Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Liver Transpl. 2011 Feb;17(2):159-66. doi: 10.1002/lt.22206.
The purpose of this study was to evaluate the results of percutaneous transhepatic management of anastomotic biliary strictures using the dual catheter placement technique (2 drainage catheters inserted via single percutaneous tract). The protocol of this retrospective study was approved by the institutional review board of our institution and written informed consent was waived. Percutaneous transhepatic biliary drainage and subsequent balloon dilation of anastomotic strictures were performed in 79 patients. Serial exchanges of drainage via catheter with larger diameters up to 14-French were performed at 1-month intervals followed by 3 exchanges of dual catheters at 2 month intervals. Drainage catheters were removed when follow-up cholangiography revealed improved strictures without recurrence of symptoms or elevation of biochemical findings. Technical success was achieved in all 79 (100%) patients after percutaneous transhepatic treatment. The mean period of dual catheter placement was 6.5 ± 1.1 months (range, 5.5-14.2 months). Clinical success was achieved in 78 (98.7%) of 79 patients and drainage catheters were removed 23.8 ± 8.8 months (range, 11.4-43.3 months) after the initial percutaneous transhepatic biliary drainage. Procedure-related complications occurred in 14 (17.8%) patients. During the mean follow-up period of 34.5 ± 3 months (range, 24.4-38.5 months) in the 78 patients, the primary patency rates were 96%, 92%, and 91% at 1, 2, and 3 years, respectively. Seven (9%) of the 78 patients experienced recurrent symptoms at a mean of 15.4 ± 8.9 months (range, 6.1-26.2 months) after catheter removal. In conclusion, the dual catheter placement technique seems to be an easy, safe, and effective method with an acceptable catheter intervention period for the treatment of anastomotic strictures following LDLT.
本研究旨在评估经皮经肝途径应用双导管置管技术（通过单一经皮通道插入 2 根引流导管）治疗胆肠吻合口狭窄的效果。本回顾性研究方案得到了我院机构审查委员会的批准，并豁免了书面知情同意。79 例患者接受了经皮经肝胆道引流和随后的吻合口狭窄球囊扩张治疗。在 1 个月的时间间隔内，通过导管进行系列的引流管交换，直至使用 14-French 直径的引流管，随后每 2 个月进行 3 次双导管交换。当随访胆管造影显示狭窄改善且无症状复发或生化指标升高时，即可拔除引流管。所有 79 例（100%）患者经皮经肝治疗后均获得技术成功。双导管留置的平均时间为 6.5 ± 1.1 个月（范围：5.5-14.2 个月）。78 例（98.7%）患者获得临床成功，初次经皮经肝胆道引流后 23.8 ± 8.8 个月（范围：11.4-43.3 个月）拔除引流管。14 例（17.8%）患者出现与操作相关的并发症。在 78 例患者的平均 34.5 ± 3 个月（范围：24.4-38.5 个月）的随访期间，1、2、3 年的原发通畅率分别为 96%、92%和 91%。78 例患者中有 7 例（9%）在拔除导管后平均 15.4 ± 8.9 个月（范围：6.1-26.2 个月）时出现症状复发。总之，对于 LDLT 后胆肠吻合口狭窄的治疗，双导管置管技术似乎是一种简单、安全、有效的方法，且导管介入时间可接受。
