Chien-Chung Tsai

Percutaneous choledochoscopic biliary tract stone removal: experience in 645 consecutive patients

Our experience in non-operative retrieval of biliary tract stones through PTCS (percutaneous transhepatic cholangioscopy, n = 103) and POC (post-operative choledochoscopy, n = 542) plus the use of Dormia basket and EHL (electrohydraulic lithotripsy) is presented. The results of transhepatic and T-tube routes are compared, with emphasis on the technical difficulties encountered. The success rates were 96% and 97% in POC and PTCS, respectively. No mortality was related to these procedures. Intrahepatic duct angulation and stricture were the factors most often responsible for failure. Postoperative choledochoscopic stone removal is safe and the method of choice for retained biliary tract calculi, while PTCS is highly indicated for those high-risk patients with or without previous biliary surgery. POC and PTCS have, therefore, their own indications and differ in their clinical applications.

Transarterial embolisation of vascular lesions associated with percutaneous drainage catheters

Selective hepatic and renal angiography were performed in seven patients with clinically significant haemorrhage from vascular lesions caused by percutaneous transhepatic drainage (3 cases) and percutaneous nephrostomy catheteres (4 cases). We demonstrated hepatic artery pseudoaneurysms in 2 patients, a hepatoportal fistula in 1, renal artery pseudoaneurysms in 3 and both an arteriovenous fistula and a pseudoaneurysym of reneal artery in 1. A tamponade effect of the drainage catheter, preventing extravasation of contrast medium was seen in one patient. We superselectively catheterised the injured artery and performed transacterial embolisation in all cases using coil spring emboli in 6 and Gelfoam cubes in 1. Postembolisation angiography was carried out ti check the location of the embolic material and patency of the remaining arterial supply. Bleeding was controlled in 6 of the 7 patients after 4, 7, 15, 23, 26, 27 months of follow-up. One patient rebled after a month, an operation was performed and she died of sepsis 2 weeks later. Transarterial embolisation was a safe, life-saving procedure in these cases of haemorrhage due to percutaneous drainage catheters, avoiding surgical intervention in this particulary high-risk patients.

Primary Malignant Melanoma of The Esophagus: Report of a Case

原發性食道惡性黑色素瘤是罕見的疾病。本例報告一名60歲女性患者，最近二個月來因吞嚥固體食物特別困難而至本院求診。食道攝影及內視鏡檢查發現在食道中下部有一息肉樣的腫瘤，經手術切除。病理診斷證實為惡性黑色素瘤，由於此病預後極差，手術治療目前仍是緩解症狀及延長生命的主要治療方法。