经皮经肝内镜会师术治疗难治性胆管梗阻安全有效。
Percutaneous-transhepatic-endoscopic rendezvous procedures are effective and safe in patients with refractory bile duct obstruction.
机构信息
Department of Medicine B for Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany.
Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany.
出版信息
United European Gastroenterol J. 2019 Apr;7(3):397-404. doi: 10.1177/2050640619825949. Epub 2019 Jan 17.
BACKGROUND
Percutaneous-transhepatic-endoscopic rendezvous procedures (PTE-RVs) are rescue approaches used to facilitate biliary drainage.
OBJECTIVE
The objective of this article is to evaluate the safety and the technical success of PTE-RVs in comparison with those of percutaneous transhepatic cholangiographies (PTCs).
METHODS
Percutaneous procedures performed over a 10-year period were retrospectively analyzed in a single-center cohort. Examinations were performed because of a previous or expected failure of standard endoscopic methods including endoscopic retrograde cholangiography (ERC) or balloon-assisted ERC to achieve biliary access.
RESULTS
In total, 553 percutaneous procedures including 163 PTE-RVs and 390 PTCs were performed. Overall, 71.3% of the patients suffered from malignant disease with pancreas-carcinoma (32.8%) and cholangio-carcinoma (19.0%) as the most frequent, while 28.7% of the patients suffered from benign disease. Many patients had a postoperative change in bowel anatomy (50.8%).PTC had a higher technical success rate (89.7%); however, the technical success rate of PTE-RVs was still high (80.4%; < 0.003). Overall complications occurred in 23.5% of all procedures. Significantly fewer complications occurred after performing PTE-RVs than after PTCs (16.6% vs 26.4%; = 0.037).
CONCLUSION
Beside a high technical efficacy of PTE-RVs, significantly fewer complications occur following PTE-RVs than following PTCs; thus, PTE-RV should be preferred over PTC alone in selected patients.
背景
经皮经肝内镜联合经皮经肝胆道引流术（PTE-RV）是一种用于辅助胆道引流的抢救方法。
目的
本文旨在评估与经皮经肝胆道造影术（PTC）相比，PTE-RV 的安全性和技术成功率。
方法
回顾性分析了一家中心 10 年间的经皮操作，这些检查是由于标准内镜方法（包括内镜逆行胆胰管造影术（ERC）或球囊辅助 ERC）预计或之前失败，无法实现胆道进入而进行的。
结果
共进行了 553 例经皮操作，包括 163 例 PTE-RV 和 390 例 PTC。总体而言，71.3%的患者患有恶性疾病，其中胰腺癌（32.8%）和胆管癌（19.0%）最为常见，而 28.7%的患者患有良性疾病。许多患者术后肠解剖结构发生改变（50.8%）。PTC 的技术成功率更高（89.7%）；然而，PTE-RV 的技术成功率仍然很高（80.4%；<0.003）。所有操作中，总并发症发生率为 23.5%。与 PTC 相比，PTE-RV 后并发症发生率显著降低（16.6%比 26.4%；=0.037）。
结论
除了 PTE-RV 的高技术疗效外，与 PTC 相比，PTE-RV 后并发症发生率显著降低；因此，在选择患者时，应优先选择 PTE-RV 而不是单独进行 PTC。
Zotero 插件