Efficacy and safety analysis of continued nursing of complications in discharged patients after percutaneous transhepatic biliary drainage

BACKGROUND Percutaneous hepatobiliary drainage(PTCD)is an effective method for the treatment of biliary obstruction and other diseases,but postoperative complications are still one of the important problems faced by patients.Continuous nursing is a comprehensive nursing model that plays an important role in postoperative recovery.The purpose of this study was to investigate the effect of continuous nursing on the incidence of complications in patients after PTCD surgery through meta-analysis and to evaluate its efficacy and safety.AIM To evaluate the effect of extended nursing on the incidence of complications in discharged patients after percutaneous transhepatic biliary drainage(PTBD).METHODS Randomized controlled studies on PTBD postdischarge extended care were identified in the CNKI,Wanfang,VIP,CBM,PubMed,Cochrane Library,Embase,Web of Science,and other databases.The quality of the included studies was evaluated using the Joanna Briggs Institute of Australia literature quality evaluation tool,and a meta-analysis of the included studies was performed with RevMan 5.4 software.RESULTS Finally,9 studies were included,with a total sample size of 854 patients(425 patients in the control group and 429 patients in the intervention group).Meta-analysis revealed that extended care effectively reduced biliary tract infection(RR:0.42,95%CI:0.30-0.57),puncture wound infection(RR:0.19,95%CI:0.06-0.65),catheter protrusion or displacement in discharged patients after PTBD(RR:0.31,95%CI:0.18-0.54),catheter blockage(RR:0.23,95%CI:0.13-0.42),skin infection around the drainage tube(RR:0.30,95%CI:0.12-0.77),and catheter-related readmissions(RR:0.34,95%CI:0.18-0.65)(P<0.05).CONCLUSION Compared with conventional discharge care,extended care can effectively reduce the occurrence of complications such as biliary tract infection,puncture wound infection,catheter prolapse or displacement,catheter blockage,skin infection around the drainage tube,and catheter-related readmission in discharged patients after PTBD.

Endoscopic ultrasound-guided biliary drainage using electrocauteryenhanced lumen-apposing metal stent for malignant biliary obstruction:A promising procedure

In this editorial,we comment on the article by Peng et al.Palliative drainage for biliary obstruction resulting from unresectable malignant lesions includes internal and external drainage.The procedures of biliary drainage are usually guided by fluoroscopy or transcutaneous ultrasound,endoscopic ultrasound(EUS),or both.Endoscopic retrograde cholangiopancreatography(ERCP)has been primarily recommended for the management of biliary obstruction,while EUS-guided biliary drainage and percutaneous transhepatic biliary drainage(PTBD)are alternative choices for cases where ERCP has failed or is impossible.PTBD is limited by shortcomings of a higher rate of adverse events,more reinterventions,and severe complications.EUS-guided biliary drainage has a lower rate of adverse events than PTBD.EUS-guided biliary drainage with electrocautery-enhanced lumen-apposing metal stent(ECE-LAMS)enables EUS-guided biliaryenteric anastomosis to be performed in a single step and does not require prior bile duct puncture or a guidewire.The present meta-analysis showed that ECELAMS has a high efficacy and safety in relieving biliary obstruction in general,although the results of LAMS depending on the site of biliary obstruction.This study has highlighted the latest advances with a larger sample-based comprehensive analysis.

Peripheral portal vein-oriented non-dilated bile duct puncture for percutaneous transhepatic biliary drainage

AIM: To evaluate the efficacy of peripheral portal vein(PV)-oriented non-dilated bile duct(BD) puncture for percutaneous transhepatic biliary drainage(PTBD).METHODS: Thirty-five patients with non-dilated BDs underwent PTBD for the management of various biliary disorders, including benign bilioenteric anastomotic stricture(n = 24), BD stricture(n = 5) associated with iatrogenic BD injury, and postoperative biliary leakage(n = 6). Under ultrasonographic guidance, percutaneous transhepatic puncture using a 21-G needle was performed along the running course of the peripheral targeted non-dilated BD(preferably B6 for right-sided approach, and B3 for left-sided approach) or along the accompanying PV when the BD was not well visualized. This technique could provide an appropriate insertion angle of less than 30° between the puncture needle and BD running course. The puncture needle was then advanced slightly beyond the accompanying PV. The needle tip was moved slightly backward while injecting a small amount of contrast agent to obtain the BD image, followed by insertion of a 0.018-inch guide wire(GW). A drainage catheter was then placed usinga two-step GW method. RESULTS: PTBD was successful in 33(94.3%) of the 35 patients with non-dilated intrahepatic BDs. A rightsided approach was performed in 25 cases, while a left-sided approach was performed in 10 cases. In 31 patients, the first PTBD attempt proved successful. Four cases required a second attempt a few days later to place a drainage catheter. PTBD was successful in two cases, but the second attempt also failed in the other two cases, probably due to poor breath-holding ability. Although most patients(n = 26) had been experiencing cholangitis with fever(including septic condition in 8 cases) before PTBD, only 5(14.3%) patients encountered PTBD procedure-related complications, such as transient hemobilia and cholangitis. No major complications such as bilioarterial fistula or portal thrombosis were observed. There was no mortality in our series.CONCLUSION: Peripheral PV-oriented BD puncture for PTBD in patients with non-dilated BDs is a safe and effective procedure for BD stricture and postoperative bile leakage.

Impact of Percutaneous Transhepatic Biliary Drainage on Clinical Outcomes of Patients with Malignant Obstructive Jaundice Undergoing Laparoscopic Pancreaticoduodenectomy

Preoperative biliary drainage may increase the morbidity and mortality of pancreatico-duodenectomy.Studies on percutaneous transhepatic biliary drainage(PTBD)before laparoscopic pancreaticoduodenectomy(LPD),however,are scarce.The aim of this study was to examine the impact of PTBD on clinical outcomes of patients with malignant obstructive jaundice undergoing LPD.Clinical data of 172 patients who had malignant obstructive jaundice and underwent LPD from 2014 to 2017 in our hospital were retrospectively analyzed.Demographics,catheterrelated complications,postoperative complications,and oncological outcormes were collected and analyzed.Propensity score matching was performed to minimize selection bias associated with the comparison of data between patients who underwent PTBD and then LPD(PTBD group),and those given LPD alone(LPD group).The results showed that,in the PTBD group relative to the LPD group,the operating time was significantly shortened(250.28±69.95 vs.278.58±86.51 min,P=0.0196),the intraopcrative blood loss was markedly reduced(271.96±403.47 vs.429.72±482.47 mL,P=0.022),and overall rates of complications(16.33%vs.36.49%,P=0.0025)including postoperative haemorrhage(2.04%vs.12.16%,P=0.0072)and delayed gastric emptying(4.08% vs.13.51%,P=0.0251)were greatly decreased.The propensity score-matched analysis,with 48 patients enrolled in each group,revealed no statistically significant differences in operating duration(262.71±68.64 vs.280.25±83.52 min,P=0.264),intraoperative blood loss(290.21±407.71 vs.373.75±422.33 mL,P=0.327)and delayed gastric emptying(4.17% vs.12.50%,P=0.1396).PTBD group had lower incidences in overall complications(22.92% vs.39.58%,P=0.0481)and postoperative haemorrhage(2.08% vs.12.50%,P=0.0497)than LPD group.In conclusion,patients with malignant obstructive jaundice may benefit from PTBD procedure before LPD in terms of perioperative outcomes.

Percutaneous transhepatic cholangiography vs endoscopic ultrasound-guided biliary drainage:A systematic review

BACKGROUND Percutaneous transhepatic cholangiography is a diagnostic and therapeutic procedure that involves inserting a needle into the biliary tree,followed by the immediate insertion of a catheter.Endoscopic ultrasound-guided biliary drainage(EUS-BD)is a novel technique that allows BD by echoendoscopy and fluoroscopy using a stent from the biliary tree to the gastrointestinal tract.AIM To compare the technical aspects and outcomes of percutaneous transhepatic BD(PTBD)and EUS-BD.METHODS Different databases,including PubMed,Embase,clinicaltrials.gov,the Cochrane library,Scopus,and Google Scholar,were searched according to the guidelines for Preferred Reporting Items for Systematic reviews and Meta-Analyses to obtain studies comparing PTBD and EUS-BD.RESULTS Among the six studies that fulfilled the inclusion criteria,PTBD patients underwent significantly more reinterventions(4.9 vs 1.3),experienced more postprocedural pain(4.1 vs 1.9),and experienced more late adverse events(53.8%vs 6.6%)than EUS-BD patients.There was a significant reduction in the total bilirubin levels in both the groups(16.4-3.3μmol/L and 17.2-3.8μmol/L for EUSBD and PTBD,respectively;P=0.002)at the 7-d follow-up.There were no significant differences observed in the complication rates between PTBD and EUSBD(3.3 vs 3.8).PTBD was associated with a higher adverse event rate than EUSBD in all the procedures,including reinterventions(80.4%vs 15.7%,respectively)and a higher index procedure(39.2%vs 18.2%,respectively).CONCLUSION The findings of this systematic review revealed that EUS-BD is linked with a higher rate of effective BD and a more manageable procedure-related adverse event profile than PTBD.These findings highlight the evidence for successful EUS-BD implementation.

Percutaneous transhepatic biliary drainage for obstructive jaundice caused by metastatic gastric cancer： efficacy and complications

Objective： The aim of our study was to evaluate the efficacy and incidence of complications of percutaneous transhepatic biliary drainage （PTBD） as palliative treatment of obstructive jaundice caused by metastatic gastric cancer. Methods： Hospital records were reviewed for 32 consecutive patients with biliary obstruction caused by metastatic gastric cancer who underwent PTBD at our institution between October 2004 and April 2010. Patients （23 males and 9 females） age ranged from 35 to 72 years. The indexes of hepatic function before PTBD and within one month after PTBD were compared. The incidence of complications and corresponding treatments were also documented. Results： The level of obstruction was defined as the distal bile duct （beyond the level of the liver hilum） in 22 patients （group 1） and the liver hilum in 10 patients （group 2）. Successful decompression of the biliary system after PTBD was defined by a total bilirubin decrease of more than 30% of the baseline value. Success rates were 100% （22/22） for group 1, 70% （7/10） for group 2, and 90.6% （29/32） for all patients. Differences in success rates between group 1 and group 2 were significant （P = 0.024）. Serum TBIL, ALT, and AST significantly decreased from （292.8 ± 179.9） μmol/L, （174.5 ± 107.4） IU/L, （159.9 ± 103.9） IU/L before PTBD to （111.5 ± 92.5） μmol/L, （58.5 ± 46.3） IU/L, （59.6 ± 48.9） IU/L, respectively within one month after PTBD （P 0.05）. Complications associated with PTBD included cholangitis in 13 patients （40.5%）, drainage tube displacement in 6 patients （18.8%）, hemobilia in 4 patients （12.5%）, tube occlusion in 2 patients （6.3%）, and pancreatitis in 1 patient （3.1%）. All complications were successfully treated with appropriate measures. Conclusion： Hepatic function can be improved by PTBD without serious complications in patients with obstructive jaundice caused by metastatic gastric cancer.

Portal vein embolization in the treatment of portal vein bleeding after percutaneous transhepatic biliary drainage: A case report and literature review

Percutaneous transhepatic biliary drainage(PTBD)is an effective treatment for benign and malignant obstructive jaundice.Major bleeding complications occur in approximately 2–3%of patients after PTBD,which can result in death.A case involving a 63-year-old male with malignant obstructive jaundice,who experienced severe bleeding after PTBD,is reported.Emergency digital subtraction angiography,celiac trunk artery and superior mesenteric artery angiography were performed;however,no signs of arterial bleeding were found.To identify etiology,portal venography was performed under ultrasound guidance and portal vein bleeding was diagnosed.Ultimately,selective portal vein embolization successfully stopped the bleeding.

Catheter tract implantation metastases associated with percutaneous biliary drainage for extrahepatic cholangiocarcinoma

AIM： To estimate the incidence of catheter tract implantation metastasis among patients undergoing percutaneous transhepatic biliary drainage （PTBD） for extrahepatic cholangiocarcinoma, and to provide data regarding the management of this unusual complication of PTBD by reviewing cases reported in the literature. METHODS： A retrospective analysis of 67 consecutive patients who underwent PTBD before the resection of extrahepatic cholangiocarcinoma was conducted. The median follow-up period after PTBD was 106 too. The English language literature （PubMed, National Library of Medicine, Bethesda, MD, USA）, from .lanuary 1966 through December 2004, was reviewed. RESULTS： Catheter tract implantation metastasis developed in three patients. The cumulative incidence of implantation metastasis reached a plateau （6%） at 20 mo after PTBD. All of the three patients with implantation metastasis died of tumor progression at 3, 9, and 20 mo after the detection of this complication. Among the 10 reported patients with catheter tract implantation metastasis from extrahepatic cholangiocarcinoma （including our three patients）, two survived for more than 5 years after the excision of isolated catheter tract metastases. CONCLUSION： Catheter tract implantation metastasis is not a rare complication following PTBD for extrahepatic cholangiocarcinoma. Although the prognosis for patients with this complication is generally poor, the excision of the catheter tract may enable survival in selected patients with isolated metastases along the catheter tract.

Biliary drainage for obstructive jaundice caused by unresectable hepatocellular carcinoma: the endoscopic versus percutaneous approach

BACKGROUND: For palliative treatment of the obstructive jaundice associated with unresectable hepatocellular carcinoma (HCC), percutaneous transhepatic biliary drainage (PTBD) or endoscopic retrograde biliary drainage (ERBD) has been performed. PTBD is preferred as an initial procedure. Little is known about the better option for patients with obstructive jaundice caused by unresectable HCC. METHODS: Sixty patients who had received ERBD or PTBD for the palliative treatment of obstructive jaundice caused by unresectable HCC between January 2006 and May 2010 were included in this retrospective study. Successful drainage, drainage patency, and the overall survival of patients were evaluated. RESULTS: Univariate analysis revealed that the overall frequency of successful drainage was higher in the ERBD group (22/29, 75.9%) than in the PTBD group (15/31, 48.4%) (P=0.029); but multivariate analysis showed marginal significance (P=0.057). The duration of drainage patency was longer in the ERBD group than in the PTBD group (82 vs 37 days, respectively, P=0.020). Regardless of what procedure was performed, the median survival time of patients who had a successful drainage was much longer than that of the patients who did not have a successful drainage (143 vs 38 days, respectively, P<0.001).CONCLUSION: Besides PTBD, ERBD may be used as the initial treatment option to improve obstructive jaundice in patients with unresectable HCC if there is a longer duration of drainage patency after a successful drainage.

Safety and efficacy of microwave ablation for periductal hepatocellular carcinoma with intraductal cooling of the central bile ducts through a percutaneous transhepatic cholangial drainage tube

Background and aims:Biliary thermal injury caused by microwave ablation(MWA)for a hepatocellular carcinoma(HCC)close to the central bile ducts always results in severe complications and leads to mortality.Some studies have demonstrated that intraductal cooling of the biliary tract with chilled saline during thermal ablation can successfully prevent these complications.In this study,we present a novel bile duct cooling technique through a percutaneous transhepatic cholangial drainage(PTCD)tube for preventing biliary thermal injury caused by MWA,and compare the feasibility and safety of the intraductal cooling technique when performed with a PTCD tube and with an endoscopic nasobiliary drainage(ENBD)tube.Methods:Participants were randomly assigned to undergo MWA of HCC with intraductal chilled saline perfusion through a PTCD tube or an ENBD tube.The main study outcomes were bile duct complications related to MWA and local tumor recurrence,p value<0.05 was considered to indicate a statistically significant difference.Results:A total of 23 patients with an HCC(23 nodules)close to a central bile duct were enrolled in this study.Of these patients,12 had a PTCD tube and 11 had an ENBD tube placed into the hepatic duct close to the lesions.There were no PTCD-and ENBD-related mortality cases.There was no complication related to the PTCD procedure;however,3 patients(27.27%)developed acute pancreatitis and 1 patient(9.09%)had hemorrhage in the ENBD group(p=0.037).One patient(8.33%)in the PTCD group had bile leakage and 2 patients(18.18%)in the ENBD group developed a biloma.Within 5 years,1 patient in the PTCD group and 2 patients in the ENBD group had local recurrence.There was no significant difference in local recurrence,nonlocal hepatic recurrence,mortality rate,or median cumulative overall survival between the 2 groups.Conclusions:The intraductal cooling technique using a PTCD tube is a feasible and effective method for preventing bile duct thermal injury caused by MWA for an HCC close to the central bile ducts.It does not increase local recurrence and may be safer than intraductal cooling through an ENBD tube.

Biliopleural fistula: A rare complication of percutaneous transhepatic gallbladder drainage

A 79-year-old previously healthy man presented with acute acalculous cholecystitis with obstruction of the biliary tract. He was successfully treated with antibiotics and percutaneous transhepatic gallbladder drainage, but returned to the hospital two days after discharge with a rare complication of this technique, biliopleural fistula. A thoracostomy tube was inserted to drain the pleural effusion, and the patient’s previous antibiotics reinstated. After two weeks of drainage and antibiotics, the fistula healed spontaneously without the need for further intervention.

PTBD联合体外辅助胆汁入肠治疗恶性梗阻性黄疸患者疗效研究

目的观察采用经皮肝穿刺胆道引流(PTBD)联合体外辅助胆汁入肠治疗恶性梗阻性黄疸患者的疗效。方法2019年9月~2022年9月我院诊治的恶性梗阻性黄疸患者100例(其中胆管细胞癌42例、胰头癌35例、胆囊癌23例),被随机分为对照组50例和观察组50例,分别采用单纯的PTBD治疗或在PTBD治疗的基础上,联合体外辅助胆汁入肠治疗。使用PUZS-600A型全自动生化分析仪检测血生化指标。结果在治疗2周后,观察组体质指数、血钠、血钾和血清白蛋白水平分别为(20.3±2.2)kg/m^(2)、(144.8±14.6)mmol/L、(4.6±0.5)mmol/L和(35.2±4.2)g/L,显著高于对照组[分别为(16.9±1.8)kg/m^(2)、(138.2±10.7)mmol/L、(4.3±0.4)mmol/L和(30.1±4.9)g/L,P<0.05];观察组血清TBIL、AST、ALT和GGT水平分别为(142.5±34.5)μmol/L、(42.7±18.6)U/L、(45.9±12.9)U/L和(215.2±74.3)U/L,显著低于对照组[分别为(172.3±36.8)μmol/L、(58.4±14.4)U/L、(62.35±17.8)U/L和(271.9±62.1)U/L,P<0.05];术后,观察组出现5例胆汁外渗、8例置管部位疼痛、1例腹泻、1例胆汁性腹膜炎,对照组出现6例胆汁外渗、11例置管部位疼痛、3例胆汁性腹膜炎,两组并发症发生率无显著性统计学差异(30.0%对40.0%,P>0.05)。结论采用PTBD联合体外辅助胆汁入肠治疗恶性梗阻性黄疸患者有利于短期改善营养状况和肝功能指标,作为姑息治疗,值得临床应用。

Successful disintegration,dissolution and drainage of intracholedochal hematoma by percutaneous transhepatic intervention

Hemobilia is a rare biliary complication of liver transplantation.The predominant cause of hemobilia is iatrogenic,and it is often associated with traumatic operations,such as percutaneous liver intervention,endoscopic retrograde cholangiopancreatography,cholecystectomy,biliary tract surgery,and liver transplantation.Percutaneous transhepatic cholangiography and liver biopsy are two major causes of hemobilia in liver transplant recipients.Hemobilia may also be caused by coagulation defects.It can form intracholedochal hematomas,causing obstructive jaundice.Herein we describe a patient with an intracholedochal hematoma resulting in significant obstructive jaundice after liver transplantation for fulminant hepatic failure.Previous studies have shown that percutaneous transhepatic manipulation is a major cause of hemobilia after liver transplantation,but in our case,percutaneous transhepatic intervention was used to relieve the biliary obstruction and dissolve the biliary clot,with a good outcome.

基于奥马哈系统构建PTBD术后带管出院患者护理敏感性结局指标

目的 构建PTBD术后带管出院患者护理敏感性结局指标体系,为改善患者护理结局提供新策略。方法 基于奥马哈问题分类与护理结局系统,应用德尔菲法对19名专家进行2轮函询,确定出三级指标体系。结果 第1轮函询问卷有效回收16/19份,第2轮有效回收16/16份。专家咨询的判断系数为0.93,熟悉程度为0.89,权威系数为0.91,一、二、三级指标的肯德尔系数Kendall’s w分别为0.262、0.231、0.199,差异有统计学意义(均P<0.05)。最终确定了PTBD术后带管出院患者护理敏感性结局指标体系,涵盖4大领域共包括一(15个)、二(24个)、三(49个)级指标条目。结论 构建的PTBD术后带管出院患者的护理敏感性结局指标体系结果可靠,可信度较高。

Comprehensive review on EUS-guided biliary drainage

Feasibility of endoscopic retrograde cholangiopancreatography(ERCP) for biliary drainage is not always applicable due to anatomical alterations or to inability to access the papilla. Percutaneous transhepatic biliary drainage has always been considered the only alternative for this indication. However,endoscopic ultrasonography-guided biliary drainage represents a valid option to replace percutaneous transhepatic biliary drainage when ERCP fails. According to the access site to the biliary tree,two kinds of approaches may be described: the intrahepatic and the extrahepatic. Endoscopic ultrasonography-guided rendezvous transpapillary drainage is performed where the second portion of the duodenum is easily reached but conventional ERCP fails. The recent introduction of self-expandable metal stents and lumen-apposing metal stents has improved this field. However,the role of the latter is still controversial. Echoendoscopic transmural biliary drainage can be challenging with potential severe adverse events. Therefore,trained endoscopists,in both ERCP and endoscopic ultrasonography are needed with surgical and radiological backup.

PTBD与EUS-BD在恶性胆道梗阻患者ERCP失败后的应用进展

恶性胆道梗阻(malignant biliary obstruction,MBO)是指因胆道内或胆道邻近部位的肿瘤病变压迫胆道引起胆汁排出受阻,因其外科手术干预率低,故选取姑息治疗为主,即实现胆道引流。内镜下逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)是实现胆道引流的标准方法,当其操作失败时,临床上多采用经皮肝穿刺胆道引流术和超声内镜引导下胆道引流术,本文将整理相关文献,对MBO患者ERCP失败后的两种胆道引流方法作一综述。

恶性胆道梗阻患者引流前后胆道微生物群改变初步研究

目的探讨恶性胆道梗阻引流前后胆道微生态改变情况,从微生态角度研究胆道梗阻与引流干预对胆汁微生物群的影响。方法2020年1月至2022年12月对32例恶性胆道梗阻患者行DSA导引下经皮穿刺置管引流术(PTCD),22 G引流针进入胆道并经造影确认位于肝内胆管内后抽取15~20 mL胆汁,经导丝植入外或内外引流管,7 d后经引流管抽取胆汁。两次胆汁样本送检培养及基因测序。收集整理患者一般资料,包括是否发生急性胆管炎及其严重程度,是否使用过抗生素进行治疗等。结果32例患者中胆管细胞癌15例,胰腺癌10例,肝细胞癌3例,肝门淋巴结转移瘤(胃肠道恶性肿瘤)4例。引流前胆汁微生物群中伯克霍尔德菌属、不动杆菌属、假单胞菌属和葡萄球菌属相对丰度高,正常胆道内其他微生物种多样性和均匀度均降低。结论正常胆道系统内存在稳定的微生物群,恶性梗阻胆道微生物群组成与之相似。引流后胆汁内肠属菌群丰度增加,原胆道微生物群落的物种丰度及多样性减少,可解释胆道引流后患者更容易发生胆道感染的临床现象。

经皮肝穿刺胆道引流术患者出院准备度评估指标的构建

目的构建经皮肝穿刺胆道引流术PTBD患者出院准备度评估指标。方法以Meleis等的转移理论为基础,通过查阅文献、半结构式访谈及小组讨论,初步形成PTBD患者出院准备度评估指标,并采用德尔菲法进行2轮专家函询,通过层次分析法确定各指标权重。结果2轮函询问卷的有效回收率均为100%,专家权威系数为0.964和0.972,肯德尔和谐系数为0.240和0.228(P<0.001),最终形成的PTBD患者出院准备度评估指标,包含4个一级指标、35个二级指标。结论构建的PTBD患者出院准备度评估指标具有较好的科学性和可靠性,可作为判断PTBD患者出院准备程度的评估工具。

经皮穿肝胆道引流(PTBD)结合经动脉灌注化疗(TAI)治疗胰头癌伴梗阻性黄疸

目的 评价经皮穿肝胆道引流（percutaneous transhepatic biliary drainage,PTBD）结合经动脉灌注化疗（transarterial infusion,TAI）治疗中晚期胰头癌伴梗阻性黄疸的临床价值。方法 回顾性收集伴有梗阻性黄疸的胰头癌患者 28例,所有患者均先行PTBD解除胆道梗阻症状,待有效引流后行经动脉灌注化疗。分析患者的临床受益反应（clinical benefit response,CBR）、支架通畅时间、生存期和并发症。结果 28例患者共行PTBD 28次,胆红素由术前（168.9±64.1） μmol/L降到术后最低（37.2±6.2） μmol/L,其中15例放置胆道支架,支架平均通畅时间为10.6个月,共接受经动脉灌注化疗 81次,所有病例均未出现Ⅲ-Ⅳ不良反应,总临床受益反应为64.3%,平均生存期7.07个月。结论 PTBD结合经动脉灌注化疗是治疗中晚期胰头癌伴梗阻性黄疸患者安全可行的办法。

梗阻性黄疸患者MRCP及肝胆断层MR检查对于PTC及PTBD指导作用的分析

目的 比较MRCP与PTC在梗阻性黄疸的诊断过程中的优缺点,探讨 MRCP对 PTC和 PTBD治疗的指导作用。方法 15例梗阻性黄疸患者分别进行MRCP和PTC检查,并行PTBD介入治疗,分析图像,对两种检查方法的定位、定性诊断的正确率和对胆道显示的情况进行比较。结果 MRCP与 PTC的定位诊断和定性诊断的正确率分别为:PTC100%和80%;MRCP 100%和93%。MRCP与 PTC相比在梗阻性黄疸患者中能够更好地显示肝内外胆道的情况。与MRCP检查同时进行的横断面和冠状断层图像可以准确显示胆道管腔以外的病变。在 MRCP指导下,PTBD介入治疗留置引流管单纯外引流6例,内外引流9例。引流效果满意,没有严重并发症发生。结论 梗阻性黄疸患者的MRCP及肝胆断层MRI检查,可以较PTC提供更多的诊断信息,并对PTBD提供有力的指导作用,减少并发症,提高手术成功率。