Intraductal cooling protection technique via PTCD tube versus via ENBD tube in percutaneous microwave ablation for HCC: a comparative study of the protective effect on bile duct thermal damage
10.3969/j.issn.1008-794X.2018.01.009
- VernacularTitle:经皮胆管穿刺引流与经内镜鼻胆管引流胆管冷却保护技术在肝癌微波消融中的应用对比
- Author:
Naijian GE
1
;
Jian HUANG
;
Yefa YANG
;
Shuqun SHENG
;
Xiaohe YU
;
Junjun ZHU
;
Yijun ZHANG
;
Xue LIU
;
Mengchao WU
Author Information
1. 200438上海,第二军医大学附属东方肝胆外科医院微创介入中心
- Keywords:
hepatocellular carcinoma;
microwave ablation;
biliary complication;
bile duct cooling technique
- From:
Journal of Interventional Radiology
2018;27(1):35-39
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the preventive effect on bile duct thermal damage of percutaneous transhepatic cholangial drainage (PTCD) intubation with that of endoscopic nasobiliary drainage (ENBD)intubation,through which cooling liquid is continuously infused,in treating hepatocellular carcinoma (HCC)located close to the hepatic hilum by using percutaneous microwave ablation (PMWA) therapy.Methods The clinical data of 23 patients with HCC that was located close to the hepatic hilum,who were admitted to authors' hospital during the period from September 2013 to September 2016 to receive PMWA,were retrospectively analyzed.Among the 23 patients,PTCD intubation was employed in 12 and ENBD intubation was adopted in 11,and the cooling tube was placed in the bile duct near the tumor.Through the tube 4℃ cooling saline was rapidly and continuously infused,meanwhile PMWA was carried out under the guidance of B-ultrasound.The occurrence of thermal damage of the bile duct,the cooling technique-related complications,and the recurrence of HCC were compared between PTCD ~oup and ENBD group.Results The mean follow-up time was 20 months (3.0-36.0 months),and no operation-related death occurred in all 23 patients.In each group,postoperative biloma occurred in one patient.No obvious cooling techniquerelated complications were observed in PTCD group,but in ENBD group 4 patients (36.36％) developed cooling technique-related complications,including hemorrhage after incision of duodenal papilla (n=1,9.09％) and acute pancreatitis (n=3,27.27％);the difference in the incidence of cooling technique-related complications between the two groups was statistically significant (P=0.037).No statistically significant differences in local recurrence rate,intrahepatic recurrence rate and mortality existed between the two gro ups(P=1.00,P=0.77 and P=0.61,respectively).Conclusion For the treatment of HCC located close to the hepatic hilum with radical PMWA therapy,continuous infusion of cooling liquid through PTCD intubation or ENBD intubation to prevent the thermal damage of the bile duct is clinically feasible and effective,and PTCD intubation method has less technique-related complications than ENBD intubation method.
