Istituto di Radiologia, Università degli Studi di Torino, Ospedale S Giovanni Battista di Torino, Torino, Italy.
Radiol Med. 2013 Apr;118(3):386-400. doi: 10.1007/s11547-012-0863-1. Epub 2012 Aug 8.
We sought to evaluate the feasibility and efficacy of percutaneous treatment of early postoperative biliary complications. The primary aims were to evaluate clinical and technical success and complications and perioperative mortality, and secondary aims were to evaluate treatment duration and recurrence rate.
Between March 2007 and March 2010, 75 patients (42 men and 33 women; age range, 17-88 years; mean age, 60.8 years) underwent interventional radiology procedures to treat early postoperative biliary complications of biliary and pancreatic-duodenal surgery with biliodigestive anastomosis (37.7%), laparoscopic cholecystectomy (30.6%), hepatic resection (21.1%) and several other surgical procedures (10.6%). Complications included fistulas (73%), stenoses (20%) and complete bile duct transections (7%).
Interventional radiology achieved complete clinical success in 74 cases (85.9%) and in particular in 95.2% of fistulas, 76.5% of stenoses and 33.3% of complete bile duct transections. Mean indwelling catheter time was 34.9 days, with an average of 4.1 procedures. There were two cases of severe haemobilia (2.3%). Minor complications occurred in 7% of cases. Perioperative mortality rate was 1.2% and overall recurrence rate 6.7% (range, 1-18 months; mean, 10 months), with recurrences occurring predominantly in stenoses. All patients were retreated successfully.
Percutaneous procedures are feasible, effective and safe for treating early postoperative biliary complications. They provide a valuable alternative to presendoscopy, which is precluded in many of these patients, and to surgery, which has higher morbidity and mortality rates.
我们旨在评估经皮治疗早期术后胆系并发症的可行性和疗效。主要目的是评估临床和技术成功率、并发症和围手术期死亡率，次要目的是评估治疗持续时间和复发率。
在 2007 年 3 月至 2010 年 3 月期间，75 例（42 名男性和 33 名女性；年龄 17-88 岁；平均年龄 60.8 岁）患者接受了介入放射学治疗，以治疗胆胰十二指肠吻合术（37.7%）、腹腔镜胆囊切除术（30.6%）、肝切除术（21.1%）和其他几种手术（10.6%）后的早期术后胆系并发症。并发症包括瘘管（73%）、狭窄（20%）和胆管完全横断（7%）。
介入放射学在 74 例（85.9%）患者中实现了完全临床成功，特别是在 95.2%的瘘管、76.5%的狭窄和 33.3%的胆管完全横断患者中。留置导管时间平均为 34.9 天，平均需要 4.1 次操作。有 2 例严重的胆血症（2.3%）。7%的病例发生轻微并发症。围手术期死亡率为 1.2%，总复发率为 6.7%（范围为 1-18 个月；平均为 10 个月），复发主要发生在狭窄部位。所有患者均成功接受了再次治疗。
经皮治疗对于治疗早期术后胆系并发症是可行、有效且安全的。与这些患者中许多人不能进行的内镜前治疗以及具有更高发病率和死亡率的手术相比，它们提供了一种有价值的替代方案。
