Mastier Charles, Valette Pierre-Jean, Adham Mustapha, Mabrut Jean-Yves, Glehen Olivier, Ponchon Thierry, Rousset Pascal, Rode Agnès
Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France.
Department of Radiology, Hopital Edouard Herriot, Hospices Civils de Lyon, 10 Place d'Arsonval, 69003, Lyon, France.
Cardiovasc Intervent Radiol. 2018 Oct;41(10):1566-1572. doi: 10.1007/s00270-018-2005-1. Epub 2018 Jun 5.
To assess the effectiveness of percutaneous radiological treatment for complex biliary leaks compared to simple biliary leaks.
We retrospectively analyzed 101 percutaneous treatments for bile leak performed from January 1994 to January 2012. Sixty (59%) bile leaks were classified as simple and 41 (41%) as complex based on a morphological classification that considered eight types of biliary wound on cholangiography images. The main treatment was percutaneous transhepatic biliary drainage (PTBD), and additional procedures were performed when required. The technical success of PTBD, leak healing, and recurrence, as well as complication rates were compared between the simple and complex leak groups.
Technical success of PTBP was achieved in 94/101 (93%) patients: 59/60 (98%) for simple leaks and 35/41 (85%) for complex leaks (p = 0.017). When PTBD internalization was achieved, leak healing was obtained in 80/94 (85%) patients: 52/59 (88%) for simple leaks and 28/35 (80%) for complex leaks (p = 0.37), with additional percutaneous procedures required in five patients with simple leaks and 13 patients with complex leaks (p = 0.001). There was no recurrence in 75/80 (94%) patients: 50/52 (96%) for simple leaks and 25/28 (89%) for complex leaks (p = 0.34). Major complications occurred in 28/101 (28%) patients: 16/59 (27%) for simple leaks and 12/41 (29%) for complex leaks (p = 0.82).
Once PTBD internalization is achieved, complex leaks heal as well as simple leaks.
评估经皮放射治疗复杂胆漏与简单胆漏相比的有效性。
我们回顾性分析了1994年1月至2012年1月期间进行的101例经皮胆漏治疗。根据胆管造影图像上八种胆管伤口类型的形态学分类，60例（59%）胆漏被分类为简单胆漏，41例（41%）为复杂胆漏。主要治疗方法是经皮肝穿胆道引流（PTBD），并在需要时进行额外的操作。比较了简单胆漏组和复杂胆漏组PTBD的技术成功率、漏口愈合情况、复发情况以及并发症发生率。
101例患者中有94例（93%）实现了PTBD的技术成功：简单胆漏组为59/60例（98%），复杂胆漏组为35/41例（85%）（p = 0.017）。当实现PTBD内引流时，94例患者中有80例（85%）漏口愈合：简单胆漏组为52/59例（88%），复杂胆漏组为28/35例（80%）（p = 0.37），简单胆漏组有5例患者和复杂胆漏组有13例患者需要额外的经皮操作（p = 0.001）。80例患者中有75例（94%）无复发：简单胆漏组为50/52例（96%），复杂胆漏组为25/28例（89%）（p = 0.34）。101例患者中有28例（28%）发生了严重并发症：简单胆漏组为16/59例（27%），复杂胆漏组为12/41例（29%）（p = 0.82）。
一旦实现PTBD内引流，复杂胆漏与简单胆漏的愈合情况相同。
