of application of ERCP, gradual transition from predominantly diagnostic ERCP to therapeutic ERCP,ERCP while synchronizing of therapeutic ERCP in diagnosis of (which has a dual role in diagnosis and treatment of technology), which is the b-mode ultrasound and CT, MRCP simple inspection, diagnosis cannot be compared. With the development of duodenal papilla sphincterotomy (Endoscopic sphincterotomy,EST), as well as the invention of a series of ERCP accessories, equipment, applications, was born one after another series of ERCP therapy and should be ready for clinical trials include:endoscopic dilatation of duodenal papilla (Endoscopic papillary balloon dilation,EPBD), Endoscopic Naso-biliary drainage (Endoscopic nosalbiliary drainage and ENBD), obstructive jaundice with biliary stent placement surgery (metal stents and plastic stents) and 12 duodenum pancreatic duct endoscopic stone extraction technique, the pancreatic duct stent placement, and so on. ERCP one of the core technologies of diagnosis and treatment of endoscopic duodenum sphincterotomy surgery (EST) and endoscopic dilatation of duodenal papilla (EPBD) has become the preferred method for treatment of bile duct stones. ERCP is the preferred treatment for bile duct stones. ERCP treat bile duct stones, has without opened abdominal, trauma less, and patients recovery fast, efficient, security, complications less and light, patients hospital costs less, especially for bile duct stones repeatedly, and recurrence, and frail accompanied by other organ disease cannot tolerance surgical surgery of patients is more with clinical practical value, Secondary ERCP in patients with common bile duct stones with good compliance, while not under the influence of past whether the ERCP procedure. But normal ERCP need to be done under the assistance of x-ray, x ray radiation has an obvious effect on the human body, Long term frequent exposure to x-ray, leukopenia causes bone marrow suppression, retardation, cataract, alopecia, carcinogenic, cause fetal malformations, infertility and so on. To reduce healthcare workers, patients, pregnant women and fetal harm, Started under the guide of b-ultrasound in our Department in our hospital ERCP, ERCP with tradition and technique of ERCP b-ultrasound guided to mature and develop, we are learnig non-x-ray ERCP. While some special cases:such as critically ill patients in the intensive care unit ventilator-assisted breathing, tracheal intubation, or critically ill patients ventilator-assisted breathing vein during tracheal intubation under general anesthesia in the operating room, you won’t be able to leave the intensive care unit, or ERCP theatre tradition, so therefore no x-ray emergency bedside ERCP therapy. On the other hand, no x-ray ERCP treatment may reduce hospital, Department of investment costs, low power requirements, ease of County and township-level hospitals. Of course, ERCP is level four digestive surgery, and requires high technical difficulty, risk is also greater, more complications and serious, such as:gastrointestinal perforation, upper gastrointestinal bleeding, pancreatitis, which can have serious complications, patients with life-threatening complications or even death. Therefore, we are not in favor of County and township-level hospitals beginning no x-ray ERCP spillage in the case of traditional ERCP technical proficiency in attempts. Our Gastroenterology predecessors is based on more than 10 years tradition ERCP, ERCP technology, experience situations to explore, research, pick some relatively non-complex cases tried without the x-ray-guided non-x-ray ERCP. In General, no x-ray of ERCP endoscopic ERCP should be done by an experienced physician for relatively simple cases.This research through the collection of cases of x-ray guided treatment of bile duct stones by ERCP, explore non-feasibility of x-ray guided treatment of bile duct stones by ERCP and its clinical effects.MethodsSelected January 2011 ～2013 June 213 patients with gender, age is not limited to non-subordinate affiliated first people’s Hospital in Shunde, Southern Medical University diagnosed parallel therapeutic ERCP in patients with common bile duct stones, By b-mode ultrasound and (or) CT and (or) MR diagnosis of common bile duct stones,And stones in the common bile duct is less than 3, the largest stone<2.0 cm in diameter. Do not merge with hepatic duct and intrahepatic bile duct and gall stones, no history of chronic cholecystitis or gallbladder removal... ultrasound or CT examination did not indicate that the liver, biliary tract and gallbladder disease, liver function, serum bilirubin and serum amylase normal; without a long history of chronic disease, no hypertension, diabetes mellitus, systemic diseases such as liver, kidney and heart disease and patients with other malignancies. Randomly allocated to non-x-ray ERCP and normal ERCP group,no x-ray ERCP with 103 cases were no x-ray ERCP biliary duct stone extraction in treating ordinary ERCP 110 patients in the traditional x-ray down ERCP biliary duct stone extraction in treating. No x-ray ERCP principle:traditional ERCP operation using x-ray fluoroscopy functions (c-arm) to observe the contrast agent injection process used in diagnosis of pancreas and bile duct disease, endoscopic treatment and decide the next step, While endoscopic x ray to see the attachment in the pancreas and bile duct operation, under the x-ray crossed the calculus of bile duct, open bowls, drop down and shake basket to make stones into the basket and remove the stones, basket cannot trap available microlith stone balloon clearance. No x-ray preoperative ERCP b-ultrasound, abdominal CT or MRCP for diagnosing, pick some relatively simple cases experienced by ERCP endoscopic doctor for no x-ray, skillful and gentle, according to axis after successful intubation to extract bile, Then the Guide wire, which will help place a bow guide wire Exchange technique of duodenal papilla cutting axe, will cut a small duodenal papilla, is greater in small incision of bile duct calculus based uplink balloon dilation, then stone mesh blue or stone balloon stone extraction, placed after Naso-biliary surgery, elective endoscopic cholangiography, Knowledge of whether bile duct stone residue and other diseases, if the sediment of small bile duct residual calculus, via endoscopic nasobiliary repeated washing to be washed out, If the large bile duct stones, you need elective ERCP II stones. Compared between the 2 groups in the stone, stone time success rates and complication rates, the difference between hospitalization and hospitalization costs.Attachment:ERCP success criteria:selective success common bile duct cannulation, bile duct stones partly or wholly removed, bile duct patency.ERCP fail criteria:bile duct intubation fails, bile duct stones could not be removed.Results1, no x line ERCP group take stone success 95 cases, success rate 92.2%, failed 8 cases, which has 5 cases due to nipples next huge resting room,3 cases due to guide silk insert difficult, Hou by contrast shows bile duct Xia segment narrow modified surgery treatment; and General ERCP group success 103 cases, take stone success rate for 93.6%, failed 7 cases, take stone failed 7 cases, which has 4 cases due to nipples next huge resting room,3 cases by contrast shows bile duct Xia segment narrow modified surgery treatment. No significant difference between the two groups.2, ERCP complications related to group 2, no x-ray,9 cases complication rate was 8.7%,9 patients had complications, complications rate was 8.7%, pancreatitis, respectively in 5 cases (4.8%), cholangitis in 2 cases (1.9%),2 cases of hemorrhage (1.9%), were cured by medical treatment. Normal ERCP complications related to group 8, complication rate was 7.2%, pancreatitis, respectively in 5 cases (4.5%), cholangitis in 2 cases (1.8%), bleeding in 1 (0.9%), were cured by medical treatment. Comparison between the two groups, the difference was not significant.3, Average stones ERCP group no x-ray operating time, length of hospital stay (0.76±0.17H,5.70±0.89D, respectively) with normal ERCP Group (0.77± 0.19H,5.63±1.06d, respectively), the difference was not significant (p>0.05). ERCP in average no x-ray and hospitalization costs compared to normal ERCP (9115±699:9011±865), the difference was not significant (p>0.05).Conclusion1, ERCP lithotomy no x-ray treatment of bile duct stones with safety and feasibility.2, No x-ray ERCP lithotomy avoided the x-ray damage to the patient;3, For inclusion within the scope of common bile duct stones, no x-ray complications of ERCP lithotomy effect, with no significant difference in normal ERCP lithotomy, worthy of further study.4, No x-ray of ERCP endoscopic ERCP should be done by an experienced physician for relatively simple cases.