Department of Diagnostic Radiology and Neuroradiology, Ernst Moritz Arndt University, Greifswald 17489, Germany.
AJR Am J Roentgenol. 2010 Oct;195(4):851-7. doi: 10.2214/AJR.09.3461.
The purpose of this article is to compare the technical success and guidance of percutaneous transhepatic biliary drainage (PTBD) in patients with nondilated and dilated bile duct systems using different techniques to supplement the conventional approach.
Between 2006 and 2008, 71 patients (mean age, 66.6 years) underwent PTBD with 97 interventions. According to sonographic evaluation of bile duct morphology, patients were divided into two groups: 50 patients with dilated and 21 patients with nondilated bile ducts. In a retrospective analysis, both groups were compared for technical success, fluoroscopy time, complications, and medical indications. The use of interventional guidance (deviations from the standard protocol) in patients with nondilated bile ducts was recorded.
The technical success rate was 90% in patients with dilated bile ducts versus 81% in patients with nondilated ducts, with no significant difference (p = 0.36). The greater complexity of the intervention in patients with nondilated bile ducts resulted in longer fluoroscopy times (p = 0.04). Complication rates were not different between the two groups. The main indication for PTBD was relief of a compressed biliary system in patients with dilated ducts and postoperative management of complications or prevention of tumor-associated bile duct obstruction in patients with nondilated ducts. T-drainage, additional CT-guided puncture, and temporary gallbladder drainage were performed in 16 of 21 interventions for patients with nondilated bile ducts, resulting in a 100% success rate, versus a success rate of 60% in the five PTBDs of nondilated ducts performed in the conventional manner.
T-drainage, additional CT-guided puncture, and temporary gallbladder drainage improve the technical success of PTBD when used in patients with nondilated bile ducts. With these measures, technical success and complication rates in patients with nondilated ducts are comparable to those for PTBD of dilated bile ducts.
本文旨在比较使用不同技术对非扩张性和扩张性胆管系统进行经皮经肝胆管引流（PTBD）的技术成功率和指导效果，以补充传统方法。
2006 年至 2008 年，71 例患者（平均年龄 66.6 岁）接受了 97 次 PTBD 介入治疗。根据胆管形态的超声评估，患者分为两组：50 例胆管扩张患者和 21 例非扩张性胆管患者。在回顾性分析中，比较了两组患者的技术成功率、透视时间、并发症和医学适应证。记录了非扩张性胆管患者使用介入指导（偏离标准方案）的情况。
胆管扩张患者的技术成功率为 90%，而非扩张性胆管患者为 81%，差异无统计学意义（p=0.36）。非扩张性胆管患者介入操作的复杂性更大，透视时间更长（p=0.04）。两组患者的并发症发生率无差异。胆管扩张患者行 PTBD 的主要适应证为缓解受压的胆道系统，而非扩张性胆管患者的主要适应证为术后处理并发症或预防肿瘤相关胆管阻塞。21 例非扩张性胆管患者中有 16 例行 T 管引流、额外的 CT 引导下穿刺和临时胆囊引流，成功率为 100%，而非扩张性胆管行传统 PTBD 的 5 例成功率为 60%。
在非扩张性胆管患者中，使用 T 管引流、额外的 CT 引导下穿刺和临时胆囊引流可提高 PTBD 的技术成功率。通过这些措施，非扩张性胆管患者的技术成功率和并发症发生率与扩张性胆管的 PTBD 相当。
