Plastic Biliary Tube Drainage

Curing disease: Indication 1, biliary obstruction caused by malignant tumor (primary or secondary), can be used as a preoperative preparation, but also as a palliative treatment for patients with advanced cancer. 2, bile duct stones have the following conditions: elderly or other surgery is extremely risky, not suitable for surgery. It is not suitable for EST or endoscopic stone removal. Prevention of stone incarceration or cholangitis episodes can be used as a preoperative preparation. 3, benign biliary stricture, can be applied after endoscopic biliary dilatation; sclerosing cholangitis, timidity. Contraindications 1. ERCP contraindications. 2, hilar cholangiocarcinoma, intrahepatic multi-stage bile duct invasion and drainage range is extremely limited, use with caution. Preoperative preparation Instruments for duodenoscopy (biopsy channel above 3.2mm), guide wire, biliary dilatation catheter (8.5-11.5Fr, depending on the endoscope channel used), 7-14Fr plastic tube and its supporting bracket Conveyor (7-8Fr bracket conveyor is only a pusher of the same diameter, 10Fr or more bracket conveyor, in addition to the push tube, there is a 5-7Fr lining positioning tube), all instruments should be strictly sterilized. Surgical procedure 1. Perform routine ERCP to understand the nature, location, and extent of biliary lesions, and determine the location of the internal tube drainage. 2, through the contrast catheter inserted into the guide wire, beyond the obstruction segment, into the bile duct required drainage. 3, the biliary tract stenosis is more serious need to biliary dilatation, choose the appropriate dilatation catheter to guide the wire into the biliary tract, under fluoroscopy to determine the maximum diameter of the dilation tube has passed the stenosis, left 3-5min and then exit. 4. The guide wire is inserted into the inner tube and its corresponding conveyor, and the inner tube is gradually fed into the biliary tract under fluoroscopy, and the inner tube under the barb is left in the duodenal cavity, and finally the inner tube is removed. Push the tube. complication 1, cholangitis and sepsis are mainly seen in the drainage range is small, the effect is not good, or intraoperative injection of too much contrast agent, in addition to strengthening the application of antibiotics, if necessary, should consider re-intubation. 2, pancreatitis is generally only a transient increase in pancreatic amylase, most patients gradually return to normal within 72h, should be fasted, can also be given appropriate anti-pancreatic enzymes or drugs that inhibit pancreatic secretion. 3, built-in tube blockage and prolapse usually 7-10Fr built-in tube average patency period is about 3 months, once patients with jaundice recurrence or cholangitis episodes, should promptly replace the failed built-in tube, can use snare, stone basket or dedicated The retrievor removes the internal tube and places it into a new internal tube. Those who need long-term drainage should be replaced once every 3-4 months when conditions permit. 4. Duodenal injury, bleeding or perforation is rare.