Journal of Korean Society of Medical Ultrasound 1999;18(1): 11-15.
Ultrasound-guided Pe rcutaneous Transhepatic Biliary Drainage: Experiences in 146 Patients.
Jai Keun Kim, Jeong Sik Yu, Ki Whang Kim, Soo Yoon Chung, Mi Gyoung Jeong, Deuk Lin Choi, Gui Hyang Kwon, Hae Kyung Lee
1Department of Diagnostic Radiology, Yonsei University College of Medicine.
2Department of Diagnostic Radiology, Sowha Children's Hospital.
3Department of Diagnostic Radiology, Soonchunhyang University College of Medicine.
  Published online: January 1, 2001.
ABSTRACT
PURPOSE: Percutaneous biliary drainage is an important technique for palliative therapy of obstructive biliary disease and diagnostic information. The purpose of this study is to review and evaluate the experiences of ultrasound-guided percutaneous transhepatic biliary drainage. MATERIALS AND METHODS: Ultrasound-guided percutaneous transhepatic biliary drainage was performed on 146 occasions in 134 patients. The causes of biliary obstruction were: benign diseases (19 cases, 14.2%) such asbile duct stones or stricture, cholangiocarcinoma (37 cases, 27.6%), pancreatic carcinoma (35 cases, 26.1%), metastasis (22 cases, 16.5%), gall bladder cancer (14 cases, 10.4%), ampulla of Vater cancer (4 cases, 3.0%), hepatocellular carcinoma (3 cases, 2.2%). Retrospectively reviewing medical records, we found out frequency of external or external/internal biliary drainages, puncture of left or right hepatic duct, and presence of bileinfection. Ultrasound-guided percutaneous transhepatic biliary drainage was compared with conventional biliary drainage of previous reports on the basis of frequency of complications. RESULTS: External (124 procedures, 84.9%) and external/internal biliary drainage (22 procedures, 15.1%) were carried out by puncture of dilated right (59.6%) or left (40.4%) intrahepatic duct. Sixty-nine complications occurred in 47 patients. Catheter related complications (33/69, 47.8%) were most common: catheter dislodgement (17/69, 24.6%), malfunction (9/69, 13.1%), leakage (7/69, 10.1%). Other minor complications such as simple fever (16/69, 23.2%), cholangitis (7/69, 10.1%), hemobilia (4/69, 5.8%), biloma (2/69, 2.9%) and wound infection (1/69, 1.5%) occurred. Major complications including sepsis (4/69, 5.8%) and bile peritonitis (2/69, 2.9%) were also noted. Puncture-related complications such as hemobilia, biloma and bile peritonitis occurred in 8 cases (5.5%). CONCLUSION: Comparing with conventional X-ray guided drainage, ultrasound-guided percutaneous transhepatic biliary drainage is a safe procedure for obstructive biliary disease by decreasing puncture-related complications such as hemobilia, biloma, bile peritonitis. Ultrasound-guided percutaneous transhepatic biliary drainage provides more effective decompression by approaching left hepatic duct
Keywords: Bile ducts; Obstruction; Bile ducts; Interventional procedure
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