改良经皮经肝胆管引流术治疗胆肠吻合口漏
Interventional treatment of biliodigestive anastomosis leaks with a modified percutaneous transhepatic cholangiodrainage.
机构信息
Radiology and Nuclear Medicine, Luzerner Kantonsspital Zentrumsspital, Luzern, Switzerland
Radiology and Nuclear Medicine, Luzerner Kantonsspital Zentrumsspital, Luzern, Switzerland.
出版信息
BMJ Open Gastroenterol. 2022 Feb;9(1). doi: 10.1136/bmjgast-2021-000803.
INTRODUCTION
Biliodigestive leaks are typically caused by an insufficiency at the surgical anastomosis. Biliodigestive anastomosis (BDA) insufficiencies can lead to bilomas, abscesses and vascular erosion in chronic conditions.
MATERIAL AND METHODS
We performed a retrospective analysis of the medical and radiological records of all patients with biliodigestive insufficiency who received interventional treatment between July 2015 and February 2021. Nine patients (three with unilateral drainage and six with bilateral drainage) were treated with a modified percutaneous transhepatic cholangiodrainage (PTCD). Clinical success was considered after complete resolution of the peribiliary collections, absence of bile within the surgical drains, radiological patency of the BDA (contrast medium flowing properly through the BDA and no signs of leakage) and haemodynamic stability of the patient without signs of sepsis.
RESULTS
Clinical success was achieved in all nine patients. No patients required revision surgery to repair their BDA. The mean indwelling drainage time was 34.8±16.5 days. The mean number of interventional procedures performed per patient was 6.6±2.0.
CONCLUSION
Patients who present with BDA insufficiency may benefit from interventional radiological techniques. Our modified PTCD resolved the BDA leak in all nine cases and should be considered as a valuable option for the treatment of patients with this complication. Our technique demonstrated to be feasible and effective.
介绍
胆肠吻合口漏通常是由于手术吻合口不充分引起的。胆肠吻合口(BDA)不充分可导致慢性情况下的胆汁瘤、脓肿和血管侵蚀。
材料和方法
我们对 2015 年 7 月至 2021 年 2 月期间接受介入治疗的所有胆肠吻合口不足患者的医疗和放射记录进行了回顾性分析。9 例患者(3 例单侧引流,6 例双侧引流)接受了改良经皮经肝胆管引流术(PTCD)治疗。在经皮经肝胆管引流术完全缓解、手术引流管内无胆汁、胆肠吻合口通畅(造影剂通过胆肠吻合口顺利流动且无渗漏迹象)且患者血流动力学稳定无感染迹象后,认为临床成功。
结果
9 例患者均取得临床成功。无患者需要再次手术修复胆肠吻合口。留置引流时间平均为 34.8±16.5 天。每位患者平均介入治疗次数为 6.6±2.0 次。
结论
出现胆肠吻合口不足的患者可能受益于介入放射学技术。我们的改良经皮经肝胆管引流术成功解决了所有 9 例胆肠吻合口漏的问题,应被视为治疗这种并发症的有价值的选择。我们的技术被证明是可行和有效的。