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.

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.

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

我们的学习的目的是评估胆汁的排水(PTBD ) 由变形胃的癌症作为妨碍的黄疸的辩解的治疗引起了的经皮的 transhepatic 的复杂并发症的功效和发生的目的。方法医院记录为 32 个连续病人被考察，胆汁的阻塞由变形胃的癌症引起了在我们在 2004 年 10 月和 2010 年 4 月之间的机构经历了 PTBD。病人(23 男性和 9 女性) 变老从 35 ～ 72 年。在 PTBD 前并且在在 PTBD 以后的一个月以内的肝的功能的索引被比较。复杂并发症和相应治疗的发生也被记录。结果阻塞的水平被定义为远侧的胆汁管(在肝核的水平以外) 在 22 个病人(组 1 ) 和在 10 个病人(组 2 ) 的肝核。在 PTBD 以后的胆汁的系统的成功的解压缩被超过 30% 基线价值的全部的 bilirubin 减少定义。成功率为组 1 是 100%(22/22 ) ， 70%(7/10 ) 为组 2，和 90.6%(29/32 ) 为所有病人。处于成功率在之间的差别组 1 和组 2 是重要的(P = 0.024 ) 。浆液 TBIL，中高音，和著名计算机生产厂商显著地减少了从(292.8 ????? 呒 ????????????? 慔慧獬湩 ????????????????? ″ ? 匠牵楶楶? 僚 ??? 吗？？

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.

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.

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.

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 mo. The English language literature (PubMed, National Library of Medicine, Bethesda, MD, USA), from January 1966through 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.

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.

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.

梗阻性黄疸PTCD出血并发症的危险因素

目的探讨梗阻性黄疸患者经皮肝穿刺胆道置管引流术(percutaneous transhepatic cholangial drainage,PTCD)出血并发症相关的影响因素。方法收集贵州医科大学附属医院、中南大学湘雅二医院、贵州医科大学附属肿瘤医院2015年1月至2021年1月,接受PTCD资料完整的1042例梗阻性黄疸患者的临床资料,并对PTCD出血并发症相关的危险因素进行回顾性分析。结果引流管成襻位置对PTCD出血并发症有影响,差异有统计学意义(P<0.01),与总胆管成襻位置相比,左右肝管成襻术后出血风险增加155.6%(OR=2.556,95%CI:1.251~5.225),左右肝管下一级分支成襻术后出血增加414.4%(OR=5.144,95%CI:2.618~10.106)。穿刺成功后引流方式选择差异有统计学意义(P<0.05),与外引流方式相比,内外共同引流方式增加术后出血风险159.1%(OR=2.591,95%CI:1.102~6.091)。术前血小板计数与术前总胆红素水平为PTCD出血并发症的独立危险因素(P<0.05);术前血小板计数每增加1个单位,术后出血并发症的发生的概率减少0.2%(OR=0.998,95%CI:0.995~1.000),且术前血小板计数<228×109/L时,对术后出血产生影响;术前总胆红素每增加1个单位,术后出血并发症的发生概率增加0.3%(OR=1.003,95%CI:1.001~1.004),且术前总胆红素>264.4μmol/L时,对术后出血产生影响。结论PTCD引流管成襻位置及引流方式是PTCD出血并发症的独立危险因素,成襻位置越靠近三级分支,出血风险越大;内外引流方式的出血风险高于外引流方式。术前总胆红素、术前血小板计数是PTCD出血并发症的独立危险因素;术前总胆红素水平与出血风险呈正相关;术前血小板计数水平与出血风险呈负相关。

Prediction of effective percutaneous transhepatic biliary drainage in patients with hepatocellular carcinoma: A multi-central retrospective study

Background and aim:Percutaneous transhepatic biliary drainage(PTBD)does not always lead to a reduction in serum total bilirubin(TBil)level in patients with hepatocellular carcinoma and obstructive jaundice.We aimed to develop a model for pre-PTBD prediction of post-procedural TBil decrease in these patients.Materials and methods:Retrospective database searches were conducted at four teaching hospitals(reference period:January 2010 to December 2018),and baseline characteristics of eligible patients were extracted.Any decrease in TBil after PTBD and the lowest level of TBil post-PTBD<5 mg/dL,3 mg/dL,and 2 mg/dL were each taken as the standard of effectiveness for computation of its own predictive nomogram.For data dimension decrease and feature selection,the least absolute shrinkage and selection operator(LASSO)regression model was used.A multivariable logistic regression analysis was used to develop nomograms.Each nomogram's performance was internally evaluated for its calibration,discriminative ability,and clinical usefulness.Results:Included in the study were 138 patients.The model for end-stage liver disease(MELD)score,platelet count,and portal vein thrombosis(PVT)were predictors in the nomogram for any decrease in TBil;international normalized ratio(INR),MELD score,platelet count,and PVT were predictors for a decrease to<5 mg/dL;MELD score,cholinesterase level(CHE),platelet count,and PVT were predictors for a decrease to<3 mg/dL;and MELD score,CHE,platelet count,and pre-albumin level were predictors for a decrease to<2 mg/dL.The clinical value of the nomograms was proven by decision curve analysis.Conclusions:These models may help inform clinical decision making for performing PTBD procedures.

Change and significance of T-cell subsets and TNF-α in patients with advanced malignant obstructive jaundice treated by percutaneous transhepatic biliary external and internal drainage

The aim of this article was to study the influence of immunity function of advanced malignant obstructive jaundice(MOJ)treated by percutaneous transhepatic biliary external and internal drainage.Ninety-six cases of MOJ were divided into two groups according to the different ways of biliary drainage.Fifty-two external drainage tubes were placed in 41 cases of percutaneous transhepatic biliary exter-nal drainage group and 66 metal stents were placed in 55 cases of percutaneous transhepatic biliary internal drainage group.Liver function,serum TNF-α and cellular function were examined one day before operation and one week after operation and liver function was re-examined two weeks after operation,in order to observe the change and analyze the association among them and compare with the control group.All patients’conditions were improved after operation.In the percutaneous transhepatic biliary external and internal drainage groups,the total level of bilirubin decreased from(343.54±105.56)μmol/L and(321.19±110.50)μmol/L to(290.56±103.46)μmol/L and(283.72±104.95)μmol/L after operation respectively,which were significantly lower than pre-operation(P<0.05),but there was no significant difference between the two groups(P>0.05).Serum alanine aminotransferase(ALT)of all patients one week after opera-tion was significantly lower than that before operation.TNF-a in percutaneous transhepatic biliary external and internal groups decreased from(108.58±19.95)pg/mL,(109.98±16.24)pg/mL of pre-operation to(104.32±19.59)pg/mL,(83.92±13.43)pg/mL of post-operation respectively,there was notable improvement(P<0.01)in internal drainage group after operation.Patients’serum CD4,CD3 and CD4/CD8 were notably increased,but CD8 was notably decreased(P<0.05).There was no difference in external drainage group(P>0.05).There was a significant difference between the two groups.Serum TNF-α and ALT had positive correlation.Percutaneous transhepatic biliary internal or external drain-age was an effective and important method to treat MOJ.Patients’immune function was weak when they suffered MOJ,but body’s cellular immune function can be notably improved after internal biliary drainage.

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.

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。

经皮穿肝胆道引流术(PTCD)辅助支架置放治疗胆管和十二指肠恶性梗阻

目的总结采用经皮穿肝胆道引流术(percutaneous transhepatic cholangial drainage,PTCD)及经PTCD途径逆行建立输送通道置放十二指肠支架治疗胰头癌、十二指肠乳头癌伴发胆道梗阻及十二指肠梗阻的体会,评价该方法的可行性和有效性。方法 3例高龄女性患者,年龄88～92岁,CT、MRI或胃镜检查诊断为胰头癌胆道梗阻2例,十二指肠乳头癌1例。3例患者均接受了PTCD术,其中2例患者在胆道内置放金属内支架,1例患者置放外引流导管。3例患者均在PTCD术后2.5～4个月出现十二指肠道梗阻。经PTCD途径逆行插入导丝,再经食管从口腔拉出,用作辅助导丝,在辅助导丝支撑下建立输送通道,通过支架输送系统置放支架。结果 3例患者支架置入后能进流质或半流质饮食。3例患者分别随访29、28、7个月,支架通畅,患者全身状况好。结论联合采用PTCD及经PTCD途径逆行建立输送通道置放十二指肠支架治疗低位十二指肠梗阻方法可行,疗效确切。

经PTCD途径胆道金属支架置入术治疗恶性梗阻性黄疸137例临床疗效分析

目的探讨经皮经肝胆道引流(PTCD)后置入胆道金属支架姑息性治疗恶性梗阻性黄疸的临床应用价值。方法对137例失去根治性手术机会或不愿行手术治疗的恶性梗阻性黄疸患者,在超声引下行PTCD,术后1周在DSA下经PTCD窦道置入胆道金属支架,经此途径将体外引流转换为内引流。结果 137例患者术前血清总胆红素水平为(274.7±151.5)μmol/L,术后1周血清总胆红素下降到(150.1±100.6)μmol/L(P<0.01),肝功能明显改善(P<0.01),术后平均生存时间为(9.29±0.77)个月。结论经PTCD途径胆道金属支架置入术是一种治疗恶性梗阻性黄疸的有效方法,可明显延长患者生存时间、改善生活质量,具有安全、简便、创伤小、可重复等优点。