[Interventional management of severe complications after percutaneous transhepatic cholangic drainage and percutaneous implantation of biliary stents].

ABSTRACT

OBJECTIVE: To evaluate the efficacy of interventional management in treatment of severe complications after percutaneous transhepatic cholangiography and percutaneous implantation of biliary stents. METHODS: Percutaneous biliary drainage and implantation of biliary stents for malignant biliary obstruction under fluoroscopic guidance was performed in 113 patients. Thirteen of them developed severe complications drainage catheter slipping and locating between liver and abdominal in 4 cases, bowl obstruction due to lower implantation or slipping of stent into the duodenum in 4 cases, and plenty of bloody drainage in 5 cases. RESULTS: For the 4 cases of drainage catheter slipping, under guidance of CT scan (2 cases) or DSA fluoroscopy (2 cases), 21G needle was used to puncture the drainage catheter left in biliary tract in order to fix the catheter so as to avoid its continuous slipping. Then curved catheter located between the abdominal wall and liver could be pulled straight and then advanced into the biliary tract again with the help of a guide wire. For the complication of bowl obstruction in 4 cases, stent was captured and pulled out through oral cavity and then a new stent was implanted back with the help of endoscopy in 3 cases. One patient refused to accept re-implantation of stent and had to undergo nasobiliary drainage. Complication of bloody drainage was successfully overcome by embolizing the bleeding blood vessel or implanting covered stent in the site of fistula caused by puncture in 5 cases. CONCLUSION: Active attitude and methods should be adopted to cope with severe complications after percutaneous transhepatic biliary drainage and percutaneous implantation of biliary stents for better prognosis.