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Экспульсия дренирующего катетера из паренхимы печени после чрескожной чреспеченочной холангиостомии – причина и возможности профилактического мониторинга

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Catheter Expulsion from the Liver After Percutaneal Transhepatic Cholangiostomy (PTCAS) – the Cause, the Way of Prophylactic Follow%Up, the Original Prevention Technique

Purpose. The cause, the way of prophylactic follow-up and the original technique of catheter expulsion prevention after PTCAS are discussed. Material and Methods. PTCAS was performed to 198 patients with mechanical jaundice of age ranging from 37 to 88 years; in 125 cases the biliary obstruction was proximal, at the level of liver hilum. The distal biliary block was documented in 73 cases. PTCAS was performed under combined ultrasound-X-ray control. Color Doppler mode was used in all cases to choose the safe punction trace in order to minimize the probability of the liver vessel damage. Daily fluoroscopy follow-up during first 6 days after the procedure was performed to 144 (72,7%) patients in order to document the presence of the catheter fold between liver surface and abdominal wall, which means the catheter expulsion start. Results. The adequate biliary drainage was achieved in all cases; procedure led to different degree condition improvement in 196 cases; in 2 cases the outcome was lethal caused by the liver failure and not by the procedure itself. Among the complications hemoperitoneum (10 cases) should be mentioned, which was managed medically. The catheter expulsion from the liver happened in 6 (3.0%) cases total; 2 patients of them were from the group (54) to whom no X-Ray daily follow-up was not performed and expulsion was suspected because of bile passage stop from the catheter. In the rest 4 cases expulsion occurred despite the daily X-Ray monitoring. In 1 case the expulsion was documented at 24 hour follow up; ultrasound revealed the biliary hypertension and patient underwent repeated PTCAS successfully. The rest 5 patients underwent the open surgery; in 4 cases the catheter was positioned through the bile-leaking hole on the liver surface and fixed to the liver surface by suture. In 1 case the drainage canal orifice was closed by suture and repeated PTCAS was performed successfully on the 4th day after surgery. Catheter expulsion might be caused by liv

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