Cha Jung Guen, Lee Sang Yub, Han Young Seok, Chun Jae Min, Han Ja Ryung, Hong Jihoon, Ryeom Hun Kyu, Jung Min Kyu, Heo Jun, Lim Kyoung Hoon
Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea.
Department of Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea.
Eur J Radiol Open. 2020 Dec 1;7:100301. doi: 10.1016/j.ejro.2020.100301. eCollection 2020.
To review a single-center experience of percutaneous biliary recanalization for liver transplantation-related benign biliary stricture, particularly focusing on the technical aspect.
Twenty-three recipients of liver transplantation (LT) with 27 benign biliary strictures underwent percutaneous recanalization using a step-by-step technique from June 2017 to March 2020. The step-by-step technique includes a hairy wire or an usual 0.035-inch wire passage, a coaxial system, supporting catheters of various shapes and wires, and an extraluminal passage. The success rate of percutaneous biliary recanalization, degree of stricture, interval between LT and biliary recanalization, procedure time, number of sessions, and recanalization techniques were analyzed.
Among the 27 lesions, 26 (96 %) were successfully recanalized using a percutaneous approach without major complications. Of the 27 lesions, 8 were complete obstructions and 19 were partial obstructions. Consequently, the average interval between LT and biliary recanalization was 28.8 ± 42.7 months (range, 2-192 months). The average procedure time was 50 ± 65 min (range, 8-345 min). The average number of sessions was 1.4 ± 1 (range, 1-6). The case distribution for the used recanalization techniques was as follows: twelve cases utilized step 1, 10 utilized step 2, 4 utilized step 3, and only 1 case utilized step 4. The complete obstruction group required a more advanced technique and spent more recanalization time than the partial obstruction group.
The step-by-step percutaneous biliary recanalization technique had a high success rate without major complications. According to the patient's biliary anatomy appropriate selection of an angled 5-Fr support catheter and wire is essential in increasing the recanalization success rate.
回顾单中心经皮胆道再通治疗肝移植相关良性胆道狭窄的经验，尤其关注技术方面。
2017年6月至2020年3月，23例肝移植受者的27处良性胆道狭窄采用逐步技术进行经皮再通。逐步技术包括使用毛导丝或普通0.035英寸导丝通过、同轴系统、各种形状的支撑导管和导丝以及腔外通道。分析经皮胆道再通的成功率、狭窄程度、肝移植与胆道再通的间隔时间、手术时间、疗程数及再通技术。
27处病变中，26处（96%）采用经皮方法成功再通，无严重并发症。27处病变中，8处为完全梗阻，19处为部分梗阻。因此，肝移植与胆道再通的平均间隔时间为28.8±42.7个月（范围2 - 192个月）。平均手术时间为50±65分钟（范围8 - 345分钟）。平均疗程数为1.4±1次（范围1 - 6次）。所用再通技术的病例分布如下：步骤1使用12例，步骤2使用10例，步骤3使用4例，仅1例使用步骤4。完全梗阻组比部分梗阻组需要更先进的技术且再通时间更长。
逐步经皮胆道再通技术成功率高，无严重并发症。根据患者胆道解剖结构适当选择成角的5F支撑导管和导丝对于提高再通成功率至关重要。
