A Preliminary Study On The Application Of Two-point Traction Of Guidewire Method In Percutaneous Transhepatic Sinus Dilation

Objective:The clinical data of patients underwent percutaneous transhepatic sinus dilatationof the guidewire two-point traction method and the traditional method were collected,and the safety and feasibility of the two-point traction of guidewire method was discussed.Methods:The clinical data of patients underwent percutaneous transhepatic sinus dilatation from January 2013 to January 2018 in the Shengjing Hospital of China Medical University were analyzed retrospectively.40 cases were included,23 patients underwent percutaneous transhepatic sinus dilatation use the the two-point traction of guidewire method.Before the sinus dilatation,the guidewire was inserted into the PTCD drainage tube and was introduced under the duodenoscope.Both ends of the wire are fixed in vitro to increase the tension of the guidewire,underwent the sinus tract dilatation operate in one phase.17 patients used traditional sinus dilation methods.The success rate of operation,operation time,volume of intraoperative blood loss,stone clearance rate,complications of the two groups were recorded.Results:There was no significant difference in gender,history of biliary tract surgery,puncture site,and stone distribution between the two groups(P>0.05),although there was statistical difference in age(P<0.05),no effect on the surgical procedure.The success rate(100%vs 70.6%,P=0.009),operation time[(37.70±17.30)min vs(84.88±60.69)min,t=-3.113,P=0.006],intraoperative blood loss[(11.48±10.83)ml vs(30.47±31.67)ml,t=-2.372,P=0.029],one phase sinus size[(18.35±2.14)Fr vs(13.86±3.08)Fr,t=5.226,P=0.000]of sinus dilatation with the two-point traction of guidewire method was better than that of the traditional method.The difference were statistically significant.The incidence of serious complications(including cholangitis,severe biliary tract bleeding,bile duct injury,pancreatitis)was higher in the traditional method group than in the two-point traction of guidewire method group(35.3%vs 4.3%,?~2=4.518,P=0.034),the difference was statistically significant.There was no statistical difference in overall stone clearance rates between the two groups(63.6%vs 58.3%,P=1.000).Conclusion:From the results of limited patient data,the two-point traction of guidewire method can provide the exact guidance for percutaneous transhepatic sinus dilation,which is effective and easily conducted,but still need further expansion of sample size to confirm.