Percutaneous Liver Puncture Research Articles

Different percutaneous transhepatic biliary stent placements and catheter drainage in the treatment of middle and low malignant biliary obstruction.

For cases of middle and low biliary obstruction with left and right hepatic duct dilatation, the type of approach and whether different approaches affect the difficulty of puncture operation and intraoperative and postoperative complications have not been discussed in detail. To compare the efficacy of different percutaneous transhepatic biliary stent placements and catheter drainage in treating middle and low biliary obstruction. A retrospective analysis was performed on the medical records of 424 patients with middle and low biliary obstruction who underwent percutaneous liver puncture biliary stent placement and catheter drainage at the Department of Interventional Radiology, Shaanxi Provincial People's Hospital between March 2016 and March 2022. Based on the puncture path, patients were categorized into two groups: Subxiphoid left hepatic lobe approach group (Group A, 224 cases) and right intercostal, right hepatic lobe approach group (Group B, 200 cases). Liver function improvement, postoperative biliary bleeding incidence, postoperative pain duration, and abdominal effusion leakage around the drainage tube were compared between the two groups at 3 d and 1 wk after the surgery. Patient survival time was recorded during follow-up. All 424 surgeries were successful without adverse events. Group A comprised 224 cases, and Group B had 200 cases. There was no statistically significant difference in basic data between Group A and Group B (P > 0.05). No significant difference in postoperative biliary bleeding incidence was observed between the groups (P > 0.05). The decreased rates for total bilirubin (Group A: 69.23 ± 4.50, Group B: 63.79 ± 5.65), direct bilirubin (Group A: 79.30 ± 11.19, Group B: 63.62 ± 5.64), and alkaline phosphatase (Group A: 60.51 ± 12.23, Group B: 42.68 ± 23.56) in the 1st wk after surgery were significantly faster in Group A than in Group B. The decreased rate of gamma-glutamyl transpeptidase was also significantly faster in Group A at both 3 d (Group A: 40.56 ± 10.32, Group B: 32.22 ± 5.12) and 1 wk (Group A: 73.19 ± 7.05, Group B: 58.81 ± 18.98) after surgery (P < 0.05). Group A experienced significantly less peritoneal effusion leakage around the drainage tube than Group B (P < 0.05). The patient survival rate was higher in Group A compared to Group B (P < 0.05). In treating jaundice patients with middle and low biliary obstruction, a percutaneous left liver puncture demonstrated better clinical efficacy than a percutaneous right liver puncture.

Analysis of therapeutic efficacy and treatment model of interventional treatment in hepatic hemangiomas with poor blood supply

Objective To analyze the efficacy and complications of interventional treatment in hepatic hemangiomas with poor blood supply, and to explore the mode of treatment. Methods From May 2013 to October 2016, at Tianjin Third Central Hospital, 82 patients with hepatic hemangiomas with poor blood supply were enrolled and divided into intervention group, puncture group and combination group. Conventional hepatic artery intubation was performed in intervention group, using a microcatheter to superselect to hemangioma and injecting pingyangmycin-lipiodol emulsion into the tumor of hemangioma. Patients of puncture group underwent the ultrasound-guided percutaneous liver puncture, and the pingyangmycin-lipiodol emulsion was injected into the tumor. The patients of combination group first received intervention treatment, and the pingyangmycin-lipiodol emulsion were injected again into the tumor area lacking of iodized oil deposition through percutaneous transhepatic puncture. After treatment, the complications and clinical efficacy of patients in three groups were evaluated and the reasons of patients lost to follow-up were analyzed. The analysis of variance, Chi-square test and Fisher′s exact test were performed for statistical analysis. For patients lost to follow up, intention-to-treat (ITT) analysis and per protocol (PP) analysis were used. Results Among 82 patients with hepatic hemangiomas with poor blood supply, there were 27 in intervention group, 24 in puncture group and 31 in combination group. Seven patients developed serious complications such as liver failure. At three months after the treatment, the overall efficacy of combination group (20.9%, 9/31) was higher than that of intervention group (7.4%, 2/27) and puncture group (4.2%, 1/24), and the differences were statistically significant (χ2=6.296, P=0.014; χ2=5.622, P=0.031). At six months after the treatment, the overall efficacy of combination group (ITT analysis 70.3%, 26/37; PP analysis 71.0%, 22/31) was still higher than that of intervention group (40.9%, 9/22) and puncture group (7/18), and the differences were statistically significant (ITT analysis χ2=4.929 and 4.969, PP analysis χ2=4.789 and 4.851; all P<0.05). At twelve months after the treatment, a total of 41 patients of three group were lost. Among them, the patients with ineffective treatment by clinical effect evaluation accounted for 63.4% (26/41), which was higher than those with significantly effective treatment (12.2%, 5/41) and those with effective treatment (24.4%, 10/41), and the differences were statistically significant (χ2=22.873 and 12.676, both P<0.01). Conclusions The efficacy of the interventional treatment alone for hepatic hemangiomas with poor blood supply is poor and the complications should be considered when selecting the appropriate treatment methods. Key words: Liver hemangioma; Poor blood supply type; Treatment model; Analysis of therapeutic effect; Psychological factor

A successful treatment for hepatocellular carcinoma with Osler–Rendu–Weber disease using radiofrequency ablation under laparoscopy

Hepatocellular carcinoma (HCC) can be difficult to diagnose and treat in patients with Osler-Rendu-Weber disease due to vascular malformation and regenerative nodular hyperplasia. In addition, percutaneous liver puncture should be avoided for the diagnosis and treatment as the procedure carries a high risk of bleeding. We herein report the successful treatment of HCC in a patient with Osler-Rendu-Weber disease using radiofrequency ablation (RFA) under laparoscopy. A 71-year-old man with Osler-Rendu-Weber disease was admitted to our hospital for the treatment of HCC. He also had chronic hepatitis C virus infection. The arterioportal shunts in the liver were detected by computed tomography (CT) and angiography. A tumor 20mm in size was detected as a defected-lesion in the hepatic segment IV during the portal phase by CT. RFA under laparoscopy was performed for the curative treatment for HCC, with sufficient ablation obtained. Although the blood gushed out from the needle tract at the end of the procedure, complete hemostasis was achieved promptly using coagulation forceps. The post-operative course was favorable. Thus, laparoscopic RFA is a useful treatment modality for HCC in patients with Osler-Rendu-Weber disease, as a hemostasis device can be used with direct visualization.

Comparison of the efficacy of endoscopic retrograde pancreatic angiography and percutaneous liver puncture biliary drainage metal stent implantation in the treatment of malignant obstructive jaundice

Objective To compare the clinical effect of ERCP and PTCD metal stent implantation in the treatment of malignant obstructive jaundice. Methods 42 patients who were treated successfully with ERCP biliary metal stent implantation in the treatment of malignant obstructive jaundice were selected as the ERCP group, 38 patients who were successfully treated with PTCD biliary metal stent implantation in the treatment of malignant obstructive jaundice, were selected as the PTCD group.The changes of alanine aminotransferase, aspartate aminotransferase, direct bilirubin, total bilirubin content and complications of patients were compared between two groups. Results On the third day of the ERCP group after operation, alanine aminotransferase, aspartate aminotransferase, direct bilirubin, total bilirubin levels were (203.94±12.53)U/L, (180.94±17.53)U/L, (185.63±17.53)μmol/L, (240.41±18.79)μmol/L respectively, those of the PTCD group were (230.63±13.95)U/L, (209.19±19.74)U/L, (192.52±16.93)μmol/L, (266.83±20.73)μmol/L respectively, which were significantly lower than before operation(all P<0.05). The incidence rate of complications of ERCP group was 4.76%, which was significantly lower than 23.68% of the PTCD group(χ2=6.02, P<0.05). Conclusion ERCP and PTCD biliary metal stent placement in the treatment of malignant obstructive jaundice can effectively relieve the obstruction.The incidence of complications of PTCD is slightly higher in both common complications. Key words: Enteroscheocele; Endoscopic retrograde pancreatic angiography; Percutaneous liver puncture biliary drainage; Metal stent implantation; Jaundice, obstructive, malignant

Efficiency of Abdominal Ultrasound and Computer Tomography in Diagnostic and Differential Diagnostic of Focal Liver Lesions

Summary Introduction. The liver is a parenchimal abdominal organ with wide variety of primary benign or malignant tumors as well as metastatic tumors. Aim of the study. Was to evaluate the informativity and usefulness of abdominal ultrasound (US) and computer tomography (CT) imaging results in diagnostics of focal liver lesions. Material and methods. The study was conducted in Pauls Stradins Clinical University Hospital. Retrospective analysis of 126 patients with focal liver lesions was performed in the time period of 5 years (2009 till 2014). The medical records of patients with focal liver lesions were analyzed. Primary diagnosis detected by US or CT was evaluated and compared with final morphology after surgical operation or liver biopsy. The obtained results were expressed in percent and analyzed. Sensitivity and specificity of CT scan to detect malignant hepatic lesions was estimated and expressed as percentage with 95% confidence interval. Results. A total of 126 patients with diagnosed liver lesions were included in the study. 96 patients were in the group with performed liver CT scans, with median age of 58.9 years. 30 patients were included in the group with liver US, with median age of 60.1 years. Liver biopsy under US control was performed for 95 patients, but surgical operations with liver resections for 31 patients. 86 patients had malignant liver lesions, but 40 had benign liver lesions. In the US group primary and final diagnosis agreement was in 26 (87%) cases, but diagnosis disagreement in 4 (13%) cases. Diagnosis disagreement was found in 26 (27.1%) cases in the CT group, but agreement was in 70 (72.9%) cases. Overall sensitivity of CT to detect malignant hepatic lesions was 95.2% (95%CI 86.7-98.3%) and specificity was 64.7% (95%CI 47.9-78.5%). Conclusions. CT is a good imaging method for detection of focal liver lesions. In case of unclear diagnosis, percutaneous liver puncture biopsy is recommended. It is mandatory to develop a unified CT scan and US investigation protocol to improve the quality of investigation as well as further treatment tactics.

Inflammatory pseudotumor of the liver. Importance of intraoperative pathology

Abstract Background Inflammatory pseudotumour is a rare entity, considered benign, and characterised by inflammatory cell mesenchymal proliferation. Clinical case The case is presented 70-year-old man with fever of unknown origin syndrome. He was diagnosed with liver abscesses (one segment IV, adjacent to gallbladder fundus and segment VI), who progressed slowly after antibiotic treatment. In the absence of a diagnosis, although fine needle puncture-aspiration and different imaging tests were performed, elective surgery was decided. The intra-operative histopathology reported the existence of an inflammatory pseudotumour. Conclusions Inflammatory pseudotumours are clinically classified into different types according to their aetiology, varying therapeutic management based on the same. It is very difficult to diagnose because of the absence of symptoms, blood disorders, or specific radiological findings. Definitive diagnosis often requires histopathological confirmation, in most cases by percutaneous liver puncture, but sometimes exploratory laparotomy or even performing a hepatectomy for confirmation is necessary. The natural history of inflammatory pseudotumour is its regression; thus conservative management may be used through regular checks until resolution, or can be treated with antibiotics, anti-inflammatories and even corticosteroids. Surgical resection is indicated for persistent unresolved systemic symptoms despite medical treatment, in those situations where growth is evident, with or without symptoms, when involving the hepatic hilum, and finally, in case where the possibility of malignancy cannot be ruled out.

Clinical nursing care for liver abscess patients treated by indwelling drainage tube after puncture under ultrasonic guidance

Objective To discuss the clinical nursing care for liver abscess patients treated by indwelling drainage tube after puncture under ultrasonic guidance.Methods 64 liver abscess patients with diameter of the abscess longer than 5cm were treated by indwelling drainage tube after puncture under ultrasonic guidance,clinical nursing care was performed before and after the operation.Results The recovery rate of liver abscess treated by puncture was 100％,no complication occurred.Conclusions It is feasible for the liver abscess patients to perform puncture under ultrasonic guidance,and meticulous nursing is a pivotal measure to improve cure rate. Key words: Liver abscess; Percutaneous liver puncture; Nursing care

Clinical application of drainage by placement of catheter through percutaneous liver puncture under guidance of B-mode ultrasonography for treatment of hepatic abscess

随着肠道传染病的有效控制,抗生素的不断升级换代和诊疗技术的进步,肝脓肿的病死率已下降到6%～14%[1],但仍存在进一步降低并发症发生率和病死率的问题[2].自2000年1月至2005年10月,我们采用超声引导下经皮肝穿刺置管引流治疗34例肝脓肿,取得了良好效果,现报告如下。