Ultrasound-guided percutaneous transhepatic gallbladder or bile duct drainage in hepatobiliary diseases / 中国微创外科杂志

ABSTRACT

Objective To investigate the practical value of ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD) and percutaneous transhepatic bile duct drainage (PTBD)in the treatment of hepatobiliary diseases. Methods A total of 68 times of ultrasound-guided PTGD/PTBD were performed in 60 patients from December 2000 to December 2003, including 15 cases of acute pyogenic cholecystitis, 8 cases of acute severe cholangitis and 37 cases of malignant obstructive jaundice. Results Out of the 15 cases of acute pyogenic cholecystitis, PTGD was completed successfully in 14 cases and failed in 1 case which then required a conversion to open operation. The 37 cases of malignant obstructive jaundice had undergone 45 times of PTBD, which consisted of 42 times of successful drainage tube placement and 3 times of failure (2 cases of conversions to open operation and 1 case of quitting treatment). Out of the 37 cases, resection of bile duct carcinoma or palliative cholangiojejunostomy was conducted in 14 cases, stents were inserted into the bile ducts under radioscopy in 8 cases, and the drainage tubes were left in place permanently in 15 cases (the maximum survival time was over 2 years and the mean survival time was 9 months). Of the 8 cases of acute severe cholangitis, successful drainage was achieved in 6 cases, a conversion to open surgery was required in 1 case because of blocked drainage, and 1 patient died of the multiple organ failure (MOF). Complications included 2 cases of bile leakage, 3 cases of hemorrhage, 1 case of portal vein-bile duct fistula, and 7 cases of drainage tube dislocation or blockage. Conclusions Ultrasound-guided PTGD/PTBD is an effective alternative for bile duct drainage, with advantages of minimal invasion, simplicity and accurateness of performance, safety and fewer complications. It presents much clinical value for hepatobiliary diseases, especially acute cholecystitis.