Prevention and treatments for complications of ultrasound-guided PTCD

Abstract

Objective To explore the prevention and treatment strategies for complications of ultrasound-guided percutaneous transhepatic cholangiography and drainage (PTCD). Methods Clinical data of 75 patients undergoing ultrasound-guided PTCD from November 2014 to November 2018 in the Fifth People's Hospital of Dongguan were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 46 cases were male and 29 female, aged 33-85 years with a median age of 57 years. Primary diseases: bile duct stones (n=22), periampullary carcinoma (n=19), pancreatic head carcinoma (n=18) and hilar cholangiocarcinoma (n=16). 65 patients were classified as Child-Pugh grade A and 10 grade B. All patients were confirmed complicating with different degrees of intrahepatic bile duct dilatation by ultrasound, CT scan or MRI before operation. The incidence and prevention strategies of PTCD complications were analyzed. Results The success rate of operation was 99%(74/75). 5 patients were observed with perioperative complications, including 3 cases of hemorrhage, 1 case of biliary tract infection and 1 case of biliary leakage. 1 case of hemorrhage underwent selective hepatic arteriography and embolization, 1 case of hemorrhage was treated by hemostatics lavage via drainage tube, and 1 case of hemorrhage was healed spontaneously. 1 case of biliary tract infection and 1 biliary leakage were cured with second PTCD and antibiotics. Conclusions Hemorrhage, biliary tract infection and bile leakage are common complications of ultrasound-guided PTCD, and should be timely delivered according to the causes of incidence. Conservative treatments are effective usually. Adequate preoperative preparation, appropriate puncture path, appropriate depth of tube indwelling, proper fixation and protection of drainage tube are of significance for the prevention and treatment of PTCD complications. Key words: Drainage; Ultrasonography, interventional; Intraoperative complications; Postoperative complications