Percutaneous Transhepatic Cholangiography, Percutaneous Biliary Drainage and Metallic Endoprotesis Applications in Malign Biliary Obstructions

Abstract

Objective:We aimed to present the effectiveness of percutaneous transhepatic cholangiography, percutaneous biliary drainage and metallic endoprotesis applications in patients with inoperable biliary obstructions. Materials and Methods: Percutaneous transhepatic cholangiographies(PTC) and percutaneous biliary drainages (PBD) were performed in 44 patients with inoperabl malignant obstructive jaundice who had been hospitalized in the radiology department of our hospital over a three years period. Six patients (13.6%) underwent external biliary drainage(EBD), 27 patients (61.4%) underwent internal-external biliary drainage(I-EBD) and metallic stents were placed in 11 patients (25%) on average 6 days (1-34 days) after I-EBD. The mean total bilirubin(TB), ALP, ALT, AST, GGT values taken before and after drainage in all patients were compared. Results: Biliary drainage was technically successful in all patients.İn the first two weeks after biliary drainage, 38 cases (86%) had a general condition improvement, weakness and itching decreased. The mean TB;19,41 ± 9,09; 9,39 ± 15,34, ALP; 701,27 ± 352,53 ; 357,48 ± 268,70, ALT; 122,45 ± 75,42; 62,91 ± 61,90, AST; 129,14 ± 84,31; 94,93 ± 118,79, GGT; 684,48 ± 428,83; 322,39 ± 253,26 values taken before and after drainage in all patients were compared and a significant decrease was found in the post-procedure values (p<0,050). In the follow-up, minor complications were observed in 10 patients (22.7%). Conclusion: It is necessary to prevent inoperable patients from entering hepato-renal failure in order to prolong life time as much as possible. PBD and stent applications significantly improves impaired liver function, allowing the patients general condition improvement. Low complication rates and quickyl improving general condition of patients without need for another surgery gradually increase the value of this radiological intervention.

Keywords

• Endoprotesis;
• Malign Obstruction;
• Percutaneous Biliary Drainage;

İnoperabl Malign Biliyer Obstrüksiyonlarda Perkütan Transhepatik Kolanjiyografi, Perkütan Biliyer Drenaj ve Metalik Endoprotez Uygulamaları

Abstract

Amaç: İnoperabl malign bilier obstrüksiyonlu hastalarda, perkütan transhepatik kolanjiyografi(PTK) sonrasında uygulanan perkütan bilier drenaj(PBD) ve metalik endoprotez uygulamalarının etkinliğini sunmayı amaçladık. Gereç ve Yöntem: Girişimsel radyoloji ünitemize 3 yıllık süre içerisinde refere edilen, malign tıkanma sarılığı olan inopere 44 hastaya, PTK sonrası PBD uygulandı. Altı olguya (%13,6) sadece eksternal bilier drenaj(EBD), 27 olguya (%61,4) sadece internal-eksternal bilier drenaj(İEBD), 11 olguya (%25) ise ortalama 6 gün (1-34 gün) sonra İEBD sonrası metalik stent uygulandı. Drenaj öncesi ve sonrası alınan ortalama total bilirubin(TB), ALP, ALT, AST, GGT değerleri karşılaştırıldı. Bulgular: Hastaların tümünde safra drenajı sağlanarak işlem başarıyla sonlandırıldı. PBD sonrası ilk 2 haftada 38 olgunun (%86) genel durumunda iyileşme, halsizlik ve kaşıntı gibi şikayetlerde azalma saptandı. Tüm hastalarda drenaj öncesi ve sonrası ortalama total bilirubin(TB); 19,41 ± 9,09; 9,39 ± 15,34, ALP; 701,27 ± 352,53 ; 357,48 ± 268,70, ALT; 122,45 ± 75,42; 62,91 ± 61,90, AST; 129,14 ± 84,31; 94,93 ± 118,79, GGT; 684,48 ± 428,83; 322,39 ± 253,26 olarak hesaplandı ve işlem sonrası değerlerde anlamlı düşüş saptandı (p<0,050). Takipte toplam 10 hastada (%22,7) minör komplikasyonlar izlendi. Sonuç: İnoperabl malign tıkanma sarılıklı hastalarda yaşamı mümkün olduğunca uzatabilmek için hastanın hepato-renal yetmezliğe girmesini önlemek gereklidir. Perkütan biliyer drenaj ve biliyer endoprotez uygulamaları, bozulmuş olan hepatik fonksiyonları büyük ölçüde düzelterek hastanın genel durumunun iyileşmesine olanak sağlamaktadır. Bir başka cerrahi müdahale gerekmeden hızlı bir şekilde hastanın genel durumunu iyileştirmesi ve düşük komplikasyon oranları bu radyolojik girişimin değerini giderek artırmaktadır.

Keywords

• Malign obstrüksiyon;
• Perkütan Biliyer Drenaj;
• Stent;

References

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