tailieunhanh - Gastrointestinal Oncology - part 7

Các biến chứng liên quan đến thoát nước qua da bao gồm chảy máu và nhiễm trùng huyết. Hầu hết các nhiễm trùng huyết xảy ra ở bệnh nhân có biểu hiện viêm đường mật, trong các thiết lập của mật bị ô nhiễm từ các thủ tục trước. | 250 Chapter 14 Figure 14-2C. Internal external drainage catheter in a different patient with ampullary carcinoma. As opposed to the external catheters which provide external drainage only internal external catheters allow for preservation of bilioenteric circulation and provide added stability based on the length of the catheter within the duct. Complications related to percutaneous drainage include bleeding and sepsis. Most sepsis occurs in patients presenting with cholangitis in the setting of bile contaminated from previous procedures. Most early hemobilia is related to venous bleeding and will frequent resolve with time or exchanging the catheter for one of slightly larger diameter. Delayed hemobilia or that resulting in significant blood loss is more likely related to arterial injury and will necessitate arterial embolization in most cases. Most patients dislike exteriorized catheters for both physical and psychological reasons. When possible every attempt is made to convert the catheters to internal stents. The same criteria for placement of endoscopic stents apply here the patient should have a diagnosis of cancer or recurrent cancer in the appropriate circumstance in whom surgical resection for cure is not possible. Additionally either the goal of drainage should have been met or there are no possible additional procedures that may be necessary eg drainage of other parts of the biliary tree . Clearly the patient must also have a patent and functional small bowel. Occasionally plastic stents will have been placed endoscopically but could not be exchanged or failed due to tumor overgrowth. These stents must also be addressed as their presence precludes placement of metallic stents the plastic stent would be trapped . These stents may be pushed into the small bowel and eliminated in the feces Figure 14-3 or may be removed percutaneously using a snare. If the stent cannot be removed percutaneously endoscopic removal is necessary. Most percutaneous stents .