Banerjee B, Harshfield D L, Teplick S K
Department of Medicine, University of Arkansas for Medical Sciences, Little Rock.
J Vasc Interv Radiol. 1994 Nov-Dec;5(6):895-8. doi: 10.1016/s1051-0443(94)71633-x.
Extrahepatic biliary obstruction can be managed endoscopically or percutaneously. When endoscopic therapy fails, percutaneous drainage with or without endoscopic assistance may be performed. However, transhepatic drainage may itself be unsuccessful. In such patients, a transcholecystic approach combined with endoscopic therapy was used to achieve biliary drainage.
After attempts at transhepatic biliary drainage failed, a percutaneous cholecystostomy was performed in four patients, with subsequent cannulation of the common bile duct, endoprosthesis insertion, or papillotomy.
The success rate was 100%, with no major complication or procedure-related mortality. Slight bleeding from a sphincterotomy was the only minor complication.
When percutaneous transhepatic access to the bile duct fails, the transcholecystic route can be safely used with care to successfully achieve biliary drainage.
肝外胆管梗阻可通过内镜或经皮途径进行处理。当内镜治疗失败时，可进行有或无内镜辅助的经皮引流。然而，经肝引流本身可能不成功。在此类患者中，采用经胆囊途径联合内镜治疗以实现胆管引流。
在经肝胆管引流尝试失败后，对4例患者进行了经皮胆囊造瘘术，随后进行胆总管插管、内置支架置入或乳头切开术。
成功率为100%，无重大并发症或与手术相关的死亡。括约肌切开术后轻微出血是唯一的轻微并发症。
当经皮经肝进入胆管失败时，经胆囊途径可谨慎安全地使用，以成功实现胆管引流。
