Inaccessible Postoperative Abdominal Abscess: Percutaneous Drainage Technique with Puncture of a Sinus Tract

The present report describes percutaneous drainage involving puncture of a sinus tract in 14 patients with inaccessible postoperative abdominal abscesses. In eight patients, a sinus tract formed by a previously placed surgical drain was percutaneously punctured under ultrasound guidance. In six patients, a sinus tract was accessed under fluoroscopic guidance, aiming at an indwelling surgical drain. A drainage catheter was successfully placed into the abscesses in 13 patients (92.9%). Complete resolution of abscesses was documented on follow-up computed tomography. Percutaneous drainage with puncture of a sinus tract may be a feasible and effective treatment for inaccessible postoperative abdominal abscesses.     

CT引导下经皮穿刺引流治疗阑尾周围脓肿

目的 评价CT引导下经皮穿刺引流阑尾周围脓肿的安全性和效果. 资料与方法 38例阑尾周围脓肿患者接受CT导向下经皮穿刺引流.回顾性分析患者的临床资料、置管数目、引流量、带管时间、并发症和随访结果. 结果 对5例脓肿＜4 cm者行细针单独抽吸,另33例各经皮置入一根引流管;引流脓液25～270 ml,平均80 ml;带管6～24天,平均9天;无严重并发症发生;随访31例,2例复发给予抗生素治愈. 结论 对液化完全且局限的阑尾周围脓肿,CT引导下经皮穿刺引流安全有效.     

彩色多普勒超声引导下经皮经肝胆管引流术的临床应用价值

目的 探讨彩色多普勒超声在经皮经肝胆管穿刺置管引流术中的临床应用价值,提高经皮经肝胆管穿刺置管引流术的成功率.方法 应用彩色多普勒超声引导对46例梗阻性黄疸患者进行54人次经皮经肝胆管穿刺置管引流术,其中选择左外叶下段支胆管进针置管者34例38人次,右前叶支胆管进针置管者12例18人次,均将引流管置入患者扩张的胆管内并保留.结果 46例54人次经皮经肝胆管穿刺置管引流术成功率100%,其中1次性成功率占87%(40/46),2次性成功率占8.7%(4/46),3次性成功率占4.35%(2/46).其中选择左外叶下段支胆管穿刺置管1次性成功率达91%(31/34),右前叶支胆管1次性成功率为75%(9/12).穿刺胆管扩张范围为3～11 mm.患者临床症状均明显改善.结论 彩色多普勒超声引导下的经皮经肝胆管引流术具有穿刺置管简便、实时、安全、微创、准确率高的优点,选择左外叶下段支胆管穿刺置管成功率较右叶支高.     

Predicting Success in Percutaneous Transhepatic Biliary Drainage

Purpose

To develop a model to predict successful bilirubin decrease following percutaneous biliary drain placement.

Methods

A total of 257 patients who were identified having undergone percutaneous transhepatic biliary drain placement (PTBD) at our institution between 2002 and 2013 had their medical records and imaging reviewed. Of those, 190 of these patients met criteria and were used in the analysis. A regression model was performed on logarithm-transformed collected variables to predict post-drainage logarithmic transformed total bilirubin levels. A stepwise variable selection method based on Schwarz Bayesian Information Criterion was used to select the most closely associated variables. The model was validated with a Monte Carlo simulation. A short program was developed to calculate the point estimate using the model developed and compared to actual values.

Results

The variables that best predicted bilirubin reduction were initial Tbl (PrTbl), INR and ALT. The selected model had a root mean squared error of 0.8. The model had a negative predictive value (PoTbl is below 2 mg/dL) of 83%.

Conclusions

PTBD may not achieve decreasing bilirubin in patients with a malignant obstruction. This is an initial model that can help determine which patients may not benefit from PTBD placement. With more patients, the model’s validity can be increased and provide useful clinical determinant to aide patient care.

     

经皮肝胆道内,外引流术的临床应用

目的：总结３９例应用经皮经肝胆道内、外引流术治疗良恶性阻塞性黄疸病例的经验，探讨其临床疗效及应用价值。材料与方法：３９例均为不宜或不能外科治疗者。良性病变５例，恶性病变３４例。均采用经皮经肝胆道穿刺，３８例穿刺成功者再行阻塞段胆管开通术。２８例获得开通，其中１７例行金属内支架置入术（ＥＭＢＥ），２例行球囊导管扩张术，９例行多侧孔导管引流术。另１０例未获开通者则仅行外引流治疗。结果：各引流方式均获较     

Percutaneous Drainage of 300 Intraperitoneal Abscesses with Long-Term Follow-Up

The purpose of the study was to evaluate the efficacy of percutaneous drainage of intraperitoneal abscesses with attention to recurrence and failure rates. A retrospective analysis of percutaneous treatment of 300 intraperitoneal abscesses in 255 patients (147 male, 108 female; average age: 38 years; range: 40 days to 90 years) for whom at least 1-year follow-up data were available was performed. Abscesses were drained with fluoroscopic, sonographic, or computed tomographic guidance. Nine abscesses were drained by simple aspiration; catheter drainage either by Seldinger or trocar technique was used in the remaining 291 abscesses with 6F to 14 F catheters. Initial cure and failure rates were 68% (203/300) and 12% (36/300), respectively. Sixty-one abscesses (20%) were either palliated or temporized. The recurrence rate was 4% (12/300) and nine of them were cured by recatheterization, whereas three of them were treated by medication or surgery. The overall success and failure rates were 91% (273/300) and 9% (27/300), respectively, with temporized, palliated, and recatheterized recurred abscesses. The 30-day mortality rate was 3.1% (8/255). The mean duration of catheterization was 13 days. Intraperitoneal abscesses with safe access routes should be drained percutaneously because of high success and low morbidity, mortality, and recurrence rates.     

经皮肝胆管引流术治疗胆管恶性病变的并发症

目的:分析经皮肝穿胆管造影及引流术(PTBD)治疗恶性梗阻性黄疸(MOJ)的并发症发生率及原因,并探讨相关的预防措施。方法:复习311例PTBD治疗MOJ的病例资料,统计并发症种类及病例数,分析并发症的发生原因。结果:PTBD治疗MOJ311例,共发生各种并发症165例(53.1%),其中胆管感染46例(14.8%),引流管移位38例(12.2%),引流管堵塞31例(10%),瘘口渗漏20例(6.4%),瘘口皮肤感染18例(5.8%),胆管出血6例(1.9%),胆汁性腹膜炎2例(0.6%),胆汁引流过多2例(0.6%),肝脓肿1例(0.3%),气胸1例(0.3%)。结论:PTBD治疗MOJ具有较高的并发症发生风险,严格掌握PTBD适应证和禁忌证,及时处理引流管相关问题,可减少和控制严重PTBD并发症的发生。     

Transhepatic Placement of Metallic Biliary Stent for Internal Drainage of Persistent Liver Abscesses

Transhepatic placement of a metallic biliary stent for internal drainage of persistent liver abscesses was performed in 9 patients (males; median age, 65 years; range, 57–82 years) with refractory liver abscess. The median follow-up period was 2.8 months (range, 0.4–50.3 months). Technical success was achieved in all cases without any major complications. Clinical success, defined as the removal of the drainage tube without recurrent symptoms of infection, was achieved in 8 cases. Median duration until removal of the drainage tube from stent placement was 7 days (range, 0–36).     

Soft-Tissue-Anchored Transcutaneous Port for Long-Term Percutaneous Transhepatic Biliary Drainage

Purpose A transcutaneous port (T-port) has been developed allowing easy exchange of a catheter, which was fixed inside the device, using the Seldinger technique. The objective of the study was to test the T-port in patients who had percutaneous transhepatic biliary drainage (PTBD).Methods The T-port, made of titanium, was implanted using local anesthesia in 11 patients (mean age 65 years, range 52–85 years) with biliary duct obstruction (7 malignant and 4 benign strictures). The subcutaneous part of the T-port consisted of a flange with several perforations allowing ingrowth of connective tissue. The T-port allowed catheter sizes of 10 and 12 Fr.Results All wounds healed uneventfully and were followed by a stable period without signs of pronounced inflammation or infection. It was easy to open the port and to exchange the drainage tube. The patients quality of life was considerably improved even though several patients had problems with repeated bile leakage due to frequent recurrent obstructions of the tubes. The ports were implanted for a mean time of 9 months (range 2–21 months). Histologic examination in four cases showed that the port was well integrated into the soft tissue. Tilting of the T-port in two cases led to perforation of the skin by the subcutaneous part of the ports, which were removed after 7 and 8 months.Conclusion The T-port served as an excellent external access to the biliary ducts. The drainage tubes were well fixed within the ports. The quality of life of the patients was considerably improved. Together with improved aesthetic appearance they found it easier to conduct normal daily activities and personal care. However, the problem of recurrent catheter obstruction remained unsolved.     

经皮肝穿刺胆道引流术介入治疗恶性胆道梗阻

目的探讨经皮肝穿刺胆道引流(PTCD)术和植入支架治疗恶性胆道梗阻的疗效及其并发症。方法75例恶性胆道梗阻的患者在DSA的引导下接受经皮肝穿刺胆道引流。结果37例单纯放了内外引流管,38例放置了胆道支架,其中9例为双支架,3例术后行经肝动脉化疗和/或栓塞。减黄总有效率达85.4%。支架阻塞5例。主要并发症:败血症3例,肝功能损害6例,肝动脉假性动脉瘤2例。结论PTCD术成功率高,减黄疗效好,是姑息性治疗恶性胆道梗阻安全、简单的治疗方法。     

Potentially Life-Threatening Neck Abscesses: Therapeutic Management Under CT-Guided Drainage

Purpose To evaluate the effectiveness of CT-guided drainage of potentially life-threatening neck abscesses.Methods Between September 2001 and December 2003, 15 patients presented to the emergency room with potentially life-threatening neck abscesses. Their clinical condition was critical due to the abscess size (larger than 3 cm in diameter; mean diameter 5.2 cm, SD 0.91 cm) and/or abscess location. A CT scan was carried out immediately to assess the lesion. At the same time, under CT guidance, an 8 Fr trocar-type pigtail catheter was inserted, in order to drain the abscess. The decision to drain percutaneously was based on a consensus between the surgical, infectious disease and radiology teams .The catheter was kept in place until drainage stopped, and a follow-up scan was performed.Results In 14 (93%) patients, the abscess was completely drained, and in 1 (7%) case the collection was still present because of multiple internal septation. That patient was treated by surgical management. The catheter was in place for a mean of 3 days (SD 0.96 day).Conclusion Despite the fact that the number of our patients is small, CT-guided percutaneous drainage seems to be a fast, safe and highly effective low-cost method for the treatment of potentially life-threatening neck abscesses.     

The Usefulness of Virtual Fluoroscopic Preprocedural Planning During Percutaneous Transhepatic Biliary Drainage

CardioVascular and Interventional Radiology - To retrospectively evaluate the usefulness of virtual fluoroscopic preprocedural planning (VFPP) in the percutaneous transhepatic biliary drainage...     

Risk Factors for Immediate and Delayed-Onset Fever After Percutaneous Transhepatic Biliary Drainage

Objectives

To prospectively investigate the pre and intra-procedural risk factors for immediate (IF) and delayed-onset (DOF) fever development after percutaneous transhepatic biliary drainage (PTBD).

Methods

Institutional review board approval and informed patient consent were obtained. Between February 2013 and February 2014, 97 afebrile patients (77 at the Sapienza University of Rome, Italy and 20 at the Sun Yat-sen University of Guangzhou, China) with benign (n = 31) and malignant (n = 66) indications for a first PTBD were prospectively enrolled. Thirty pre- and intra-procedural clinical/radiological characteristics, including the amount of contrast media injected prior to PTBD placement, were collected in relation to the development of IF (within 24 h) or DOF (after 24 h). Fever was defined as ≥37.5 °C. Binary logistic regression analysis was used to assess independent associations with IF and DOF.

Results

Fourteen (14.4 %) patients developed IF and 17 (17.5 %) developed DOF. At multivariable analysis, IF was associated with pre-procedural absence of intrahepatic bile duct dilatation (OR 63.359; 95 % CI 2.658–1510.055; P = 0.010) and low INR (OR 4.7 × 10^?4; 95 % CI 0.000–0.376; P = 0.025), while DOF was associated with unsatisfactory biliary drainage at the end of PTBD (OR 4.571; 95 % CI 1.161–17.992; P = 0.030).

Conclusions

The amount of contrast injected is not associated with post-PTBD fever development. Unsatisfactory biliary drainage at the end of PTBD is associated with DOF, suggesting that complete biliary tree decompression should be pursued within the first PTBD. Patients with unsatisfactory drainage and those with the absence of pre-procedural intrahepatic bile duct dilatation, which is associated with IF, require tailored post-PTBD management.

     

CT,B超定位引导在经皮经肝穿刺胆道引流术中的应用价值

目的探讨经皮经肝穿刺胆道引流术(PTBD),应用CT、B超定位引导的价值。方法制定合理的穿刺计划后,在CT及B超引导下,在C形臂检查床上操作。结果穿刺建立引流通道148个部位,最终全部穿刺成功,其中CT定位引导下穿刺成功98个部位;CT联合B超引导成功26个部位;B超引导下成功24个部位。结论在进行PTBD操作时,合理运用CT、B超引导能明显提高成功率、减少并发症。     

Incidence of Important Hemobilia Following Transhepatic Biliary Drainage: Left-Sided Versus Right-Sided Approaches

Our purpose here is to describe our experience with important hemobilia following PTBD and to determine whether left-sided percutaneous transhepatic biliary drainage (PTBD) is associated with an increased incidence of important hemobilia compared to right-sided drainages. We reviewed 346 transhepatic biliary drainages over a four-year period and identified eight patients (2.3%) with important hemobilia requiring transcatheter embolization. The charts and radiographic files of these patients were reviewed. The side of the PTBD (left versus right), and the order of the biliary ductal branch entered (first, second, or third) were recorded. Of the 346 PTBDs, 269 were right-sided and 77 were left-sided. Of the eight cases of important hemobilia requiring transcatheter embolization, four followed right-sided and four followed left-sided PTBD, corresponding to a bleeding incidence of 1.5% (4/269) for right PTBD and 5.2% (4/77) for left PTBD. The higher incidence of hemobilia associated with left-sided PTBD approached, but did not reach the threshold of statistical significance (p = 0.077). In six of the eight patients requiring transcatheter embolization, first or second order biliary branches were accessed by catheter for PTBD. All patients with left-sided bleeding had first or proximal second order branches accessed by biliary drainage catheters. In conclusion, a higher incidence of hemobilia followed left- versus right-sided PTBD in this study, but the increased incidence did not reach statistical significance.     

Modified Surgical Drain–Guided Percutaneous Catheter Drainage of Postoperative Fluid Collection in Inaccessible Locations

PurposeTo investigate the feasibility and safety of a modified surgical drain–guided percutaneous catheter drainage technique for postoperative fluid collection in inaccessible locations.Materials and MethodsThe modified technique was used in 24 patients (age, 58.6 years ± 11.3; men, 58.3%) from September 2015 to March 2021. All fluid collections had no safe access route on preprocedural computed tomography (CT) images. Every patient had a long (>20 cm) and tortuous surgical drain, which prevented the use of conventional surgical drain exchange. A favorable midpoint of the surgical drain tract was punctured under either ultrasound or fluoroscopic guidance, and a guide wire was advanced into the fluid collection. Technical success was defined as the successful placement of a drainage catheter, and clinical success was defined as the complete evacuation of fluid collection without recurrence. Follow-up was performed using CT images and a chart review. Adverse events within 30 days of the procedure were evaluated.ResultsTarget fluid collections in the pelvic cavity (n = 9); subphrenic (n = 7), peripancreatic (n = 4), and subhepatic spaces (n = 3); and abdominal cavity (n = 1) were drained using catheters measuring 7–10.2 F in diameter and 25–30 cm in length. The technical success rate was 91.7% (22/24), and the clinical success rate was 90.9% (20/22). No procedure-related or catheter-related adverse events were observed. The median follow-up period was 8.2 months (range, 10–1,721 days).ConclusionsThe modified surgical drain–guided percutaneous catheter drainage technique is a useful alternative when conventional exchange techniques cannot be used because of long and tortuous surgical drain paths.     

超声引导下经皮经肝胆管穿刺置管引流在梗阻性黄疸病人中的应用

目的　评价超声引导下经皮经肝穿刺胆管置管引流 (UPTBD)对梗阻性黄疸病人的治疗价值。方法　对 1995年 1月至 2 0 0 2年 7月期间的 4 17例梗阻性黄疸病人进行 4 97次UPTBD治疗 ,并回顾总结他们的临床资料。结果　接受PTBD治疗共有 4 17例 (5 1例病人进行了两个胆管枝的PTBD) ,穿刺成功率达 93.2 % (4 36 / 4 6 8) ,32例首次穿刺失败的病人有 2 9例进行了第二次穿刺置管 ,全部成功。发生胆汁漏 /胆汁性腹膜炎 9例 ,胆道出血 8例 ,感染性休克 1例 ,无腹腔出血、后腹膜血肿、气胸等其他并发症。对 6 4例置管引流患者进行肝功能检测 ,与穿刺前相比 ,引流后 1周和 3周检测病人血清胆红素、转氨酶均显著下降。结论　UPTBD是一项姑息性治疗梗阻性黄疸的快捷、安全、有效的方法     

经皮肝穿刺胆汁引流术治疗恶性梗阻性黄疸临床分析

经皮经肝穿刺胆汁引流术(PTBD)是恶性梗阻性黄疸常见姑息性治疗方法[1].本院自1997-08-2007-08对78例有完整资料的恶性梗阻性黄疸患者行PTBD术,术后治疗效果满意,现总结如下.