Interventional therapy for biliary restenosis occurring after surgical T-tube drainage : preliminary investigation
LI Zhen;Shi Bingtao;LI Ya;LI Xin;WANG Jiaxiang;HAN Xinwei;Department of Interventional Radiology,First Affiliated Hospital of Zhengzhou University;
Objective To evaluate the curative effect, safety and feasibility of interventional therapy for biliary restenosis occurring after surgical T-tube drainage. Methods The clinical data of 25 patients with biliary restenosis that occurred after surgical T-tube drainage, who were admitted to authors' hospital during the period from June 2014 to March 2016, were retrospectively analyzed. The primary diseases included bile duct carcinoma(n=6), gallbladder carcinoma(n=3), biliary stone(n=13), hepatocellular carcinoma(n=2)and gastric cancer after surgery(n=1). Abnormal junction of pancreatic duct and biliary duct was observed in4 patients. Interventional procedure via T-tube route was carried out in 22 patients, and T-tube radiography with subsequent percutaneous transhepatic cholangial drainage(PTCD) was conducted in 3 patients. Biliary balloon expansion combined with biliary drainage was performed in 21 patients, and biliary metal stent implantation was adopted in 4 patients. For patients with benign biliary stricture, the drainage tube was retained for 2-3 months before it was removed. All the patients were followed up for 3-24 months at outpatient clinic or by the telephone. The curative effect was evaluated with drainage-tube radiography.Results The interventional operation was successfully accomplished in all patients, no procedure-related complications occurred, the technical success rate was 100%. In 15 patients with benign biliary stricture,biliary plasty with balloon expansion via the T-tube fistula was conducted, then a 10.2-12 F drainage catheter was placed in the biliary tract and the T-tube was pulled out. During the follow-up period, one patient with anastomotic stricture of bile duct carcinoma died of pulmonary infection at 8 months after treatment. Of the 10 patients with malignant stricture, the biliary obstruction was located above the T-tube level in 3, and all the 3 patients received PTCD. Among the 3 patients, 2 patients had hepatocellular carcinoma complicated by biliary invasion, as the extent of the cancerous thrombus was very large, both internal drainage tube and external drainage tube had to be implanted. After jaundice regression, the two patients died of hepatic failure at one month and 2.2 months after the operation respectively. One patient with gallbladder carcinoma complicated by invasion of bile duct received implantation of biliary stent, and the patient died of tumor deterioration at 2.5 months after the procedure. In 7 patients, the biliary obstruction was located below the T-tube level. Implantation of internal drainage tube and external drainage tube via the T-tube fistula was performed in 4 patients, and implantation of metal stent was adopted in 3 patients. Among them, 2 patients with gallbladder carcinoma died of tumor deterioration at 3.8 months and 5 months after the operation respectively. In 5 patients with cholangiocarcinoma, biliary stent restenosis occurred in 2 at 3months after the treatment, and PTCD was adopted. Three patients died of tumor deterioration complicated by organ function failure at 3.6 months, 5.2 months and 9.0 months after the operation respectively. Conclusion For the treatment of biliary restenosis occurring after surgical T-tube drainage, interventional therapy is safe and feasible with reliable curative effect, it can significantly improve the life quality of patients.
【CateGory Index】： R657.4