Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary.
Institute of Bioanalysis, University of Pécs, Pécs, Hungary.
PLoS One. 2021 Nov 18;16(11):e0260223. doi: 10.1371/journal.pone.0260223. eCollection 2021.
Historically, surgical bilioenteric bypass was the only treatment option for extrahepatic bile duct obstruction, but with technological advancements, percutaneous transhepatic drainage (PTD) and endoscopic solutions were introduced as a less invasive alternative. Endoscopic methods may lead to a decreasing indication of PTD in the future, but today it is still the standard treatment method, especially in hilar obstructions.
In our retrospective data analysis, we assessed technical success rate, reintervention rate, morbidity, mortality, and the learning curve of patients treated with PTD over 12 years in a tertiary referral center.
599 patients were treated with 615 percutaneous interventions. 94.5% (566/599) technical success rate; 2.7% (16/599) reintervention rate were achieved. 111 minor and 22 major complications occurred including 1 case of death. In perihilar obstruction, cholangitis were significantly more frequent in cases where endoscopic retrograde cholangiopancreatography had also been performed prior to PTD compared to PTD alone, with 39 (18.2%) and 15 (10.5%) occurrences, respectively.
The results and especially the excellent success rates demonstrate that PTD is safe and effective, and it is appropriate for first choice in the treatment algorithm of perihilar stenosis. Ultimately, we concluded that PTD should be performed in experienced centers to achieve low mortality, morbidity, and high success rates.
在过去，外科胆肠旁路术是治疗肝外胆管梗阻的唯一选择，但随着技术的进步，经皮经肝胆道引流（PTD）和内镜治疗方法作为一种微创选择被引入。内镜方法可能会导致未来 PTD 的适应证减少，但今天它仍然是标准的治疗方法，尤其是在肝门部梗阻。
在我们的回顾性数据分析中，我们评估了在一家三级转诊中心接受 PTD 治疗的患者 12 年来的技术成功率、再次干预率、发病率、死亡率和学习曲线。
599 例患者接受了 615 次经皮介入治疗。获得了 94.5%（566/599）的技术成功率；2.7%（16/599）的再干预率。发生了 111 例轻微并发症和 22 例严重并发症，包括 1 例死亡。在肝门周围梗阻中，与单独 PTD 相比，在 PTD 之前进行内镜逆行胰胆管造影术（ERCP）的患者中，胆管炎的发生率明显更高，分别为 39 例（18.2%）和 15 例（10.5%）。
结果，特别是出色的成功率表明，PTD 是安全有效的，它是治疗肝门狭窄治疗算法的首选。最终，我们得出结论，PTD 应在有经验的中心进行，以实现低死亡率、发病率和高成功率。
