Giurazza Francesco, Corvino Fabio, Contegiacomo Andrea, Marra Paolo, Lucarelli Nicola Maria, Calandri Marco, Silvestre Mattia, Corvino Antonio, Lucatelli Pierleone, De Cobelli Francesco, Niola Raffaella, Cariati Maurizio
Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Cardarelli 9, 80100, Naples, Italy.
Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00136, Rome, Italy.
J Ultrasound. 2019 Dec;22(4):437-445. doi: 10.1007/s40477-019-00399-w. Epub 2019 Jul 31.
Aim of this study is to describe a multicenter experience on percutaneous transhepatic biliary drainage (PTBD) performed with ultrasound-guidance to access the biliary tree, focusing on safety, effectiveness and radiation dose exposure; differences between right- and left-sided approaches have been also evaluated.
This is a multicenter prospective single-arm observational study conducted on patients affected by biliary tree stenosis/occlusion with jaundice and endoscopically inaccessible. The procedures have been performed puncturing the biliary system under US guidance and crossing the stenosis/occlusion under fluoroscopy. Beam-on time and X-ray dose have been evaluated.
117 patients affected by biliary tree stenosis/occlusion not manageable with an endoscopic approach have been included in this analysis. The biliary stenosis/occlusion was malignant in 90.8% and benign in 9.2%. Technical success, considered as positioning of a drainage tube into the biliary tree, was 100%. Overall clinical success, considered as decrease in total bilirubin level after a single procedure, was 95.7%. The overall mean number of liver punctures to catheterize the biliary tree was 1.57. The mean total beam-on time was 570.4 s; the mean dose-area product was 37.25 Gy cm. No statistical significant differences were observed in terms of technical and dosimetry results according to right-sided and left-sided procedures. Complications rate recorded up to 30 days follow-up was 10.8%, all of minor grades.
In this series US guidance to access the biliary tree for PTBD was a safe and effective technique with an acceptable low-grade complications rate; the reported radiation dose is low.
本研究旨在描述在超声引导下经皮经肝胆道引流（PTBD）进入胆道系统的多中心经验，重点关注安全性、有效性和辐射剂量暴露；还评估了左右侧入路之间的差异。
这是一项多中心前瞻性单臂观察性研究，针对患有胆道狭窄/闭塞且伴有黄疸且内镜无法到达的患者进行。手术在超声引导下穿刺胆道系统，并在荧光透视下穿过狭窄/闭塞部位。评估了照射时间和X射线剂量。
本分析纳入了117例经内镜方法无法处理的胆道狭窄/闭塞患者。胆道狭窄/闭塞为恶性的占90.8%，良性的占9.2%。技术成功率（定义为将引流管置入胆道系统）为100%。总体临床成功率（定义为单次手术后总胆红素水平下降）为95.7%。经皮穿刺胆道系统置管的肝脏穿刺平均总次数为1.57次。平均总照射时间为570.4秒；平均剂量面积乘积为37.25 Gy·cm。根据左右侧手术的技术和剂量学结果，未观察到统计学上的显著差异。随访30天内记录的并发症发生率为10.8%，均为轻度。
在本系列研究中，超声引导下经皮经肝胆道引流进入胆道系统是一种安全有效的技术，并发症发生率低且可接受；报告的辐射剂量较低。
