Endoscopic retrograde cholangiopancreatography (ERCP) is the most challenging technique of gastrointestinal endoscopy. Patients are most likely to benefit from this mini invasive treatment, meanwhile they bear high risk of complications, which might be life-threatening. Standard operation, standardized training, quality control and whole-process management of perioperative period are critical factors for ERCP training, and should be popularized in medical centers, where ERCP are performed. This paper has illustrated the whole-process management of perioperative period for ERCP, including preoperative preparation, decision-making during operation, postoperative management, as well as prevention and treatment of complications. By performing whole-process management of ERCP, patient can benefit more from ERCP operation, and which will serve more patients.

Objective To explore the influence of telephone follow-up on home rehabilitation for patients with schizophrenia. Methods 200 patients with schizophrenia were assigned into experimental group and control group with 100 cases in each group. During their hospitalization,all patients were given conventional treating and nursing and were treated with atypical antipsychotic drugs. After getting a clinical recovery and discharge, the experimental group received telephone follow-up for 2 years while the control group received outpatient service follow-up. Results There was significant difference in scores of Positive and Negative Syndrome Scale (PANSS) in both groups with time (F=85.943, P=0.000). There was a significant interaction effect between intervention and time (F=6.458, P=0.000) and there was also a significant difference (F=26.012, P=0.000) between both groups on the scores of PANSS. At the end of the 6th, 12th, 18th and 24th month after discharge, the PANSS scores were significantly less in the experimental group than in the control group (P<0.05). The accumulative total relapse rate and frequency were significantly lower in the experimental group than in the control group anytime after discharge (P<0.05).Conclusion The telephone follow-up can significantly improve the effect of home rehabilitation for the patients with schizophrenia. It is beneficial for the patients to control disease and reduce the relapse.

0 05),but the difference was significant after administration of Cisapride two weeks and four weeks later(7 00?3 12,4 20?2 39 vs 4 90?2 45,2 10?1 19,P0 05),but the difference was statistically significant with Cisapride administrated(r=0 47,P

Objective To observe the bacterioflora of bile and it' s drugs sensitivity in patients with bile duct diseases to serve as a guidance in medication. Methods Bile of 156 cases of patients with biliary disease was collected and cultured respectively during endoscopic retrograde cholangiopancreatography (ER-CP) by deep cannulation and sucking out bile through the catheter. Forty eight blood samples among them were cultured simultaneously. Ten kinds of drug papers were used to investigate the bacterial sensitivity. The data were analysed statistically- Results Bacteria positive rate of these 156 bile samples was 62. 8% , including Gram - negative bacteria (81.6% ) and Gram - positive bacteria (18. 4% ). These bacteria consist of Pseudomonas aeruginosa (35. 1% ) , Escherichia coli(22. 8% ) , Streptococcus faecalis (16.7%) ,Entero bacilliaerogenes(7. 9% ) ,Klebsiella(7. 0% ) , Citrobacter(6. 1% ) ,Acinetobacler lwqffi(2. 6% ) and Staphylo-coccus aureus( 1. 7% ). The bacteria positive rate was only 4. 2% in the 48 blood samples. Drug sensitive rates of bacteria against 10 kinds of drugs were changed in recent years. The result indicated that the sensitive rates of bacteria were significantly higher in ciprofloxacin, fortum, cefoperazone, sulbactam + cefoperazone and cilastatin than those in ampicillin,azlocillin, cefazolin sodium, eefuroxime(P

Objective To summarize the clinical experience of the diagnosis and treatment for 23 cases with malignant peritoneal mesothelioma.Methods The clinical data of 23 cases of malignant peritoneal mesothelioma was analysed retrospectively.Results All of the 23 cases were finally diagnosed with pathology.The pertinacious abdominal pain and distension, bloody ascites,multiple abdominal masses were clinical manifestation chiefly.The examination of B type ultrasonography and CT displaied the obvious irregular thickening of peritoneum and mesenterium, multiple nodes in abdomen and pelvic masses.Conclusions The vigilance to the disease ought to be aroused when possesing the above-mentioned clinical manifestation. The diagnosis chiefly depends on the peritoneal biopsy with abdominal cavity puncture,peritoneoscopy and exploratory.

Objective To determine the effect of therapeutic ERCP(endoscopic retrograde cholan-giopancreatography) on endoscopic drainage of pancreatic pseudocysts and patency of main pancreatic duct after dilation or placement of stent. Methods Eight patients with pancreatic pseudocyst were selected after abdominal ultrasonography and computed tomography. All patients have had be operated two times because of acute pancreatitis and /or cholangitis, and were hard to receive further operation. These patients underwent endoscopic transpapillary drainage by main pancreatic duct dilation or placement of stents after ERCP, and were follow up by abdominal ultrasonography and / or computed tomography 6 months after drainage. The stent would be pulled out after the complete disappearance of the cyst. Results Diagnostic ERCP revealed that cysts communicated with main pancreatic duct in 3 cases and obstructive jaundice was present in 1 case. All patients were managed by transpapillary main pancreatic duct dilation (3 cases) and placement of stents (5 cases). Both forms of endoscopic drainage were effective in treating pancreatic pseudocyst and in 7 cases the cysts were completely disappeared within 4 months, while the rest one required surgery as the cyst merely decreased in size. Only 2 cases the levels of amylase in serum and urine were higher than normal but no severe complications occurred. Conclusion Endoscopic transpapillary drainage through main pancreatic duct dilation or placement of stents is quietly an effective, painless and safe mode in treating pancreatic pseudo-cyst. This method may be an ideal choice for the treatment of pancreatic pseudocysts in experts.

Objective To evaluate the technical feasibility and safety of transvaginal appendectomy by endoscopy in canine models.Methods Six female dogs weighing between 12-15 kg underwent transvaginal appendectomy by endoscopy.A small incision at posterior fornix of the vagina was made endoscopically by a needle knife and then dilated by a balloon dilator.After the endoscope entered the peritoneal cavity,the appendicular artery was clipped and the appendix was dissociated,and then the free appendix was ligated by an endoloop near root and removed by snare cutting.The appendix was then removed through the vaginal port.Finally,the vaginal incision was closed by clipping and endolooping.Two weeks after the procedure,the animals were sacrificed for anatomic investigation.Results Endoscopic transvaginal appendectomy was successfully performed in all animals with a mean operating time of (94.2±41.8) min.Complicated bleeding occurred in 1 dog and rectal burn in another during the operation.All the experimental animals survived the post operative period for 2 weeks without any complications.Post mortem examination revealed that the wound and vaginal incision healed well.Conclusion Transvaginal appendectomy by endoscopy is safe and feasible in a canine model,while further study and progression of appropriate accessories are needed for future clinical use.

Objective To explore the success rate and failure risk factors of biliary stenting on the patients with type Ⅰor Ⅱ duodenal malignant stricture treated by self-expandable metallic stent (SEMS). Methods A total of 36 patients with unresectable duodenal stricture after endoscopic SEMS placement be-tween February 2010 and February 2014 at Xijing Digestive Disease Hospital were enrolled.These patients underwent ERCP biliary metal stenting subsequently due to the malignant biliary stenosis.The clinical and imaging features of these patients were retrospectively analyzed.Results ERCP biliary stenting was suc-cessfully completed in 66.7% of patients with previous duodenal SEMS treatment.The success rates of pa-tients with type Ⅰ and Ⅱ duodenal stricture were 88.0% and 18.2% respectively(P <0.001).The suc-cess rates of patients with different lengths of duodenal stenosis were 88.9% for <3.5 cm and 44.4% for ≥3.5 cm (P =0.005).Compared with 80 or 90 mm duodenal stent,patients with 60 mm stent had a higher completion rate for ERCP biliary stent (88.0% VS 18.2%,P <0.001).Multivariate logistic regression a-nalysis revealed that length of duodenal stenosis ≥3.5 cm and 80 or 90 mm duodenal stent were independent factors for failure of ERCP in patients with previous SEMS placement.Conclusion For unresectable DMS patients with SEMS placement,subsequently ERCP biliary metal stenting is safe and effective.The length of duodenal malignant stenosis and longer duodenal stent are high-risk factors for the failure of ERCP biliary stenting.

Objective To analyze the safety and tolerability of endoscopic retrograde cholangiopancreatography ( ERCP) for elderly pa-tients in diagnose and therapy. Methods From Jan. 2010 to Dec. 2013, 1 560 patients were collected in our hospital for diagnosis and treatment, 1 116 cases were 60~69 years old, and the other 444 cases were over 70 years old. Retrospective data including clinical and bio-chemical characteristics, ERCP diagnosis and complications were analyzed. Results Using Logistic regression, the potential factors of com-plex multivariable were analyzed, and there was no statistical difference between the two groups (P=0. 039). The successful intubation, in-tubation difficulties and failed intubation in the examination and the treatment were of significantly difference between the two groups (P<0. 05). There were no significant difference between the two groups in common bile duct stones of bile duct obstruction and clinical di-agnosis (P>0. 05), but the ERCP diagnosis, postoperative complications and complications of acute pancreatitis were of certain difference (P<0. 05). Patients over 70 years old were of better tolerance, but their bile duct stones was about two times than that in patients of 60~69 years old (P=0. 004). Conclusion The results show that ERCP for elderly patients in diagnose and therapy is safe and well tolerated, and there were relatively less complications in patients over 70 years old.

Objective To test the accuracy of a three-dimensional dose verification system CompassR,which reconstructing dose distribution based on measurements and independent dose calculation,and to evaluate the feasibility of its application in clinical intensity-modulated radiotherapy (IMRT) quality assure.Methods A set of square-wave chart patterns of 2 cm,1 cm and 0.5 cm gaps was designed and 11 completed IMRT lung plans were selected for the test.EDR2 film and the ionization chamber were used for test and verifying of plane dose distribution and some special points dose of CompassR.The IMRT phantom plans were verified by CompassR with three-dimension based on anatomical information.Parameters including the volume γ pass rate and the average dose deviation were tested using dose volume histograms.Results In square-wave chart patterns test,the dose distribution reconstructed and calculated by CompassR coincided with the measurement using film.The γ pass rates (3％/3 mm,2％/2 mm) exceeded 90％.When the width of field is 0.5 cm,the γ pass rate was a little lower on account of the penumbra zone.Compared to the dose distribution profile which was measured by film,the maximum deviations of the dose distribution profile which was reconstructed and calculated by CompassR were 3.21％ and 2.70％.The absolute dose deviation of specific point in the IMRT plans was less than 3％,the maximum deviation occurred in the lung.Compared to film,the averageγpass rates on the isocenter plain in IMRT plan were (94.65 + 1.93)％ (3％/3 mm) which was reconstructed by CompassR.In three-dimensional dose verification,the volume γ pass rates of targets and risk organs were not less than 90％,and the deviation of average dose was less than 1％.Conclusions Accuracy of the tested system satisfies the demand of IMRT dose verification.CompassR could provide information of volumetric dosimetry and anatomical location of dose error,which is benefit for evaluating the clinical value of verification result.