J Korean Soc Med Ultrasound.  1999 Mar;18(1):11-15.

Ultrasound-guided Pe rcutaneous Transhepatic Biliary Drainage: Experiences in 146 Patients

• Kim JK
• Yu JS
• Kim KW
• Chung SY
• Jeong MG
• Choi DL
• Kwon GH
• Lee HK

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

MeSH Terms

Ampulla of Vater
Bile
Bile Ducts
Carcinoma, Hepatocellular
Catheters
Cholangiocarcinoma
Cholangitis
Constriction, Pathologic
Decompression
Drainage*
Fever
Gallbladder Neoplasms
Hemobilia
Hepatic Duct, Common
Humans
Medical Records
Neoplasm Metastasis
Palliative Care
Peritonitis
Punctures
Retrospective Studies
Sepsis
Wound Infection