Yang Yao-Bo, Yan Zhao-Yong, Jiao Yang, Yang Wei-Hao, Cui Qi, Chen Si-Pan
Department of Interventional Radiology, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China.
World J Gastrointest Surg. 2023 Jul 27;15(7):1397-1404. doi: 10.4240/wjgs.v15.i7.1397.
For cases of middle and low biliary obstruction with left and right hepatic duct dilatation, the type of approach and whether different approaches affect the difficulty of puncture operation and intraoperative and postoperative complications have not been discussed in detail.
To compare the efficacy of different percutaneous transhepatic biliary stent placements and catheter drainage in treating middle and low biliary obstruction.
A retrospective analysis was performed on the medical records of 424 patients with middle and low biliary obstruction who underwent percutaneous liver puncture biliary stent placement and catheter drainage at the Department of Interventional Radiology, Shaanxi Provincial People's Hospital between March 2016 and March 2022. Based on the puncture path, patients were categorized into two groups: Subxiphoid left hepatic lobe approach group (Group A, 224 cases) and right intercostal, right hepatic lobe approach group (Group B, 200 cases). Liver function improvement, postoperative biliary bleeding incidence, postoperative pain duration, and abdominal effusion leakage around the drainage tube were compared between the two groups at 3 d and 1 wk after the surgery. Patient survival time was recorded during follow-up.
All 424 surgeries were successful without adverse events. Group A comprised 224 cases, and Group B had 200 cases. There was no statistically significant difference in basic data between Group A and Group B ( > 0.05). No significant difference in postoperative biliary bleeding incidence was observed between the groups ( > 0.05). The decreased rates for total bilirubin (Group A: 69.23 ± 4.50, Group B: 63.79 ± 5.65), direct bilirubin (Group A: 79.30 ± 11.19, Group B: 63.62 ± 5.64), and alkaline phosphatase (Group A: 60.51 ± 12.23, Group B: 42.68 ± 23.56) in the 1 wk after surgery were significantly faster in Group A than in Group B. The decreased rate of gamma-glutamyl transpeptidase was also significantly faster in Group A at both 3 d (Group A: 40.56 ± 10.32, Group B: 32.22 ± 5.12) and 1 wk (Group A: 73.19 ± 7.05, Group B: 58.81 ± 18.98) after surgery ( < 0.05). Group A experienced significantly less peritoneal effusion leakage around the drainage tube than Group B ( < 0.05). The patient survival rate was higher in Group A compared to Group B ( < 0.05).
In treating jaundice patients with middle and low biliary obstruction, a percutaneous left liver puncture demonstrated better clinical efficacy than a percutaneous right liver puncture.
对于左右肝管扩张的中低位胆管梗阻病例，治疗方式的选择以及不同方式是否会影响穿刺操作难度和术中及术后并发症，目前尚未有详细讨论。
比较不同经皮肝穿刺胆管支架置入术及导管引流术治疗中低位胆管梗阻的疗效。
回顾性分析2016年3月至2022年3月在陕西省人民医院介入放射科接受经皮肝穿刺胆管支架置入术及导管引流术的424例中低位胆管梗阻患者的病历资料。根据穿刺路径，将患者分为两组：剑突下左肝叶入路组（A组，224例）和右肋缘下右肝叶入路组（B组，200例）。比较两组患者术后3天和1周时肝功能改善情况、术后胆道出 血发生率、术后疼痛持续时间及引流管周围腹腔积液渗漏情况。随访期间记录患者生存时间。
424例手术均成功，无不良事件发生。A组224例，B组200例。A组和B组的基础资料比较，差异无统计学意义（>0.05）。两组术后胆道出 血发生率比较，差异无统计学意义（>0.05）。术后1周，A组总胆红素（A组：69.23±4.50，B组：63.79±5.65）、直接胆红素（A组：79.30±11.19，B组：63.62±5.64）及碱性磷酸酶（A组：60.51±12.（此处原文有误，推测应为23），B组：42.68±23.56）下降速度明显快于B组。术后3天（A组：40.56±10.32，B组：32.22±5.12）和1周（A组：73.19±7.05，B组：58.81±18.98）时，A组γ-谷氨酰转肽酶下降速度也明显快于B组（<0.05）。A组引流管周围腹腔积液渗漏明显少于B组（<0.05）。A组患者生存率高于B组（<0.05）。
在治疗中低位胆管梗阻黄疸患者时，经皮左肝穿刺的临床疗效优于经皮右肝穿刺。
