腹水存在时经皮胆道引流的并发症发生率。,Abdominal Radiology

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腹水存在时经皮胆道引流的并发症发生率。
Abdominal Radiology ( IF 2.3 ) Pub Date : 2019-05-01 , DOI: 10.1007/s00261-019-01916-5
Viren Patel ₁ , Shaun W McLaughlin ₁ , Richard Shlansky-Goldberg ₁ , Terence Gade ₁ , Ryan Bonshock ₁ , Stephen Hunt ₁ , S William Stavropoulos ₁ , Scott O Trerotola ₁ , Michael C Soulen ₁ , Gregory Nadolski ₁

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背景技术腹水是经皮胆道引流术（PBD）的相对禁忌症，但是伴有腹水的胆道梗阻患者可能仍需进行PBD插入术。我们假设腹水会增加PBD的主要并发症发生率。材料确定了2005年1月至2016年8月之间放置的PBD（n = 491）。在EMR中回顾了PBD，INR，WBCE和围手术期并发症2周内腹部影像学检查的梗阻病因和位置，腹水的存在和分布。结果在研究期间共放置了491个PBD，其中26.2％有腹水（n = 129），而73.7％没有腹水（n = 362）。腹水分类为：肝周有41例（32％），弥漫性有82例（64％），非肝周有6例（4％）。总体，与没有腹水的患者（7.7％，P = 0.0004）相比，有腹水的患者（19％）发生重大并发症的比例明显更高。与肝周腹水（7.3％，P = 0.014）相比，弥漫性腹水与重大并发症发生率（26％）显着相关。在腹水患者中，未发现胆道梗阻或PBD的病因与主要并发症发生率之间存在关联。结论腹水患者的主要并发症发生率不仅超过SIR建议阈值10％，而且也显着高于无腹水的患者。腹水的分布对并发症发生率有显着影响，与肝周相比，弥漫性腹水与主要并发症发生率增加有关。

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Complication rates of percutaneous biliary drainage in the presence of ascites.

BACKGROUND Ascites is a relative contraindication to percutaneous biliary drainage (PBD), but patients with biliary obstruction presenting with ascites may still undergo PBD insertion. We hypothesized that ascites increases the major complication rate of PBD. MATERIALS PBDs placed between January 2005 and August 2016 were identified (n = 491). Etiology and location of obstruction, the presence, and distribution of ascites based on abdominal imaging within 2 weeks of PBD, INR, WBCE, and peri-procedural complications were reviewed in the EMR. RESULTS A total of 491 PBD were placed during the study period of which 26.2% had ascites (n = 129), and 73.7% did not have ascites (n = 362). Ascites was categorized as perihepatic in 41 patients (32%), diffuse in 82 patients (64%), and non-perihepatic in 6 patients (4%). Overall, a significantly higher rate of major complications occurred in patients with ascites (19%) compared to that in patients without ascites (7.7%, P = 0.0004). Diffuse ascites was associated with a significantly higher major complication rate (26%) when compared to perihepatic ascites (7.3%, P = 0.014). In ascites patients, no association between the etiology of biliary obstruction or laterality of the PBD and the rate of major complications was identified. CONCLUSIONS The major complication rate in patients with ascites not only exceeds SIR suggested threshold of 10% but is also significantly higher than that patients without ascites. The distribution of ascites had a significant effect on complication rate, with diffuse ascites being associated with increased major complication rates compared to those with perihepatic. These findings suggest careful consideration of patients for PBD with ascites, particularly diffuse ascites.

更新日期：2019-11-01

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