Background

Complementary to percutaneous intra-abdominal drainage, percutaneous transhepatic biliary drainage (PTBD) might ameliorate healing of pancreatic fistula and biliary leakage after pancreatoduodenectomy by diversion of bile from the site of leakage. This study evaluated technical and clinical outcomes of PTBD for this indication.

Methods

All patients undergoing PTBD for leakage after pancreatoduodenectomy were retrospectively evaluated in two tertiary pancreatic centers (2014–2019). Technical success was defined as external biliary drainage. Clinical success was defined as discharge with a resolved leak, without additional surgical interventions for anastomotic leakage other than percutaneous intra-abdominal drainage.

Results

Following 822 pancreatoduodenectomies, 65 patients (8%) underwent PTBD. Indications were leakage of the pancreaticojejunostomy (n = 25; 38%), hepaticojejunostomy (n = 15; 23%) and of both (n = 25; 38%). PTBD was technically successful in 64 patients (98%) with drain revision in 40 patients (63%). Clinical success occurred in 60 patients (94%). Leakage resolved after median 33 days (IQR 21–60). PTBD related complications occurred in 23 patients (35%), including cholangitis (n = 14; 21%), hemobilia (n = 7; 11%) and PTBD related bleeding requiring re-intervention (n = 4; 6%). In hospital mortality was 3% (n = 2).

Conclusion

Although drain revisions and complications are common, PTBD is highly feasible and appears to be effective in the treatment of biliopancreatic leakage after pancreatoduodenectomy.

中文翻译：

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经皮肝穿刺胆道引流治疗胰十二指肠切除术后胆胰及胆漏

背景

作为经皮腹腔内引流术的补充，经皮经肝胆道引流术 (PTBD) 可能通过将胆汁从渗漏部位分流来改善胰十二指肠切除术后胰瘘和胆道渗漏的愈合。本研究评估了 PTBD 对该适应症的技术和临床结果。

方法

在两个三级胰腺中心（2014-2019 年）对所有接受 PTBD 的胰十二指肠切除术后渗漏患者进行了回顾性评估。技术成功被定义为胆道外引流。临床成功被定义为出院并解决了渗漏，除了经皮腹腔内引流外，没有额外的吻合口渗漏手术干预。

结果

在 822 例胰十二指肠切除术后，65 名患者 (8%) 接受了 PTBD。适应症是胰空肠造口术 (n = 25; 38%)、肝空肠造口术 (n = 15; 23%) 和两者 (n = 25; 38%) 的渗漏。64 名患者 (98%) 的 PTBD 在技术上成功，40 名患者 (63%) 进行了引流修复。60 名患者 (94%) 取得了临床成功。中位 33 天 (IQR 21-60) 后泄漏解决。23 名患者 (35%) 发生了 PTBD 相关并发症，包括胆管炎 (n = 14; 21%)、胆道出血 (n = 7; 11%) 和需要再次干预的 PTBD 相关出血 (n = 4; 6%)。住院死亡率为 3%（n = 2）。

结论

尽管引流修正和并发症很常见，但 PTBD 是高度可行的，并且似乎在胰十二指肠切除术后胆胰漏的治疗中有效。