经皮经肝胆道引流作为内镜逆行胰胆管造影辅助手段的作用
Role of Percutaneous Transhepatic Biliary Drainage as an Adjunct to Endoscopic Retrograde Cholangiopancreatography.
作者信息
Verma Nikita, H K Hema, Gupta Pankaj, Kang Mandeep, Kalra Naveen, Samanta Jayanta, Mandavdhare Harshal, Sharma Vishal, Dutta Usha, Kochhar Rakesh, Sandhu Manavjit S
机构信息
Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
出版信息
J Clin Exp Hepatol. 2022 Mar-Apr;12(2):287-292. doi: 10.1016/j.jceh.2021.09.002. Epub 2021 Sep 10.
BACKGROUND
There is limited literature on the role of percutaneous transhepatic biliary drainage (PTBD) as an adjunct to endoscopic retrograde cholangiopancreatography (ERCP). This study evaluates the role of PTBD in patients with failed ERCP or post-ERCP cholangitis.
METHODS
Retrospective evaluation of clinical and intervention records of patients with biliary obstruction referred for PTBD following failed ERCP or post-ERCP cholangitis was performed. The cause of biliary obstruction, baseline serum bilirubin, white blood cell (WBC) count, serum creatinine, and procalcitonin were recorded. Technical success and clinical success (resolution of cholangitis, reduction in bilirubin levels, WBC count, creatinine, and procalcitonin) were assessed.
RESULTS
Sixty-three patients (35 females, mean age 51.4 years) were included. Indications for ERCP included malignant causes in 47 (74.6%) cases and benign causes in 16 (25.4%) cases. Indications for PTBD were failed ERCP in 21 (33.3%) and post-ERCP cholangitis in 42 (66.7%). PTBD was technically successful in all patients. Clinical success rate was 68.2% in the overall group. Mild hemobilia was noted in five (7.9%) patients. There were no major complications or PTBD related mortality. Cholangitis and acute kidney injury resolved following PTBD in 63.1% and 80% of the patients, respectively. Total serum bilirubin reduced by 47.8% and 69.4% after one week and one month of the PTBD, respectively. The average fall in procalcitonin was 5.17 ng/mL after one week of the PTBD.
CONCLUSION
PTBD is an important adjunctive drainage procedure in patients with ERCP failure or post-ERCP cholangitis.
背景
关于经皮经肝胆道引流术（PTBD）作为内镜逆行胰胆管造影术（ERCP）辅助手段的作用，相关文献有限。本研究评估PTBD在ERCP失败或ERCP术后胆管炎患者中的作用。
方法
对因ERCP失败或ERCP术后胆管炎而接受PTBD的胆道梗阻患者的临床和干预记录进行回顾性评估。记录胆道梗阻的原因、基线血清胆红素、白细胞（WBC）计数、血清肌酐和降钙素原。评估技术成功率和临床成功率（胆管炎消退、胆红素水平降低、WBC计数、肌酐和降钙素原降低）。
结果
纳入63例患者（35例女性，平均年龄51.4岁）。ERCP的适应证包括47例（74.6%）恶性病因和16例（25.4%）良性病因。PTBD的适应证为21例（33.3%）ERCP失败和42例（66.7%）ERCP术后胆管炎。所有患者PTBD技术均成功。总体组临床成功率为68.2%。5例（7.9%）患者出现轻度胆道出血。无重大并发症或与PTBD相关的死亡。PTBD后，63.1%和80%的患者胆管炎和急性肾损伤分别得到缓解。PTBD术后1周和1个月，总血清胆红素分别降低47.8%和69.4%。PTBD术后1周降钙素原平均下降5.17 ng/mL。
结论
PTBD是ERCP失败或ERCP术后胆管炎患者重要的辅助引流方法。
Zotero 插件