肝胰胆手术后经皮处理术后胆漏：一项多中心经验

Percutaneous management of postoperative Bile leak after hepato-pancreato-biliary surgery: a multi-center experience.

作者信息

Mosconi Cristina, Calandri Marco, Mirarchi Mariateresa, Vara Giulio, Breatta Andrea D, Cappelli Alberta, Brandi Nicolò, Paccapelo Alexandro, De Benedittis Caterina, Ricci Claudio, Sassone Mirian, Ravaioli Matteo, Fronda Marco, Cucchetti Alessandro, Petrella Enrico, Casadei Riccardo, Cescon Matteo, Romagnoli Renato, Ercolani Giorgio, Giampalma Emanuela, Righi Dorico, Fonio Paolo, Golfieri Rita

机构信息

Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy.

Radiology Unit, A.O.U. San Luigi Gonzaga di Orbassano, Regione Gonzole 10, 10043, Orbassano, Torino, Italy; Department of Oncology, University of Torino, Via Verdi 8, 10124, Torino, Italy.

出版信息

HPB (Oxford). 2021 Oct;23(10):1518-1524. doi: 10.1016/j.hpb.2021.02.014. Epub 2021 Mar 19.

DOI:10.1016/j.hpb.2021.02.014

PMID:33832832

Abstract

BACKGROUND

Bile leak (BL) after hepato-pancreato-biliary (HPB) surgery is associated with significant morbidity and mortality. Aim of this study was to evaluate effectiveness and safety of percutaneous transhepatic approach (PTA) to drainage BL after HPB surgery.

METHODS

Between 2006 and 2018, consecutive patients who were referred to interventional radiology units of three tertiary referral hospitals were retrospectively identified. Technical success and clinical success were analyzed and evaluated according to surgery type, BL-site and grade, catheter size and biochemical variables. Complications of PTA were reported.

RESULTS

One-hundred-eighty-five patients underwent PTA for BL. Technical success was 100%. Clinical success was 78% with a median (range) resolution time of 21 (5-221) days. Increased clinical success was associated with patients who underwent hepaticresection (86%,p = 0,168) or cholecystectomy (86%,p = 0,112) while low success rate was associated to liver-transplantation (56%,p < 0,001). BL-site,grade, catheter size and AST/ALT levels were not associated with clinical success. ALT/AST high levels were correlated to short time resolution (17 vs 25 days, p = 0,037 and 16 vs 25 day, p = 0,011, respectively) Complications of PTA were documented in 21 (11%) patients.

CONCLUSION

This study based on a large cohort of patients demonstrated that PTA is a valid and safe approach in BL treatment after HPB surgery.

摘要

背景

肝胰胆（HPB）手术后胆漏（BL）与显著的发病率和死亡率相关。本研究的目的是评估经皮经肝途径（PTA）引流HPB手术后胆漏的有效性和安全性。

方法

回顾性确定2006年至2018年间转诊至三家三级转诊医院介入放射科的连续患者。根据手术类型、胆漏部位和分级、导管尺寸和生化变量分析和评估技术成功率和临床成功率。报告PTA的并发症。

结果

185例患者接受了PTA治疗胆漏。技术成功率为100%。临床成功率为78%，中位（范围）解决时间为21（5 - 221）天。接受肝切除术（86%，p = 0.168）或胆囊切除术（86%，p = 0.112）的患者临床成功率增加，而肝移植患者成功率较低（56%，p < 0.001）。胆漏部位、分级、导管尺寸和AST/ALT水平与临床成功率无关。ALT/AST高水平与较短的解决时间相关（分别为17天对25天，p = 0.037和16天对25天，p = 0.011）。21例（11%）患者记录了PTA的并发症。