RÉSUMÉ
Objective:To investigate the diagnostic value of endoscopic ultrasonography (EUS) in pancreatic duct stones.Methods:The clinicopathologic data of 204 patients undergoing EUS for symptoms such as abdominal pain, abdominal distension and jaundice suspected of pancreatic duct stones, who were admitted to the General Hospital of Western Theater Command from January 2019 to April 2023 were retrospectively analyzed. Of 159 patients were finally enrolled, including 47 females and 112 males, aged (51.8±13.9) years. Surgery or endoscopic retrograde cholangiopancreatography (ERCP) is considered the " gold standard" for the diagnosis of pancreatic duct stones. Of 38 patients (23.9%) had abdominal ultrasound, 143 (89.9%) had CT scan and 93 (58.5%) had magnetic resonance cholangiopancreatography (MRCP) at the same time. The diagnostic accuracy of imaging examinations in pancreatic duct stones was compared.Results:In 159 patients, 61 (38.4%) were diagnosed of pancreatic duct stones. In the 159 patients, 61 (38.4%) were diagnosed of pancreatic duct stones by EUS. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, Youden index and accuracy of EUS for pancreatic duct stones were 98.4%, 99.0%, 98.4%, 99.0%, 97.3% and 98.7%, respectively. The accuracy of EUS in diagnosing pancreatic duct stones was higher than that of percutaneous ultrasound, CT and MRCP (χ 2=7.71, 13.76, and 5.70, P=0.012, <0.001, 0.033). The diagnostic accuracy of EUS is comparable with operation and ERCP (Kappa=0.854, P<0.001). Conclusion:EUS could be a superior imaging approach to diagnose the pancreatic duct stone.
RÉSUMÉ
Objective:To explore the prognostic factors of patients with Vibrio vulnificus sepsis. Methods:The clinical data of 67 patients with Vibrio vulnificus sepsis from January 2008 to December 2019 in the First Affiliated Hospital of Wenzhou Medical University were retrospectively analyzed. Univariate analysis was used to compare the differences in general information, clinical manifestations, admission laboratory indicators, antibiotics and surgery between the death group and the cured group. Then the factors with significant difference in univariate analysis were included in multivariate analysis, and the factors of prognosis were obtained. Results:Univariate analysis showed that there were significant difference in liver disease, admission with hypotension shock, multiple limb injuries; admission leukocytes, platelets, pH value, albumin, lactic acid, aspartate aminotransferase, creatinine, procalcitonin, creatine kinase, activated partial thromboplastin time, prothrombin time between the death group and the cured group (all P <0.05). Multivariate analysis showed that admission lactate ( OR=0.628, 95% CI: 0.461-0.855, P=0.003), albumin ( OR=1.330, 95% CI:1.062-1.667, P=0.013), creatine kinase ( OR=0.999, 95% CI: 0.998-1.000, P=0.016) and admission surgery time ( OR=0.118, 95% CI: 0.015-0.938, P=0.043) were risk factors of the prognosis. Patients with high lactate, creatine kinase and low albumin at admission indicate poor prognosis; patients with admission surgery time≤ 12 h have better prognosis. Conclusion:For the treatment of patients with Vibrio vulnificus sepsis, medical staff should dynamically evaluate these prognostic factors in the early stage, and early surgical treatment should be adopted to improve the prognosis of patients.