Kubesch Alica, Schütz Alexander, Dultz Georg, Finkelmeier Fabian, Filmann Natalie, Bojunga Jörg, Zeuzem Stefan, Friedrich-Rust Mireen, Walter Dirk
Goethe University Frankfurt, University Hospital, Medical Clinic 1, Frankfurt am Main, Germany.
Institute of Biostatistics and Mathematical Modeling, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.
Visc Med. 2025 Mar 28:1-6. doi: 10.1159/000545420.
Treating biliary obstruction remains a common clinical problem. Endoscopic retrograde cholangiopancreatography (ERCP) with stent insertion remains the gold standard. If ERCP fails, percutaneous transhepatic biliary drainage (PTBD) is one treatment option. Despite a high success rate, early- and late-onset complications occur frequently, ranging from 20 to 70%. With this study, we aimed to provide further insights on possible risk factors for PTBD-related complications.
All cases with PTBD placement at our institution over the past 13 years were retrospectively analyzed and median premature exchange rate as well as procedural-associated complications were determined.
A total of 976 PTBDs were inserted in 194 patients. In 853 cases (87%), only one PTBD was inserted. Most patients had a benign disease as an indication for the PTBD insertion ( = 558 cases, 56.9%). A premature PTBD exchange occurred in 246 cases (26%). The most common reason for a premature PTBD exchange or extraction was dislocation ( = 98/39.5%), followed by cholangitis in 70 cases (28.6%). A malignant indication (multivariate = 0.001 OR = 1.69 95% CI = 1.23-2.30), female sex (multivariate < 0.001 OR = 2.21 95% CI = 1.56-3.12), and a PTBD ≥14Fr (multivariate < 0.03 1.50 (1.04-2.11) were associated with a premature stent exchange in the mixed multivariate regression analysis.
Premature exchanges occur frequently in patients treated with PTBD. Especially in patients with malignancy, other interventional bile drainage interventions should be discussed. In case PTBD is chosen, earlier exchange rates than 12 weeks should be considered.
治疗胆道梗阻仍然是一个常见的临床问题。内镜逆行胰胆管造影术（ERCP）并置入支架仍然是金标准。如果ERCP失败，经皮经肝胆道引流术（PTBD）是一种治疗选择。尽管成功率很高，但早期和晚期并发症频繁发生，发生率在20%至70%之间。通过本研究，我们旨在进一步深入了解PTBD相关并发症的可能危险因素。
回顾性分析过去13年在我院进行PTBD置管的所有病例，并确定中位过早更换率以及与操作相关的并发症。
194例患者共置入976根PTBD。853例（87%）仅置入一根PTBD。大多数患者因良性疾病而进行PTBD置管（n = 558例，56.9%）。246例（26%）发生过早的PTBD更换。过早更换或拔除PTBD最常见的原因是移位（n = 98/39.5%），其次是胆管炎70例（28.6%）。在多因素回归分析中，恶性指征（多因素P = 0.001，OR = 1.69，95%CI = 1.23 - 2.30）、女性（多因素P < 0.001，OR = 2.21，95%CI = 1.56 - 3.12）以及PTBD≥14Fr（多因素P < 0.03，1.50（1.04 - 2.11））与过早的支架更换相关。
接受PTBD治疗的患者频繁发生过早更换。特别是对于恶性肿瘤患者，应讨论其他介入性胆汁引流干预措施。如果选择PTBD，应考虑在12周之前进行更换。
