Romualdas Riauka, Povilas Ignatavičius, Giedrius Barauskas
Introduction. Percutaneous transhepatic biliary drainage (PTBD) comes as safe and effective alternative when endoscopic biliary decompression is unavailable. However, PTBD as invasive procedure has its own risks and complications. Our aim was to evaluate the clinical outcomes and possible benefits of an ultrasound guided percutaneous transhepatic biliary drainage as the first step in the palliative treatment of malignant biliary obstruction.
Methods. Retrospective review of patients undergoing percutaneous transhepatic biliary drainage from January 2014 to December 2015 at the Department of Surgery, Hospital of the Lithuanian University of Health Sciences was performed. Patients were reviewed for demographic data, laboratory tests, complications, outcomes, hospital stay and mortality rate.
Results. During the study period ninety nine patients (median age – 68 years, (44 – 95) received 124 biliary drainage procedures for malignant obstructive jaundice. Prior the percutaneous drainage fifty eight patients (58.6%) were unsuccessfully treated by ERCP. Forty patients (40.4%) were diagnosed with periampullary tumours, thirty (30.3%) had proximal/hilar cholangiocarcinoma, and twenty nine (29.3%) had biliary obstruction due to metastatic disease. Acute cholangitis was present in fifty two (52.5%) patients. After drainage procedure total serum bilirubin decreased in eighty seven (87.9%) patients (from 293.72±131.9 μmol to 193.11±117.49 μmol, p<0.05). Reduction in Gammaglutamyl transferase and Alkaline phosphatase was observed in ninety four (94.9%) patients. Seventy patients (70.7%) underwent additional interval procedures. In 62 (88.6%) cases percutaneous transhepatic biliary stenting was performed. The mean hospital stay was 25.5±17.9 days (after percutaneous drainage – 19.9±17.3 days). Thirty four (34.3%) patients developed drainage related morbidity, with drainage catheter dislocation being most common (76.5% (n = 26). In hospital mortality rate was 27.3% (n = 27) with one drainage related death (procedure related mortality rate – 3.7%).
Conclusions. Percutaneous transhepatic biliary drainage is relatively safe and effective method to reduce malignant obstructive jaundice, when other, less invasive drainage methods are unavailable or ineffective and acts as a necessary step in further palliative treatment.
Raktiniai žodžiai: biliary obstruction, percutaneous, transhepatic, drainage.
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