percutaneous transhepatic biliary drainage

Percutaneous transhepatic biliary drainage (PTCD) mainly involves non-surgical reduction of deep obstructive jaundice in three aspects; emergency biliary decompression drainage for acute severe cholangitis; obstruction caused by inoperable cholangiocarcinoma Sexual jaundice is feasible for palliative treatment. According to the angiographic results, a thicker, straighter, and horizontal bile duct is selected for use in the internal drainage cannula. Basic Information Specialist classification: Digestive examination classification: other examinations Applicable gender: whether men and women apply fasting: not fasting Tips: Before the check: After a week of drainage, re-contrast to observe the catheter position and drainage effect. Normal value The accumulated bile above the obstruction site is drained out of the body. It can reduce decompression, reduce yellowness, relieve symptoms, improve systemic conditions, perform elective surgery, increase surgical safety, reduce complications, and reduce mortality. Clinical significance Abnormal result The accumulated bile above the obstruction site is not drawn out of the body. Need to check the crowd 1. Malignant biliary obstruction caused by advanced tumors. 2. Preoperative preparation of patients with deep jaundice. 3. Acute biliary tract infection, such as acute obstructive suppurative cholangitis, emergency biliary decompression and drainage, so that emergency surgery is converted to elective surgery. 4. Benign biliary stricture, multiple biliary repair, biliary reconstruction and biliary anastomotic stricture. 5. Through the drainage tube, chemotherapy, radiotherapy, lava, cytology and percutaneous fiber choledochoscopy. Precautions Contraindications before examination: After one week of drainage, re-contrast to observe catheter position and drainage effect. Taboo when checking: 1. To ensure the success of the intubation, the needle end of the puncture needle can be tilted 10 ° ~ 15 ° to the head side, so that the needle tip is slightly inclined downward after entering the bile duct, so that the guide wire can smoothly descend along the bile duct, enter the narrow distal end or Duodenum, such as parallel entry or needle tip upward, the guide wire easily hits the contralateral wall and curls or the guide wire is up and can enter the left hepatic duct. 2. Although PTC shows biliary obstruction, sometimes the guide wire can still enter the duodenum through the obstruction end. If the catheter cannot pass the obstruction, the proximal drainage can be performed for 5-7 days, so that the inflammatory edema caused by the infection in the biliary tract subsides. Then insert the guide wire and catheter to the distal end of the obstruction. 3. The drainage catheter should be prevented from falling off and clogging. Rinse 1 to 2 times daily with 5-10 ml of normal saline, and replace the catheter once every 3 days. Inspection process 1. Preoperative preparation and puncture method and percutaneous transhepatic biliary drainage. 2. First use the 22nd fine needle for PTC angiography to determine the location and nature of the lesion. 3. According to the angiographic results, a thicker, straight, horizontal bile duct is selected for use in the internal drainage cannula. 4. Another puncture point is made from the 8th intercostal space on the right side of the midline. After the local anesthesia, poke a small hole on the skin with a sharp knife. The paralyzed patient pauses breathing, and under the supervision of TV, the thick needle is quickly penetrated into the preselected bile duct. After the breakthrough feeling of entering the bile duct, the needle core is pulled out, and the guide wire is inserted after the bile flows smoothly, and the direction is continuously rotated and changed. The guide wire enters the distal bile duct or the duodenum through the obstructed end or the stenotic segment, exits the puncture needle, and after dilating the passage with the dilatation tube, the multi-lateral hole catheter is passed along the guide wire through the obstruction end or the narrow section, so that the side hole of the catheter is located The catheter is fixed above and below the obstructive or stenotic segment, and the bile is smoothly discharged from the catheter, and then the contrast agent is injected. 5. After one week of drainage, re-contrast to observe catheter position and drainage effect. Not suitable for the crowd Not suitable for people: 1. Allergic to iodine, severe coagulopathy, severe heart, liver, kidney failure and a large number of ascites. 2. The intrahepatic bile duct is divided into multiple cavities by the tumor, and the entire bile duct system cannot be drained. 3. Ultrasound examination confirmed that there was a large fluid level in the liver, the Casoni test was positive, and the suspected hepatic echinococcosis. Adverse reactions and risks 1. Wound pain, nausea, vomiting and fever are the more common minor complications, the incidence is about 20~30%. 2. Other major complications are about 5% (3~8%): sepsis about 2~4%, biliary bleeding 0.2~0.4%, bile leakage and biliary peritonitis 1~2.5%, intra-abdominal hemorrhage and liver contusion 1~3 %, death 0.1~1%. 3. Possible adverse effects of using iodine-containing contrast agents: a. A small number of people will have a warm feeling, nausea, vomiting, dizziness, sneezing when injecting an iodine-containing contrast agent, usually disappearing in a short time. b. Those with allergic constitution may cause more serious reactions, such as systemic urticaria, chills, difficulty breathing and other symptoms. c. Those with a specific constitution may have extremely rare laryngeal edema, asthma, decreased blood pressure, heart and lung failure, shock and sudden death. d. The incidence of all adverse reactions is about 3.1% to 12.7%, while the incidence of severe systemic reactions is about 0.04% to 0.2%, and the mortality rate is about one in 100,000. The success rate of percutaneous transhepatic biliary drainage: about 80~95% varies depending on the location of the biliary obstruction and the size of the bile duct.