Application of ultrasound-guided real-time percutaneous transhepatic-cholangial or transhepatic-cholecyst drainage in treatment of acute obstructive cholangitis in primary hospitals

Objective To investigate the clinical value of ultrasound-guided real-time percutaneous transhepatic-cholangial or transhepatic-cholecyst drainage( PTCD) in the treatment of patients with acute obstructive cholangitis in primary hospitals. Methods A retrospective analysis was performed for the clinical data of 38 patients with acute obstructive cholangitis who underwent ultrasound-guided real-time PTCD in Tengchong People's Hospital from February 2012 to June 2018,and among these patients,4 had malignant biliary obstruction and cholangitis and 34 had acute obstructive suppurative cholangitis caused by hepatolithiasis. Results Of all patients,30 underwent puncture of the bile duct in the right lobe of liver,6 underwent puncture of the bile duct in the left lobe of liver,and 2 underwent puncture of the gallbladder. The success rate of first-time needle insertion was 91. 2%( 35/38),and the overall success rate of puncture was 100%. There were no complications such as massive hemorrhage,biliary peritonitis,and biliary-vascular fistula. At 2 weeks after surgery,89. 5%( 34/38) of the patients had a bilirubin level reduced by ≥1/2,and 32 patients( 84. 2%) had a level of alanine aminotransferase reduced to normal. As for the 34 patients with hepatolithiasis,second-stage surgeries including bile duct exploration/cholecystolithotomy and hepatic lobectomy were performed after the infection was under control,or they were referred to superior hospitals with tube indwelling for further treatment. The 4 patients with neoplastic bile duct obstruction were referred to superior hospitals with tube indwelling,among whom 3 underwent radical surgery and 1 underwent biliary stent placement via the former deep blind fistula. Conclusion Ultrasound-guided real-time PTCD can be used as an effective,simple,and safe biliary drainage technique for the early treatment of acute biliary obstruction in primary hospitals. This technique has a high success rate and low requirements for medical equipment,and therefore,it holds promise for clinical application in primary hospitals after related technical procedures are standardized.