.人类首次急性结石性胆囊炎患者在接受胆囊造瘘置管术后行胆囊冷冻消融术的应用报道
摘要
一名71岁急性结石性胆囊炎患者因不符合外科手术条件，而接受了胆囊造瘘术并已置管引流28天。随后，病人在中度静脉麻醉下行胆囊冷冻术，共采用3根冷冻探针先后2次以10min-8min-10min的冻融循环对胆囊颈/体和胆囊底进行冷冻，之后拔除胆囊造瘘管。消融后1天患者出院。消融术后1个月磁共振和肝胆扫描（亚氨基二乙酸）显示胆囊壁增厚、囊腔扩张，但无胆囊管充盈。术后3个月磁共振显示胆囊壁回缩伴管腔塌陷。患者出院后未诉疼痛且消融后3个月无临床症状。
(牛猛翻译)
.Firstin-HumanGallbladderCryoablationinaPatientwithAcuteCalculousCholecystitisInitiallyTreatedwithaCholecystostomyTube
HughMcGregor,MD,GregoryWoodhead,MD,MilesConrad,MD,AndrewTang,MD,DavidRuiz,MD,AbdulKhan,MD,andCharlesHennemeyer,MD
ABSTRACT
A71-year-oldpoorsurgicalcandidatewithacutecalculouscholecystitiswasinitiallymanagedwithcholecystostomytubedrainagefor28days.Hesubsequentlyunderwentgallbladdercryoablationundermoderatesedationwith3cryoprobesand2separate10-8-10freeze-thawcyclestargetingthegallbladderneck/bodyandfundusfollowedbycholecystostomytuberemoval.Hewasdischarged1dayafterablation.Magneticresonanceandhepatobiliaryiminodiaceticacidscan1monthpostablationdemonstratedathick-walled,distendedgallbladderandnofillingofthecysticduct.Magneticresonance3monthspostablationdemonstratedretractionofthegallbladderwallwithluminalcollapse.Thepatientdeniedanypainafterdischargeandisasymptomatic3monthsafterablation.
CLINICALSTUDY
.预测经皮经肝胆道支架植入术治疗恶性胆道梗阻后出现早期胆道感染的风险
摘要
目的：建立用于预测经皮经肝胆管支架（PTBS）置入治疗恶性胆道梗阻（MBO）后发生早期胆道感染（EBI）的列线图。
材料与方法：在本多中心研究中，MBO患者在经PTBS治疗后被分配到模型队列或验证队列。通过多变量分析找出模型队列中的EBI独立危险因素以建立预测列线图。应用人工神经网络来评估这些因素在预测EBI中的重要性。列线图的预测准确性评估通过一致性指数（c-指数）及校准曲线进行里、外验证。
结果：共有名患者（模型队列：n=；验证队列：n=61）纳入本研究。独立危险因素包括梗阻长度（比值比[OR]，1.；95％置信区间[CI]，1.-1.；P=.），糖尿病（OR，5.；95％CI，1.-13.；P=.），梗阻部位（OR，2.；95％CI，1.-5.；P=.），以及既往手术或内镜干预（OR，3.；95％CI，1.-9.；P=.）。上述危险因素引入列线图。c-指数值在模型及验证队列中显示出良好的预测性能（分别为0.和0.）。风险的最佳临界值为0.25。
结论：列线图有利于早期、准确地预测MBO患者在经PTBS治疗后发生EBI的风险。高风险的患者（0.25）应给予更有效的预防性抗生素并进行更严密的监测。
（周大勇翻译）
.RiskPredictionforEarlyBiliaryInfectionafterPercutaneousTranshepaticBiliaryStentPlacementinMalignantBiliaryObstruction
Hai-FengZhou,MD,MingHuang,MD,Jian-SongJi,MD,PhD,Hai-DongZhu,MD,PhD,JianLu,MD,Jin-HeGuo,MD,PhD,LiChen,MD,Bin-YanZhong,MD,Guang-YuZhu,MD,andGao-JunTeng,MD,PhD,FSIR
ABSTRACT
Purpose:Toestablishanomogramforpredictingtheoccurrenceofearlybiliaryinfection(EBI)afterpercutaneoustranshepaticbiliarystent(PTBS)placementinmalignantbiliaryobstruction(MBO).
MaterialsandMethods:Inthismulticenterstudy,patientstreatedwithPTBSforMBOwereallocatedtoatrainingcohortoravalidationcohort.TheindependentriskfactorsforEBIselectedbymultivariateanalysesinthetrainingcohortwereusedtodevelopapredictivenomogram.AnartificialneuralnetworkwasappliedtoassesstheimportanceofthesefactorsinpredictingEBI.Thepredictiveaccuracyofthisnomogramwasdeterminedbyconcordanceindex(c-index)andacalibrationplot,bothinternallyandexternally.
Results:Atotalofpatients(trainingcohort:n=;validationcohort:n=61)wereincludedinthisstudy.Theindependentriskfactorswerelengthofobstruction(oddsratio[OR],1.;95%confidenceinterval[CI],1.–1.;P=.),diabetes(OR,5.;95%CI,1.–13.;P=.),locationofobstruction(OR,2.;95%CI,1.–5.;P=.),andprevioussurgicalorendoscopicintervention(OR,3.;95%CI,1.–9.;P=.),whichwereselectedintothenomogram.Thec-indexvaluesshowedgoodpredictiveperformanceinthetrainingandvalidationcohorts(0.and0.,respectively).Theoptimumcutoffvalueofriskwas0.25.
Conclusions:ThenomogramcanfacilitatetheearlyandaccuratepredictionofEBIinpatientswithMBOwhounderwentPTBS.Patientswithhighrisk(0.25)shouldbeadministeredmoreeffectiveprophylacticantibioticsandundergoclosermonitoring.