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 p...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.展开更多
In a recent issue of the World Journal of Gastrointestinal Surgery,a meta-analysis investigated the safety and efficacy of electrocautery-enhanced lumen-apposing metal stent(ECE-LAMS)implantation for managing malignan...In a recent issue of the World Journal of Gastrointestinal Surgery,a meta-analysis investigated the safety and efficacy of electrocautery-enhanced lumen-apposing metal stent(ECE-LAMS)implantation for managing malignant biliary obstruction following failed endoscopic retrograde cholangiopancreatography.This manusc-ript endeavors to offer a comprehensive look at the progression of endoscopic ultrasound-guided biliary drainage(EUS-BD)technologies,weighing their merits and drawbacks against traditional percutaneous methods.Several meta-analyses and randomized controlled trials have compared the performance of EUS-BD and percutaneous transhepatic cholangiodrainage(PTCD).These studies revealed that the technical success rate,clinical success rate,and adverse events were similar between EUS-BD and PTCD.Nevertheless,given that most of these studies preda-te 2015,the safety and effectiveness of novel EUS-BD techniques,including ECE-LAMS,compared with those of percutaneous biliary drainage remain elusive.Further investigation is imperative to ascertain whether these novel EUS-BD techniques can safely and efficaciously replace conventional percutaneous thera-peutic approaches.展开更多
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...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.展开更多
Preoperative biliary drainage may increase the morbidity and mortality of pancreatico-duodenectomy.Studies on percutaneous transhepatic biliary drainage(PTBD)before laparoscopic pancreaticoduodenectomy(LPD),however,ar...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.展开更多
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 ultras...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.展开更多
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 ...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.展开更多
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 ...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.展开更多
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...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.展开更多
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...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.展开更多
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,endoscopi...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.展开更多
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 regardin...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.展开更多
BACKGROUND: For palliative treatment of the obstructive jaundice associated with unresectable hepatocellular carcinoma (HCC), percutaneous transhepatic biliary drainage (PTBD) or endoscopic retrograde biliary drainage...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.展开更多
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 dra...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.展开更多
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 ...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.展开更多
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...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.展开更多
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 MO...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.展开更多
文摘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.
基金Supported by the National Natural Science Foundation of China,No.82001937 and No.82330061the CAMS Initiative for Innovative Medicine,China,No.2021-I2M-1-015.
文摘In a recent issue of the World Journal of Gastrointestinal Surgery,a meta-analysis investigated the safety and efficacy of electrocautery-enhanced lumen-apposing metal stent(ECE-LAMS)implantation for managing malignant biliary obstruction following failed endoscopic retrograde cholangiopancreatography.This manusc-ript endeavors to offer a comprehensive look at the progression of endoscopic ultrasound-guided biliary drainage(EUS-BD)technologies,weighing their merits and drawbacks against traditional percutaneous methods.Several meta-analyses and randomized controlled trials have compared the performance of EUS-BD and percutaneous transhepatic cholangiodrainage(PTCD).These studies revealed that the technical success rate,clinical success rate,and adverse events were similar between EUS-BD and PTCD.Nevertheless,given that most of these studies preda-te 2015,the safety and effectiveness of novel EUS-BD techniques,including ECE-LAMS,compared with those of percutaneous biliary drainage remain elusive.Further investigation is imperative to ascertain whether these novel EUS-BD techniques can safely and efficaciously replace conventional percutaneous thera-peutic approaches.
文摘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.
文摘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.
文摘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.
基金supported by the National Science Foundation of China(31971249)
文摘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.
文摘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.
基金Financial support from the Municipal Hospital Joint Research Project of Emerging Frontier Technology(Project SHDC12014112)Shanghai City,Shen Kang Group,and medical guided technology project of Shanghai Committee of Science and Technology,China(project 14411967500).
文摘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.
文摘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.
基金Supported by National Natural Science Foundation of China, No.81072029 and No.91029721Program for New Century Excellent Talents in University,Ministry of Education of China,No. NCET-09-0160
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
基金This study was funded by National Natural Science Foundation of China (81701847 to Y.Mao)Natural Science Foundation of Hunan Province (2017JJ3497 to Y.Mao)。
文摘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.
文摘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.
