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目的:探讨经T型管及其窦道和经皮肝穿刺胆道引流治疗原位肝移植术后胆道狭窄的可行性及其疗效.方法:对252例原位肝移植术后出现胆道狭窄的26例患者分别行胆道气囊扩张术、胆道引流术和胆道支架置入术.结果:3例胆道狭窄合并胆瘘患者和3例单纯吻合口狭窄患者,经气囊扩张术和胆道引流后痊愈.6例肝内外胆管多发狭窄患者,气囊反复扩张胆道狭窄段后,5例狭窄纠正而获得痊愈;1例气囊扩张治疗后出现肝内血肿,再次行肝移植.12例肝内外胆管多发狭窄合并胆泥的患者,经反复球囊导管扩张后,10例狭窄明显减轻,黄疸缓解;1例置入胆道支架,后因支架管阻塞而再次肝移植;1例治疗后狭窄仍存在,黄疸无缓解而再次肝移植.2例T型管引流口段狭窄行经皮肝穿刺胆道引流术后,狭窄明显减轻,黄疸缓解.结论:经T型管及其窦道和经皮肝穿刺胆道引流是治疗原位肝移植术后胆道狭窄的良好方法. 相似文献
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A Comparative Study of CT Fluoroscopy Combined with Fluoroscopy Versus Fluoroscopy Alone for Percutaneous Transhepatic Biliary Drainage 总被引:1,自引:0,他引:1
Ulf Laufer Johannes Kirchner Ralph Kickuth Stephan Adams Martin Jendreck Dieter Liermann 《Cardiovascular and interventional radiology》2001,24(4):240-244
Purpose: We compared CT fluoroscopy (CTF) for the initial puncture of bile ducts with conventional fluoroscopic guidance in patients
with malignant jaundice in whom percutaneous transhepatic biliary drainage (PTBD) was planned.
Methods: Forty consecutive patients were randomized to two study groups: group A underwent PTBD under CTF and fluoroscopic guidance,
group B underwent PTBD under fluoroscopic guidance alone. CTF-guided PTBD was performed using a combination of a helical CT
scanner of the latest generation and a mobile C-arm; conventional PTBD was performed under fluoroscopic guidance in the angiographic
unit. End points of the study were the success (a puncture that enabled safe placement of a guidewire in a suitable bile duct)
and the complication rate (hemobilia, bile fistula, biliary peritonitis), the number of punctures required, the time needed
for successful puncture of a suitable bile duct, and the patient's radiation exposure.
Results: CTF-guided puncture of peripheral bile ducts suitable for PTBD was successful at the first attempt in 16 cases, under conventional
fluoroscopic guidance, in only two cases. We found a significantly different number of punctures (1.2 in group A vs 2.9 in
group B), a significantly shorter time for puncture in group A (mean 39 sec), but also a significantly higher skin exposure
dosage in group A (mean 49.5 mSv surface dosage). There was no significant difference regarding the total procedure time.
Only one complication occurred in group B (portobiliary fistula).
Conclusion: CTF-guided initial puncture of bile ducts allowed a significantly reduced number of punctures and puncture times compared
with puncture under conventional fluoroscopic guidance for placement of percutaneous transhepatic biliary drainage catheters. 相似文献
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目的探讨经胆道支架置入放射性粒子条治疗恶性胆道梗阻的疗效。
方法38例恶性胆道梗阻的患者,应用125I粒子,每个125I粒子长4.5 mm、直径0.8 mm,送入导管制备粒子条。先行经皮肝穿刺胆道引流(PTCD)术;导丝经皮通过梗阻段,先行球囊导管扩张,后行经皮胆道支架成形术;然后经支架置入8~10F胆道引流管;再将装有粒子条的导管在透视下经胆道引流管送入所需照射部位,包敷固定引流管体外部分或包埋于皮下。
结果38例中36例成功施行经皮胆道支架成形术及放射性粒子条置入术,术后患者的胆红素均降至正常或接近正常(P<0.05),未出现明显不良反应。
讨论经皮胆道支架成形术后联合放射性粒子条置入术治疗恶性胆道梗阻是一种安全有效的方法。 相似文献
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The most common and serious complication of hydatid cyst of the liver is rupture into the biliary tract causing obstructive
jaundice, cholangitis and abscess. The traditional treatment of biliary-cystic fistula is surgery and recently endoscopic
sphincterotomy. We report a case of complex heterogeneous cyst rupture into the biliary tract causing biliary obstruction
in which the obstruction and cyst were treated successfully by percutaneous transhepatic endobiliary drainage. Our case is
the second report of percutaneous transbiliary internal drainage of hydatid cyst with
rupture into the biliary duct in which the puncture and drainage were not performed through the cyst cavity. 相似文献
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Comparison of C-arm CT fluoroscopy and conventional fluoroscopy for percutaneous biliary drainage procedures 总被引:1,自引:0,他引:1
Froelich JJ Wagner HJ Ishaque N Alfke H Scherf C Klose KJ 《Journal of vascular and interventional radiology : JVIR》2000,11(4):477-482
PURPOSE: To conduct a prospective randomized evaluation of C-arm computed tomography (CT) fluoroscopy for external biliary drainage procedures in comparison with conventional fluoroscopic guidance to reduce the number of transhepatic punctures as a primary endpoint. MATERIALS AND METHODS: In 18 patients with biliary obstructions, 20 external percutaneous biliary drainage procedures were prospectively performed with use of either C-arm CT fluoroscopy or conventional fluoroscopy alone. The number of hepatic punctures, procedure time, and fluoroscopy time, were analyzed separately for both methods. RESULTS: C-arm CT fluoroscopy resulted in a reduced number of transhepatic punctures, with decreased procedure and fluoroscopy times (P < .05; t test). When compared with conventional external biliary drainage procedures, a mean of 1.8+/-1 versus 4.8+/-2.8 hepatic punctures at a fluoroscopy time of 3.4+/-1.5 versus 11.4+/-7.4 minutes was required for C-arm CT fluoroscopy, while procedure times were 11+/-3.6 versus 16.2+/-9.3 minutes. CONCLUSIONS: C-arm CT fluoroscopy is associated with decreased procedure and fluoroscopy times, while fewer transhepatic punctures are required to establish external biliary drainage. 相似文献
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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 相似文献
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Vishnu Prasad Pulappadi Deep Narayan Srivastava Kumble Seetharama Madhusudhan 《The British journal of radiology》2021,94(1120)
Hemorrhagic complications are uncommon after percutaneous transhepatic biliary drainage. The presenting features include bleeding through or around the drainage catheter, hematemesis or melena. Diagnosis requires cholangiography, CT angiography or conventional angiography. Minor venous hemorrhage is managed by catheter repositioning, clamping or upgrading to a larger bore catheter. Major vascular injuries require percutaneous or endovascular procedures like embolization or stenting. A complete knowledge of these complications will direct the interventional radiologist to take adequate precautions to reduce their incidence and necessary steps in their management. This review presents and discusses various hemorrhagic complications occurring after percutaneous transhepatic biliary drainage along with their treatment options and suggests a detailed algorithm. 相似文献
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Most references in the literature on interventional radiology of the biliary tract refer to the treatment of cancer; only occasionally are benign conditions mentioned. An updated list of useful radiosurgical instruments on the market in Italy is presented. The operating technique from the preparation of the patient to the performance of percutaneous transhepatic cholangiography (PTC), biliary drainage, transhepatic bilioplasty, percutaneous extraction and chemical cholelitholisis of biliary calculi and drainage of biliary collections is then described. A personal series is then presented. It consists of 93 patients in whom one or more of the following conditions were diagnosed: exclusively intrahepatic calculosis (3 cases), calculosis of the common bile duct (23 percutaneous treatments), empyema of the gallbladder (6 cases), suppurating cholangitis (46 cases), sclerotic or inflammatory stenosis (16 cases), biliary collections (14 cases). Results are reported and commented on. 相似文献
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Treatment of biliary leaks and fistulae by simultaneous percutaneous drainage and diversion 总被引:2,自引:1,他引:1
Jonathan P. Vaccaro Gary S. Dorfman Robert E. Lambiase 《Cardiovascular and interventional radiology》1991,14(2):109-112
Although biliary fistulae and bilomas are often adequately managed with percutaneous drainage, persistent bile duct leaks are difficult to control. The primary surgical goal in this situation is to decompress the biliary system through diversion of bile flow to facilitate healing of the defect in the bile ducts. We report 3 patients with large biliary duct defects who underwent percutaneous transhepatic cholangiography which demonstrated the site of the biliary leakage. Then, extrapolating the aforementioned surgical tenet to these patients, all 3 were successfully treated with interventional radiologic techniques: simultaneous percutaneous transhepatic biliary diversion to control biliary flow and percutaneous biloma drainage to facilitate closure of the cavity. 相似文献
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PURPOSE: To evaluate the efficacy of percutaneous transhepatic biliary drainage in the treatment of biliary leaks. MATERIALS AND METHODS: Sixteen patients with a biliary leak involving either the common bile duct (n = 12), the biliary confluence (n = 2), or a hepaticojejunal anastomosis (n = 2) were treated by means of percutaneous transhepatic biliary drainage. The biliary leak was due to severe acute necrotizing pancreatitis in six patients, while 10 patients had postoperative leak. Percutaneous transhepatic biliary drainage was performed with a 12-F catheter, with two series of side holes positioned on both sides of the extravasation to divert bile flow away from the defect. RESULTS: In 13 patients, the biliary leak healed after drainage (mean duration, 78 days). In four of these patients, a slight residual narrowing of the bile duct was treated by means of either balloon dilation (n = 2) or balloon dilation followed by insertion of a metallic stent (n = 2). All 13 patients remained cured (mean follow-up, 38 months). Two patients with severe acute necrotizing pancreatitis died of complications unrelated to the biliary leak. Vascular complications occurred in two patients, one of whom died after surgical drainage of a subcapsular hematoma. CONCLUSION: Biliary leaks can be treated successfully by means of percutaneous transhepatic biliary drainage. The procedure is particularly useful when surgical or endoscopic management has failed. 相似文献
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Percutaneous Placement of Metallic Stents in Malignant Biliary
Obstruction: One-Stage or Two-Stage Procedure? Pre-Dilate or Not? 总被引:9,自引:0,他引:9
Inal M Aksungur E Akgül E Oguz M Seydaoglu G 《Cardiovascular and interventional radiology》2003,26(1):40-45
The aim of this paper was to evaluate the necessity
of percutaneous transhepatic catheter drainage and balloon dilation
procedures performed before stent insertion. One hundred and twenty-six
patients with unresectable malignant biliary obstruction underwent
palliative therapy by means of percutaneous transhepatic placement of
183 metallic biliary endoprotheses. Forty-four (35%) patients
underwent metallic stent insertion in a one-stage procedure and 82
(65%) had undergone percutaneous transhepatic catheter drainage before
stent insertion. Balloon dilation of the stenosis before stent
placement (pre-dilation) was performed in 53 (42%) of 126 patients.
The rate of the 30-day mortality was 11%, with no procedure-related
deaths. The total rate of early complications was 29%, and 84% of
these complications were due to percutaneous transhepatic catheter
drainage and pre-dilation procedures. Percutaneous transhepatic
catheter drainage and pre-dilation had no clinical or statistically
significant effect on the patients’ survival and stent patency rate.
Percutaneous transhepatic catheter drainage and balloon dilation
increased the cost of stent placement 18% and 19%, respectively.
Palliation of malignant biliary obstruction with percutaneous
transhepatic stent insertion should be done directly, in the simplest
way, without performing percutaneous transhepatic catheter drainage and
balloon dilation before stent placement. It is more useful, safe, and
cost-effective. 相似文献
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Over the past three decades, endoscopic and percutaneous biliary drainage have become readily available in most hospital settings and these minimally invasive techniques have revolutionized the treatment of patients with biliary obstruction. In the past, treatment of biliary obstruction had required surgery under general anesthesia and an extended hospital stay. Currently, the same patient can most often be treated either endoscopically as an outpatient or during a short hospital stay after percutaneous drainage under moderate sedation. This article reviews the indications and technique of percutaneous transhepatic cholangiography and biliary drainage. 相似文献
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Percutaneous transhepatic biliary drainage under ultrasonic guidance was performed in 38 patients with obstructive jaundice due to malignancy (49 intubations). The method was used for palliation in 33 patients and for pre-operative drainage because of cholangitis in five patients. Puncture of the left lobar ducts was the method of choice (35 patients). Only in cases of poor visualisation of the left biliary ducts was right-sided drainage performed (three patients). Combined left- and right-sided drainage was necessary in nine patients. All attempts with ultrasound-guided punctures were successful. There were no complications related to the punctures. Delayed complications were cholangitis (10 patients) and bleeding (one patient). The advantages of the method compared with conventional percutaneous transhepatic biliary drainage and the advantages of the left liver lobe drainage are outlined. 相似文献
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目的 精确测定肝内扩张胆管位置.设计穿刺途径,提高经皮肝穿胆道造影术(PTC)成功率.方法 对73例恶性阻塞性黄疸患者进行PTC,其中30例采用经皮肝穿靶胆管定位方法穿刺为实验组,43例采用传统法为对照组.实验组:在CT或MRI片上,取肝内胆管扩张最明显的层面,选择外周直径合适,与预计针道走行方向呈锐角的肝内胆管分支为靶胆管,靶胆管中点作为穿刺进入点,测量穿刺进入点至背部体表的距离为h值,h值为确定穿刺层面的参考值;分别测量靶胆管两端至腹部(矢状面)正中线距离为a值和b值,(a-b)值为靶胆管体表投影区的参考值;穿刺点定在h值层面与右侧肋膈角下2个肋间隙肋骨上缘相交点,针尖对准靶胆管体表投影区进行水平穿刺.对照组:取右侧腋中线肋膈角下2个肋间隙(常为第8~10肋间隙肝脏中部)肋骨上缘为穿刺点,针尖指向胸10~胸12椎体之间进行水平穿刺,至接近椎体右缘2~6 cm处.结果 实验组穿刺次数为1~4次,共62次,每例平均2.07次,成功率为48.4%;对照组穿刺次数为1~9次,共186次,每例平均4.33次,成功率为23.1%;两组比较具有显著性差异(χ2=14.294,P<0.01).结论 经皮肝穿胆道造影术靶胆管定位穿刺准确测定可提高穿刺成功率,减少肝脏损伤等并发症,对PTC是一种有效方法. 相似文献
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B W Goodacre P Chipperfield P B Harrison 《Journal l'Association canadienne des radiologistes》1990,41(5):308-310
Hemobilia is a frequent complication of percutaneous transhepatic biliary drainage, occurring most commonly at the time of initial catheter placement. The authors report on the angiographic diagnosis and embolization of a pseudoaneurysm of the right hepatic artery in a patient with hemobilia. This occurred after 2.5 years of catheter drainage for biliary obstruction due to malignant disease. Bleeding as a complication of biliary drainage can be the result of inadvertent placement of catheter side holes in the hepatic parenchyma, iatrogenic arterioportal and arteriohepatic venous shunts and pseudoaneurysms. This case report illustrates that hemobilia, even with long-term percutaneous transhepatic biliary drainage, may be associated with a radiologically treatable, drainage-related vascular abnormality rather than simply diffuse hemorrhage from a friable tumor. 相似文献
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J S Laméris J Stoker J Dees G A Nix M Van Blankenstein J Jeekel 《Clinical radiology》1987,38(6):603-608
Non-surgical methods to treat patients with inoperable malignant biliary obstruction are endoscopic retrograde biliary drainage and ultrasound guided percutaneous transhepatic biliary drainage. During a 2 year evaluation a total of 144 patients were admitted with malignant biliary obstruction: 93 with a mid- or distal common bile duct stenosis; 51 patients with a perihilar stenosis. Endoscopic biliary drainage was performed in 123 patients and ultrasound guided percutaneous biliary drainage in 57 patients. An effect on jaundice was seen in more patients after percutaneous biliary drainage (91%) than with endoscopic biliary drainage (70%). However with the percutaneous method only 63% of patients were drained internally. The site of the stenosis seemed to be an important factor. In patients with perihilar obstruction early complications after endoscopic biliary drainage occurred in 41% of drained patients compared with 3% procedure-related and 28% catheter-related complications with ultrasound guided drainage. A major complication of the endoscopic method in perihilar disease was cholangitis due to inadequate drainage. 相似文献