Patel Ranjan Kumar, Tripathy Taraprasad, Pattnaik Bramhadatta, Dutta Tanmay, Gupta Sunita, Nayak Hemant Kumar, Panigrahi Manas Kumar, Das Deepak, Barik Sandip Kumar, Mohakud Sudipta, Naik Suprava, Deep Bag Nerbadyswari
Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Indian J Radiol Imaging. 2025 Feb 11;35(3):411-417. doi: 10.1055/s-0044-1800877. eCollection 2025 Jul.
The aim of this study was to compare the technical difficulty and safety between right-sided percutaneous transhepatic biliary drainage (R-PTBD) and left-sided percutaneous transhepatic biliary drainage (L-PTBD) in patients with nondilated bile ducts. Forty-two patients (22 males and 20 females with a mean age of 46.2 ± 13.7 years) who received PTBD in nondilated bile ducts (from September 2021 to January 2024) were dichotomized into the R-PTBD ( = 22) and L-PTBD ( = 20) groups. The number of needle punctures, successful biliary punctures, technical success, difficulty in catheter placement, total fluoroscopic time, total procedure time, overall complications, and hemorrhagic complications were evaluated and compared between the groups. The R-PTBD group had significantly fewer needle punctures for biliary access (3.9 ± 1.3 vs. 4.3 ± 1.3; = 0.004) and a shorter procedure duration (21 ± 8.5 vs. 29.9 ± 13.2 minutes; = 0.021) than the L-PTBD group. The successful biliary puncture (20 [90.9%] vs. 15 [75%]; = 0.229) and technical success rate (20 [90.9%] vs. 14 [70%]; = 0.123) were also higher for the R-PTBD group than for the L-PTBD group, while R-PTBD required less fluoroscopic time (5.83 [3.5-8.13] vs. 8.16 [4.34-12.9] minutes; = 0.113). However, these differences did not reach statistical significance ( > 0.05). Further, difficulty during catheter placement was more frequently encountered in the L-PTBD group (02 [9%] vs. 04 [20%]; = 0.367). The overall complication and hemorrhagic complication rates were comparable between both groups. When both approaches are equally suitable for patients with nondilated bile ducts, R-PTBD may be favored over L-PTBD, given the evidence demonstrating less technical difficulty in the right-sided approach than in the left-sided approach.
本研究的目的是比较右侧经皮经肝胆道引流术（R-PTBD）和左侧经皮经肝胆道引流术（L-PTBD）在胆管未扩张患者中的技术难度和安全性。2021年9月至2024年1月期间接受胆管未扩张患者PTBD的42例患者（22例男性和20例女性，平均年龄46.2±13.7岁）被分为R-PTBD组（n = 22）和L-PTBD组（n = 20）。评估并比较两组之间的穿刺针数、胆管穿刺成功数、技术成功率、导管置入难度、总透视时间、总手术时间以及总体并发症和出血并发症情况。R-PTBD组胆管穿刺的穿刺针数明显少于L-PTBD组（3.9±1.3 vs. 4.3±1.3；P = 0.004），且手术持续时间更短（21±8.5 vs. 29.9±13.2分钟；P = 0.021）。R-PTBD组的胆管穿刺成功率（20例[90.9%] vs. 15例[75%]；P = 0.229）和技术成功率（20例[90.9%] vs. 14例[70%]；P = 0.123）也高于L-PTBD组，同时R-PTBD所需的透视时间更少（5.83[3.5 - 8.13] vs. 8.16[4.34 - 12.9]分钟；P = 0.113）。然而，这些差异未达到统计学意义（P>0.05）。此外，L-PTBD组更常遇到导管置入困难（2例[9%] vs. 4例[20%]；P = 0.367）。两组的总体并发症和出血并发症发生率相当。当两种方法对胆管未扩张患者同样适用时，鉴于有证据表明右侧入路的技术难度低于左侧入路，R-PTBD可能比L-PTBD更受青睐。
