Saxena Dhananjay, Sasturkar Shridhar Vasantrao, Mukund Amar, Patidar Yashwant, Choudhury Ashok Kumar, Kilambi Ragini, Kale Pratibha
Department of HPB and Liver Transplantation Surgery, Institute of Liver and Biliary Sciences, New Delhi, India.
Department of Intervention Radiology, Institute of Liver and Biliary Sciences, New Delhi, India.
Hepatol Forum. 2024 Sep 10;5(4):198-203. doi: 10.14744/hf.2023.2023.0066. eCollection 2024.
The aim of this study was to evaluate the role of intrabiliary pressure (IBP) in the pathophysiology of extrahepatic biliary obstruction (EHBO) during percutaneous transhepatic biliary drainage (PTBD).
Adult patients with EHBO who underwent PTBD were prospectively enrolled. IBP was recorded during primary PTBD. The parameters of interest were age, gender, etiology of EHBO, baseline and post-PTBD liver function tests, duration for resolution of jaundice (decrease in total serum bilirubin ≥30% of baseline or <2 mg/dL), cholangitis, bile cultures, and serum albumin levels. The level of EHBO was divided into three types: Type 1 - secondary biliary confluence involved; Type 2 - primary biliary confluence involved; Type 3 - mid and distal common bile duct obstruction.
IBP was measured in 102 patients, and finally, 87 patients, including 52 (59.77%) females, were analyzed. The mean age of the patients was 56.1±11.6 years. The most common etiology of EHBO was carcinoma of the gallbladder in 44 (50.6%) patients. The mean IBP was 18.41±3.91 mmHg. IBP was significantly higher in Type 3 EHBO compared to Type 1 and 2 (p=0.012). A significant correlation was seen between IBP and baseline total serum bilirubin (p<0.01). There was a negative correlation between IBP and baseline serum albumin (p=0.017). In 56.3% of patients, resolution of jaundice was observed by day 3, but this was not significantly associated with IBP (p=0.19). There was no correlation between IBP and cholangitis (p=0.97) or bacterial cultures (p=0.21).
IBP was significantly associated with the type of EHBO, baseline serum bilirubin, and albumin levels. IBP could not predict cholangitis or the resolution of jaundice after PTBD.
本研究旨在评估经皮经肝胆道引流（PTBD）期间胆管内压力（IBP）在肝外胆管梗阻（EHBO）病理生理学中的作用。
前瞻性纳入接受PTBD的EHBO成年患者。在初次PTBD期间记录IBP。感兴趣的参数包括年龄、性别、EHBO的病因、PTBD前后的肝功能检查、黄疸消退时间（血清总胆红素降低≥基线的30%或<2mg/dL）、胆管炎、胆汁培养及血清白蛋白水平。EHBO的程度分为三种类型：1型 - 累及二级胆管汇合处；2型 - 累及一级胆管汇合处；3型 - 胆总管中下段梗阻。
对102例患者测量了IBP，最终分析了87例患者，其中包括52例（59.77%）女性。患者的平均年龄为56.1±11.6岁。EHBO最常见的病因是44例（50.6%）患者的胆囊癌。平均IBP为18.41±3.91mmHg。3型EHBO的IBP显著高于1型和2型（p = 0.012）。IBP与基线血清总胆红素之间存在显著相关性（p<0.01）。IBP与基线血清白蛋白之间存在负相关性（p = 0.017）。56.3%的患者在第3天观察到黄疸消退，但这与IBP无显著相关性（p = 0.19）。IBP与胆管炎（p = 0.97）或细菌培养（p = 0.21）之间无相关性。
IBP与EHBO的类型、基线血清胆红素及白蛋白水平显著相关。IBP不能预测PTBD后的胆管炎或黄疸消退情况。
