ABSTRACT
Objective To systematically review the effectiveness and safety of percutaneous transhepatic biliary drainage (PTBD) versus endoscopic biliary drainage (EBD) for preoperative biliary drainage in patients with Klatskin Tumors.Methods The Pubmed,Embase,Web of Science,CNKI,VIP and WanFang Data from January 1998 to December 2017 were searched for published studies which compared endoscopic biliary drainage (EBD) with percutaneous transhepatic biliary drainage (PTBD) for preoperative biliary drainage.A Meta-analysis was then performed using the Revman 5.3 software.Results Seven cohort studies were included.There were 366 patients in the PTBD group,and 400 patients in the EBD groups.When compared with EBD,PTBD was associated with a lower risk of cholangitis (OR=0.31,95％ CI 0.20～0.48,P＜0.05),a lower risk of pancreatitis (OR=0.11,95％ CI 0.04 ～ 0.34,P＜0.05),and a lower risk of overall complications (OR=0.48,95％ CI 0.30 ～ 0.77,P=0.002).The rate of conversion from one procedure to the other was significantly lower in the PTBD group than the EBD group.The initial technical success rate and postoperative morbidity and mortality rates were similar in the 2 groups.Conclusion In patients with Klatskin tumors who require PBD,PTBD is a better initial biliary drainage method with lower incidences of procedure-related cholangitis,pancreatitis overall complications and conversion to other drainage procedures.
ABSTRACT
Objective To analyze the clinical value of percutaneous transhepatic biliary drainage (PTBD) in the treatment of obstructive jaundice.Methods A total of 479 patients with obstructive jaundice were enrolled in PLA General Hospital from July 2015 to July 2017 underwent percutaneous transhepatic biliary drainage,the preoperative serum total bilirubin was 92 ～ 614 μmol/L,the target bile duct was 2 ～ 16 mm in diameter.The PTBD was ultrasound guided.Results All of the 479 patients underwent PTBD successfully,and 99.6％ showed evident alleviation of jaundice postoperatively.Conclusions Ultrasoundguided PTBD is an effective method for reducing jaundice for preoperative or palliative treatment in patients with obstructive jaundice.The method of operation is worthy of further study.
ABSTRACT
Preoperative biliary drainage (PBD) is an important part of preoperative management of patients with hilar cholangiocarcinoma which could reduce serum total bilirubin,remove jaundice,improve liver function,and reduce the mortality and morbidity.Although PBD is widely used in biliary surgery now,there are still several controversial issues in clinical applications about the indication of PBD,the best way of PBD,implantation metastasis of PBD and so on.With the development of medical image and surgical technology,we had a better understanding of PBD now.This review summarizes the recent scenario and current advancement about the above-mentioned controversy.
ABSTRACT
The percutaneous transhepatic biliary drainage (PTBD) is an effective intervention as a palliative therapy for relieving a jaundice and cholangitis. It may be used in place of Endoscopic retrograde cholangiopancreatography (ERCP) in the obstructive biliary disease. Recently, by developing invasive procedures, the incidence of the complications such as bleeding and perforation has been increasing in the diagnosis and treatment of hepatobiliary disease. We report here on a case of remained drawstring after PTBD in a 85-year-old man. The patient was conducted PTBD for relieving a jaundice and cholangitis. And then the patient had complained of abdominal pain constantly. A few days later, we removed PTBD and attempted ERCP for removal of CBD stone. The ERCP showed remained drawstring around ampulla of vater and we removed it by IT knife. The drawstring was successfully removed.
Subject(s)
Aged, 80 and over , Humans , Abdominal Pain , Ampulla of Vater , Cholangiopancreatography, Endoscopic Retrograde , Cholangitis , Diagnosis , Drainage , Hemorrhage , Incidence , Jaundice , Palliative CareABSTRACT
PURPOSE: One of the popular and widespread treatments for intra- & extra-hepatic duct (IEHD) stone associated gallbladder (GB) stone is laparoscopic cholecystectomy (LC) with stone removal through endoscopic retrograde cholangiopancreatography (below ERCP). Because LC with stone removal through percutaneous transhepatic biliary drainage (below PTBD) is well known for its safety and feasibility in removing IEHD stones, we did this study to see the significance (safety, feasibility, effectiveness etc) of PTBD and stone removal. METHODS: We compared the odds by collecting 71 retrospective cases, victims of IEHD stone associated GB stone from January, 2004 to December, 2007 in Chung-Ang University Hospital. Comparative analysis took place in 51 cases who underwent PTBD and 20 cases treated with ERCP. We excluded 6 patients who underwent PTBD for intra hepatic duct stone. Age, sex, American Society of Anesthesiologists score, pain, nausea, pre- and post- laboratory value, symptoms, size, location and number of stones, diameter of extra hepatic duct, recurrence and clearance rate, frequency of each procedure, complications, cost were investigated in this study. RESULTS: There were no statistical differences in each group in recurrence and clearance rate or frequency of procedure. However post-procedure pancreatitis and amylase level were significantly difference in each group. PTBD group experienced much longer hospital stay but was not significantly different. Although procedure cost is three times more expensive than that of PTBD group, there were no differences in total cost and patients' expenses between the two groups. CONCLUSION: PTBD would be an alternative solution in managing IEHD stone associated with GB stone for its lower rate of complication, higher clearance with minimal discomfort.