Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Cardiovasc Intervent Radiol. 2020 Nov;43(11):1671-1678. doi: 10.1007/s00270-020-02544-z. Epub 2020 Jun 29.
Complete biliary occlusions at different anatomic locations that are not amenable to surgical, endoscopic, or routine percutaneous methods pose a challenge to physicians. Biliary ductal neoanastomosis technique can play a very important role in solving such clinical problems.
Between October 2004 and January 2018, six patients were treated in our institution for biliary drainage using biliary ductal neoanastomosis technique via sharp recanalization and a staged approach to achieve internal/external biliary drainage. All procedures were performed in an angiography suite by an interventional radiologist after multidisciplinary discussion.
The mean patient age of the cohort was 54 years and 50% of the patients were female (three/six patients). The cause of obstruction was complications or disease progression after Whipple procedure in four patients, partial hepatectomy in one patient and benign biliary stricture after radioembolization in one patient. All patients were treated with percutaneous biliary neoanastomosis. All procedures were successfully performed in all six patients (100% technical success) without any major complications. All patients were successfully managed by capped drainage catheters for the duration of the follow up (one patient was transitioned to endoscopically inserted biliary stent, and in one patient the tube was eventually removed after establishment of patent neoanastomosis).
Biliary ductal neoanastomosis is an effective treatment option when the anatomy has been significantly altered in the post-surgical setting and wire cannot be safely passed into target draining organ or the remainder of biliary system. When performed by an experienced operator, this technique is safe and effective with a high technical success rate.
对于无法通过手术、内镜或常规经皮方法治疗的不同解剖部位的完全性胆道阻塞，医生会面临挑战。胆管再吻合技术在解决此类临床问题时可以发挥非常重要的作用。
在 2004 年 10 月至 2018 年 1 月期间，我们医院通过锐性再通和分阶段方法，使用胆管再吻合技术为 6 名患者进行胆道引流治疗，以实现内外胆道引流。所有程序均由介入放射学家在多学科讨论后，在血管造影室进行。
该队列患者的平均年龄为 54 岁，其中 50%为女性（3/6 名患者）。4 名患者的梗阻原因为胰十二指肠切除术后并发症或疾病进展，1 名患者为部分肝切除术，1 名患者为放射性栓塞后良性胆管狭窄。所有患者均接受经皮胆道再吻合术治疗。在所有 6 名患者（100%技术成功率）中，所有程序均成功完成，无重大并发症。所有患者均通过带帽引流导管成功管理，在随访期间（1 名患者过渡到内镜下插入的胆道支架，1 名患者在建立新吻合后最终将导管拔出）。
当术后解剖结构发生明显改变，导丝无法安全地插入目标引流器官或胆管系统的其余部分时，胆管再吻合是一种有效的治疗选择。由经验丰富的操作者进行操作时，该技术安全有效，技术成功率高。
