Kothaj P, Okapec S, Kúdelová A
Rozhl Chir. 2014 May;93(5):247-54.
The aim of this work is to demonstrate perioperative and postoperative complications after percutaneous transhepatic drainage of the biliary tract and, on the basis of our own experience, to show the possibilities of solving these complications within hospital care as well as the ways of preventing such complications in outpatient and home care where the role of home care nurses is very important.
At the Department of Radiology in F.D. Roosevelt Teaching Hospital Banska Bystrica, more than 100 percutaenous transhepatic biliary tract drainage procedures are performed every year. In 2013, 105 such procedures were performed. Indications included nonresectable cholangiocarcinomas of the biliary confluence (Klatskin tumours) or common bile duct as well as benign bile obstructions in which endoscopic drainage could not be performed (benign stenosis of thecommon bile duct, stenosis of biliodigestive anastomosis, intrahepatic biliary stones). Between 2009 and 2013, 151 patients with percutaneous transhepatic drainage of the biliary tract were hospitalised at the Department of Surgery in F.D. Roosevelt Hospital Banska Bystrica,of whom 98 had malignant obstruction and 53 benign obstruction.
In 151 patients hospitalised at the Department of Surgery, the following postoperative complications occurred: catheter obliteration in 6.6%, biliary peritonitis in 2%, sepsis with cholangitis in 3.3% and haemorrhage in 4.6% of all patients. Mortality directly related to the PTD procedure was 0.66% (1 patient).
Percutaneous transhepatic biliary tract drainage requires a skilled radiologist who is able to manage all perioperative complications. At the same time, experienced medical staff are needed who are able to treat the drainage catheters correctly and are able to recognize severe complications in time. Complications after PTD occur also during home care of the patients; therefore, cooperation of home care nurses with hospitals where PTD is performed is therefore important. Catheter flushing should be included in the catalogue listing home care procedures.
本研究的目的是阐述经皮经肝胆道引流术后的围手术期及术后并发症，并基于我们自己的经验，展示在医院护理中解决这些并发症的可能性，以及在门诊和家庭护理中预防此类并发症的方法，其中家庭护理护士的作用非常重要。
在班斯卡·比斯特里察的F.D.罗斯福教学医院放射科，每年进行超过100例经皮经肝胆道引流手术。2013年，进行了105例此类手术。适应证包括不可切除的胆管汇合部胆管癌（克氏瘤）或胆总管癌以及无法进行内镜引流的良性胆管梗阻（胆总管良性狭窄、胆肠吻合口狭窄、肝内胆管结石）。2009年至2013年期间，151例经皮经肝胆道引流患者入住班斯卡·比斯特里察的F.D.罗斯福医院外科，其中98例为恶性梗阻，53例为良性梗阻。
在入住外科的151例患者中，发生了以下术后并发症：所有患者中导管闭塞占6.6%，胆汁性腹膜炎占2%，胆管炎伴败血症占3.3%，出血占4.6%。与经皮经肝胆道引流手术直接相关的死亡率为0.66%（1例患者）。
经皮经肝胆道引流需要一名技术熟练的放射科医生，其能够处理所有围手术期并发症。同时，需要有经验的医务人员能够正确处理引流导管并及时识别严重并发症。经皮经肝胆道引流术后并发症也会在患者家庭护理期间发生；因此，家庭护理护士与进行经皮经肝胆道引流手术的医院之间的合作非常重要。导管冲洗应纳入家庭护理程序目录中。
