Perkütan Biliyer Girişimler: Perkütan Transhepatik Kolanjiyografi, Drenaj ve Stentleme
Özet
Bu bölümde perkütan transhepatik kolanjiyografi, biliyer drenaj ve stentleme işlemleri güncel girişimsel radyoloji pratiği çerçevesinde ele alınmaktadır. Bölüm; endikasyonlar, kontrendikasyonlar, hasta hazırlığı ve işlem öncesi görüntülemenin güvenli ve etkili tedavi planlamasındaki rolünü ayrıntılı biçimde özetlemektedir. Ultrasonografi ve floroskopi kılavuzluğunda giriş teknikleri, kılavuz tel ve kateter kullanımı, drenaj stratejileri, biyopsi uygulamaları ve stent yerleştirme basamakları pratik ve sistematik bir yaklaşımla sunulmaktadır. Malign ve benign biliyer obstrüksiyonlar, biliyer kaçaklar, anastomotik darlıklar ve kompleks hiler lezyonların yönetimi özellikle vurgulanmaktadır. Ayrıca işlem güvenliği, radyasyon dozu, işlem sonrası izlem ve komplikasyon yönetimi, kanıta dayalı öneriler ve CIRSE standartları doğrultusunda tartışılmaktadır. Teknik ayrıntılar ile klinik karar verme süreçlerini birleştiren bu bölüm, biliyer obstrüksiyonların değerlendirilmesi ve tedavisinde günlük pratiğe yönelik özlü fakat kapsamlı bir rehber sunmayı amaçlamaktadır.
This chapter reviews percutaneous biliary interventions, including percutaneous transhepatic cholangiography, biliary drainage, and stenting, within the framework of current interventional radiology practice. It outlines the main indications, contraindications, patient preparation steps, and the role of pre-procedural imaging in planning safe and effective treatment. Technical principles of ultrasound- and fluoroscopy-guided access, catheter and guidewire manipulation, drainage strategies, biopsy techniques, and stent placement are summarized in a practical and systematic manner. Special attention is given to the management of malignant and benign biliary obstruction, biliary leaks, anastomotic strictures, and complex hilar lesions. The chapter also discusses procedural safety, radiation exposure, post-procedural follow-up, and complication management, with emphasis on evidence-based recommendations and CIRSE standards of practice. By integrating technical details with clinical decision-making, this chapter aims to provide a concise yet comprehensive guide for the evaluation and treatment of biliary obstruction in daily practice.
Referanslar
Das M, van der Leij C, Katoh M, et al. CIRSE standards of practice on percutaneous transhepatic cholangiography, biliary drainage and stenting. Cardiovasc Intervent Radiol. 2021;44:1499-509.
Ahmed O, Mathevosian S, Arslan B. Biliary interventions: tools and techniques of the trade. Seminars in Interventional Radiology. 2016;33:283-290.
Saad WE, Wallace MJ, Wojak JC, et al. Quality improvement guidelines for percutaneous transhepatic cholangiography and biliary drainage. J Vasc Interv Radiol. 2010;21:789-95.
Krokidis M, Hatzidakis A. Percutaneous minimally invasive treatment of malignant biliary strictures. Cardiovasc Intervent Radiol. 2014;37:316-23.
Radosa C, Schaab F, Hofmockel T, et al. Percutaneous biliary interventions. Radiologe. 2019;59:342-7.
Janssen JJ, van Delden OM, van Lienden KP, et al. Percutaneous balloon dilatation for benign biliary strictures. Cardiovasc Intervent Radiol. 2014;37:1559-67.
Faithfull GR, Smith RC, Manap NA. Percutaneous transhepatic biliary drainage for obstructive jaundice. Medical Journal of Australia. 1982;1:269-77.
Romagnoli S, Fanelli F, Barbani F, et al. CIRSE standards of practice on analgesia and sedation for interventional radiology in adults. Cardiovasc Intervent Radiol. 2020;43:1251-60.
Davidson JC, Rahim S, Hanks SE, et al. Society of Interventional Radiology consensus guidelines for the periprocedural management of thrombotic and bleeding risk. J Vasc Interv Radiol. 2019;30:1155-67.
Chehab MA, Thakor AS, Tulin-Silver S, et al. Adult and pediatric antibiotic prophylaxis during vascular and interventional radiology procedures. J Vasc Interv Radiol. 2018;29:1483-501.
Giurazza F, Corvino F, Contegiacomo A, et al. Safety and effectiveness of ultrasound-guided percutaneous transhepatic biliary drainage. J Ultrasound. 2019;22:437-45.
Lee MJ, Fanelli F, Haage P, et al. Patient safety in interventional radiology: a CIRSE IR checklist. Cardiovasc Intervent Radiol. 2012;35:244–249.
Covey AM, Brown KT. Percutaneous transhepatic biliary drainage. Techniques in Vascular and Interventional Radiology. 2008;11:14–20.
Kloeckner R, Otto G, Biesterfeld S, et al. Diagnostic reference levels for fluoroscopically guided interventions: results from a multicenter study. Cardiovasc Intervent Radiol. 2017;40:150–158.
Rees J, Mytton J, Evison F, et al. The outcomes of biliary drainage by percutaneous transhepatic cholangiography for the palliation of malignant biliary obstruction in England between 2001 and 2014: a retrospective cohort study. BMJ Open. 2020;10(1):e033576.
Liu YS, Lin CY, Chuang MT, et al. Success and complications of percutaneous transhepatic biliary drainage are influenced by liver entry segment and level of catheter placement. Abdominal Radiology. 2018;43:713-22.
Choi SH, Gwon DI, Ko GY, et al. Hepatic arterial injuries in 3110 patients following percutaneous transhepatic biliary drainage. Radiology. 2011;261:969-75.
Fidelman N, Bloom AI, Kerlan RK Jr, et al. Hepatic arterial injuries after percutaneous biliary interventions in the era of laparoscopic surgery and liver transplantation: experience with 930 patients. Radiology. 2008;247:880-6.
Garcarek J, Kurcz J, Guzinski M, et al. Ten years single center experience in percutaneous transhepatic decompression of biliary tree in patients with malignant obstructive jaundice. Advances in Clinical and Experimental Medicine. 2012;21:621-32.
Kim SH, Zangan SM. Percutaneous transhepatic biliary drainage complicated by bilothorax. Seminars in Interventional Radiology. 2015;32:54-6.
Nennstiel S, Weber A, Frick G, et al. Drainage-related complications in percutaneous transhepatic biliary drainage: an analysis over 10 years. Journal of Clinical Gastroenterology. 2015;49:764-70.
Quencer KB, Tadros AS, Marashi KB, et al. Bleeding after percutaneous transhepatic biliary drainage: incidence, causes and treatments. Journal of Clinical Medicine. 2018;7:94.
Yamashita H, Ebata T, Yokoyama Y, et al. Pleural dissemination of cholangiocarcinoma caused by percutaneous transhepatic biliary drainage during the management of resectable cholangiocarcinoma. Surgery. 2019;165:912-7.
Referanslar
Das M, van der Leij C, Katoh M, et al. CIRSE standards of practice on percutaneous transhepatic cholangiography, biliary drainage and stenting. Cardiovasc Intervent Radiol. 2021;44:1499-509.
Ahmed O, Mathevosian S, Arslan B. Biliary interventions: tools and techniques of the trade. Seminars in Interventional Radiology. 2016;33:283-290.
Saad WE, Wallace MJ, Wojak JC, et al. Quality improvement guidelines for percutaneous transhepatic cholangiography and biliary drainage. J Vasc Interv Radiol. 2010;21:789-95.
Krokidis M, Hatzidakis A. Percutaneous minimally invasive treatment of malignant biliary strictures. Cardiovasc Intervent Radiol. 2014;37:316-23.
Radosa C, Schaab F, Hofmockel T, et al. Percutaneous biliary interventions. Radiologe. 2019;59:342-7.
Janssen JJ, van Delden OM, van Lienden KP, et al. Percutaneous balloon dilatation for benign biliary strictures. Cardiovasc Intervent Radiol. 2014;37:1559-67.
Faithfull GR, Smith RC, Manap NA. Percutaneous transhepatic biliary drainage for obstructive jaundice. Medical Journal of Australia. 1982;1:269-77.
Romagnoli S, Fanelli F, Barbani F, et al. CIRSE standards of practice on analgesia and sedation for interventional radiology in adults. Cardiovasc Intervent Radiol. 2020;43:1251-60.
Davidson JC, Rahim S, Hanks SE, et al. Society of Interventional Radiology consensus guidelines for the periprocedural management of thrombotic and bleeding risk. J Vasc Interv Radiol. 2019;30:1155-67.
Chehab MA, Thakor AS, Tulin-Silver S, et al. Adult and pediatric antibiotic prophylaxis during vascular and interventional radiology procedures. J Vasc Interv Radiol. 2018;29:1483-501.
Giurazza F, Corvino F, Contegiacomo A, et al. Safety and effectiveness of ultrasound-guided percutaneous transhepatic biliary drainage. J Ultrasound. 2019;22:437-45.
Lee MJ, Fanelli F, Haage P, et al. Patient safety in interventional radiology: a CIRSE IR checklist. Cardiovasc Intervent Radiol. 2012;35:244–249.
Covey AM, Brown KT. Percutaneous transhepatic biliary drainage. Techniques in Vascular and Interventional Radiology. 2008;11:14–20.
Kloeckner R, Otto G, Biesterfeld S, et al. Diagnostic reference levels for fluoroscopically guided interventions: results from a multicenter study. Cardiovasc Intervent Radiol. 2017;40:150–158.
Rees J, Mytton J, Evison F, et al. The outcomes of biliary drainage by percutaneous transhepatic cholangiography for the palliation of malignant biliary obstruction in England between 2001 and 2014: a retrospective cohort study. BMJ Open. 2020;10(1):e033576.
Liu YS, Lin CY, Chuang MT, et al. Success and complications of percutaneous transhepatic biliary drainage are influenced by liver entry segment and level of catheter placement. Abdominal Radiology. 2018;43:713-22.
Choi SH, Gwon DI, Ko GY, et al. Hepatic arterial injuries in 3110 patients following percutaneous transhepatic biliary drainage. Radiology. 2011;261:969-75.
Fidelman N, Bloom AI, Kerlan RK Jr, et al. Hepatic arterial injuries after percutaneous biliary interventions in the era of laparoscopic surgery and liver transplantation: experience with 930 patients. Radiology. 2008;247:880-6.
Garcarek J, Kurcz J, Guzinski M, et al. Ten years single center experience in percutaneous transhepatic decompression of biliary tree in patients with malignant obstructive jaundice. Advances in Clinical and Experimental Medicine. 2012;21:621-32.
Kim SH, Zangan SM. Percutaneous transhepatic biliary drainage complicated by bilothorax. Seminars in Interventional Radiology. 2015;32:54-6.
Nennstiel S, Weber A, Frick G, et al. Drainage-related complications in percutaneous transhepatic biliary drainage: an analysis over 10 years. Journal of Clinical Gastroenterology. 2015;49:764-70.
Quencer KB, Tadros AS, Marashi KB, et al. Bleeding after percutaneous transhepatic biliary drainage: incidence, causes and treatments. Journal of Clinical Medicine. 2018;7:94.
Yamashita H, Ebata T, Yokoyama Y, et al. Pleural dissemination of cholangiocarcinoma caused by percutaneous transhepatic biliary drainage during the management of resectable cholangiocarcinoma. Surgery. 2019;165:912-7.
