Erfahrungen mit der präoperativen und palliativen perkutanen transhepatischen Cholangiodrainage (PTCD)

Abstract

In obstructive jaundice PTCD plays an important role as a preoperative or a palliative therapeutic method inspite of the availability of biliary endoprostheses. This study was carried out to assess complications following PTCD, the effect on liver function (serum parameters) and the relationship between duration of preoperative drainage and postoperative complication rate. The results demonstrate that 11-hole pigtail-catheters are useful for intrahepatic location and 32-hole ringcatheters for extrahepatic location due to reduced dislocation rates. The effect of biliary drainage after 7 rsp. 25 days on liver function was significant (p less than 0.05). As a main complication fever episodes could be observed associated with pathologic bile-/bloodcultures in most cases; other complications were similar to those presented in the literature. A prophylactic antibiotic therapy following PTCD seems to be useful, a preoperative biliary drainage is recommended until serum bilirubin levels become constant or at least for 2 weeks.

Bacteriobilia in percutaneous transhepatic biliary drainage: occurrence over time and clinical sequelaeA prospective observational study

“…Generally, bacteriobilia does not necessarily lead to clinically significant infection (17,19,20), but it may become relevant in cases of impaired biliary flow, with increasing pressure and potential transfer of bacteria into the bloodstream (6,21). Other studies have reported variable results, with cholangitis rates ranging from 6%-7% (22,23) to 14% (24), with simple fever occurring in 14%-46% (22,24). Nevertheless, general antibiotic coverage for PTBD, especially during the initial phase of placement, is therefore not uniformly recommended, because of problems with bacterial resistance.…”

Endoluminale Strahlentherapie hochsitzender Gallenwegskarzinome

“…Die Komplikationsrate von etwa 40% infolge Cholangiitis oder Prothesenverschluß war bei beiden Patientengruppen gleich (15,20). Die genannten Zahlen stimmen mit den Angaben in der Literatur zur palliativen Gallenwegsdrainage überein (1,17,33…”