Abstract：
OBJECTIVE: To introduce percutaneous selective injection of autologous platelet-rich fibrin as a novel technique for persistent bile leakage repair and sharing the results of our preliminary experience.
METHODS: Seven patients (57.1% females; mean age 69.6 ± 8 years) with the evidence of persistent bile leak secondary to hepatobiliary surgery and ineffective treatment with percutaneous transhepatic biliary drainage were submitted to fibrin injection. Platelet-rich fibrin, a dense fibrin clot promoting tissue regeneration, was obtained from centrifuged patient\'s venous blood. Repeated percutaneous injections through a catheter tip placed in close proximity to the biliary defect were performed until complete obliteration at fistulography. Technical and clinical success were evaluated.
RESULTS: Bile leaks followed pancreaticoduodenectomy in five and major hepatectomy in two patients. Technical success defined as fibrin injection at BD site was achieved in all seven patients, and clinical success defined as a complete healing of the BD at fistulography was achieved in six patients. The median time to BD closure was 76.7 ± 40.5 days and the average procedure number was 3 ± 1 per patient. In one patient, defect persistance after four treatments required gelatin sponge injection. No major complications occurred. One case of post-procedural transitory hyperpirexia was registered.
CONCLUSIONS: In persistent biliary defects, despite prolonged biliary drainage stay, percutaneous injection of autologous platelet-rich fibrin appears as a readily available and feasible emergent technique in promoting fistulous tracts obliteration still mantaining main ducts patency.
METHODS: Seven patients (57.1% females; mean age 69.6 ± 8 years) with the evidence of persistent bile leak secondary to hepatobiliary surgery and ineffective treatment with percutaneous transhepatic biliary drainage were submitted to fibrin injection. Platelet-rich fibrin, a dense fibrin clot promoting tissue regeneration, was obtained from centrifuged patient\'s venous blood. Repeated percutaneous injections through a catheter tip placed in close proximity to the biliary defect were performed until complete obliteration at fistulography. Technical and clinical success were evaluated.
RESULTS: Bile leaks followed pancreaticoduodenectomy in five and major hepatectomy in two patients. Technical success defined as fibrin injection at BD site was achieved in all seven patients, and clinical success defined as a complete healing of the BD at fistulography was achieved in six patients. The median time to BD closure was 76.7 ± 40.5 days and the average procedure number was 3 ± 1 per patient. In one patient, defect persistance after four treatments required gelatin sponge injection. No major complications occurred. One case of post-procedural transitory hyperpirexia was registered.
CONCLUSIONS: In persistent biliary defects, despite prolonged biliary drainage stay, percutaneous injection of autologous platelet-rich fibrin appears as a readily available and feasible emergent technique in promoting fistulous tracts obliteration still mantaining main ducts patency.
摘要：
目的：介绍经皮选择性注射自体富血小板纤维蛋白作为持续性胆漏修复的新技术，并分享我们的初步经验。
方法：7例患者（57.1％为女性；平均年龄69.6±8岁），有肝胆手术继发的持续胆漏和经皮肝穿刺胆道引流治疗无效的证据，接受纤维蛋白注射。富血小板纤维蛋白,致密的纤维蛋白凝块促进组织再生，是从离心患者的静脉血中获得的。通过靠近胆道缺损的导管尖端反复经皮注射，直到在纤维造影中完全闭塞。评估技术和临床成功。
结果：5例胰十二指肠切除术后发生胆汁漏，2例主要肝切除术后发生胆汁漏。技术成功定义为在BD部位注射纤维蛋白在所有7名患者中都实现了。在6例患者中，临床成功被定义为BD完全愈合。BD闭合的中位时间为76.7±40.5天，每个患者的平均手术次数为3±1。在一个病人中,四种治疗后的缺陷抗性需要注射明胶海绵。无重大并发症发生。记录了1例术后暂时性高血压。
结论：在持续性胆道缺损中，尽管胆道引流时间延长,经皮注射自体富血小板纤维蛋白似乎是一种易于使用且可行的紧急技术，可促进瘘管闭塞，但仍能保持主管道通畅。
方法：7例患者（57.1％为女性；平均年龄69.6±8岁），有肝胆手术继发的持续胆漏和经皮肝穿刺胆道引流治疗无效的证据，接受纤维蛋白注射。富血小板纤维蛋白,致密的纤维蛋白凝块促进组织再生，是从离心患者的静脉血中获得的。通过靠近胆道缺损的导管尖端反复经皮注射，直到在纤维造影中完全闭塞。评估技术和临床成功。
结果：5例胰十二指肠切除术后发生胆汁漏，2例主要肝切除术后发生胆汁漏。技术成功定义为在BD部位注射纤维蛋白在所有7名患者中都实现了。在6例患者中，临床成功被定义为BD完全愈合。BD闭合的中位时间为76.7±40.5天，每个患者的平均手术次数为3±1。在一个病人中,四种治疗后的缺陷抗性需要注射明胶海绵。无重大并发症发生。记录了1例术后暂时性高血压。
结论：在持续性胆道缺损中，尽管胆道引流时间延长,经皮注射自体富血小板纤维蛋白似乎是一种易于使用且可行的紧急技术，可促进瘘管闭塞，但仍能保持主管道通畅。
