Clinical effect of digital subtraction angiography combined with MRCP fusion navigation percutaneous transhepatic cholongial drainage in the treatment of high malignant biliary obstruction

CAO Liming; ZHANG Yongxue; CUI Jinguo; LIU Pei; CHEN Jing; ZHAO Hongen; WANG Min; LIU Shan; KANG Zhi-long

Abstract：Objective To investigate the efficacy and safety of percutaneous transhepatic cholongial drainage guided by digi-tal subtraction angiography combined with MRCP image fusion in the treatment of high malignant obstructive jaundice.Meth-ods Clinical data of 60 patients with high malignant obstructive jaundice treated with PTCD in our center were studied.The pa-tients were divided into conventional PTCD group(30 cases)and image fusion PTCD group(30 cases)according to different puncture guidance methods.The number of target bile duct puncture,dosage of contrast agent,X-ray exposure dose,exposure time and complications of the two groups were recorded.Results The basic data of the two groups showed no statistical differ-ences and were comparable.In the conventional PTCD group,42 times of puncture drainage were performed,including 14 times of left hepatic bile duct drainage and 28 times of right hepatic bile duct drainage.PTCD group underwent puncture drainage for 40 times,left hepatic bile duct drainage for 14 times and right hepatic bile duct drainage for 26 times,with no statistical differ-ences.The bile duct puncture times,contrast agent dosage,X-ray exposure dose and time of conventional PTCD group and image-fusion PTCD group were(3.6±0.5)vs(1.7±0.4)times,(98.5±21.3)vs(45.65±16.5)ml,(548.2±63.5)mGy vs(298.46±50.8)mGy,(56.5±6.2)min vs(30.4±5.2)min),respectively.There were statistical differences between the two groups,the image fusion PTCD group was better than the conventional PTCD group(P＜0.05),the difference was statistically significant(P<0.05).The complication rate of image fusion group was 6.67%,which was better than that of conventional PTCD group(26.7%),and the difference was statistically significant(P<0.05).Conclusion The application of MRCP and DSA im-age fusion to guide PTCD in the treatment of high malignant obstructive jaundice is safe and feasible,which can guide the inter-ventional physician to reduce the number of bile duct puncture,shorten the time and exposure of X-ray radiation,and reduce the dosage of contrast agent.