Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
Abdom Radiol (NY). 2022 Sep;47(9):3338-3344. doi: 10.1007/s00261-021-03207-4. Epub 2021 Aug 6.
Over 2500 percutaneous transhepatic cholangiography and biliary drainage (PTCD) procedures are yearly performed in the Netherlands. Most interventions are performed for treatment of biliary obstruction following unsuccessful endoscopic biliary cannulation. Our aim was to evaluate complication rates and risk factors for complications in PTCD patients after failed ERCP.
We performed an observational study collecting data from a cohort that was subjected to PTCD during a 5-year period in one academic and four teaching hospitals. Primary objective was the development of infectious (sepsis, cholangitis, abscess, or cholecystitis) and non-infectious complications (bile leakage, severe hemorrhage, etc.) and mortality within 30 days of the procedure. Subsequently, risk factors for complications and mortality were analyzed with a multilevel logistic regression analysis.
A total of 331 patients underwent PTCD of whom 205 (61.9%) developed PTCD-related complications. Of the 224 patients without a pre-existent infection, 91 (40.6%) developed infectious complications, i.e., cholangitis in 26.3%, sepsis in 24.6%, abscess formation in 2.7%, and cholecystitis in 1.3%. Non-infectious complications developed in 114 of 331 patients (34.4%). 30-day mortality was 17.2% (N = 57). Risk factors for infectious complications included internal drainage and drain obstruction, while multiple re-interventions were a risk factor for non-infectious complications.
Both infectious and non-infectious complications are frequent after PTCD, most often due to biliary drain obstruction.
在荷兰，每年有超过 2500 例经皮经肝穿刺胆道造影和胆道引流 (PTCD) 手术。大多数介入治疗是针对内镜逆行胰胆管造影 (ERCP) 不成功后胆道梗阻进行的。我们的目的是评估 ERCP 失败后行 PTCD 的患者的并发症发生率和并发症危险因素。
我们进行了一项观察性研究，从一个队列中收集数据，该队列在五年内在一家学术医院和四家教学医院接受了 PTCD 治疗。主要目的是在术后 30 天内发生感染性（败血症、胆管炎、脓肿或胆囊炎）和非感染性并发症（胆漏、严重出血等）和死亡率。随后，采用多水平逻辑回归分析对并发症和死亡率的危险因素进行了分析。
共有 331 例患者接受了 PTCD 治疗，其中 205 例（61.9%）发生了与 PTCD 相关的并发症。在没有预先存在感染的 224 例患者中，91 例（40.6%）发生了感染性并发症，即胆管炎 26.3%，败血症 24.6%，脓肿形成 2.7%，胆囊炎 1.3%。在 331 例患者中，114 例（34.4%）发生了非感染性并发症。30 天死亡率为 17.2%（N=57）。感染性并发症的危险因素包括内引流和引流管阻塞，而多次再干预是发生非感染性并发症的危险因素。
PTCD 后常发生感染性和非感染性并发症，最常见的原因是胆道引流管阻塞。
