percutaneous transhepatic cholangiography

Percutaneous transhepatic cholangiography (PTC) is a relatively advanced method for the diagnosis and treatment of hepatobiliary diseases. The enema was cleaned the night before the angiography and given a sedative. Percutaneous transhepatic cholangiography does not absorb the contrast agent, it will flow into the intestine like bile and then excreted with the feces, which will not affect the body. Basic Information Specialist classification: Digestive examination classification: X-ray Applicable gender: whether men and women apply fasting: fasting Tips: Clean the enema the night before the angiography and take a sedative. Normal value The accumulated bile above the obstruction site is drained out of the body. Clinical significance Abnormal results: The accumulated bile above the obstruction site did not lead out of the body. Need to check the crowd: obstructive jaundice patients to understand the location, extent and causes of biliary obstruction. Precautions Taboo before inspection: 1. Clean the enema one night before the angiography and give a sedative. 2. Give sedatives one hour before angiography, but morphine is forbidden to avoid confusion caused by Oedic sphincter spasm. 3. For iodine allergy test. Taboo when checking: 1. Avoid biliary hypertension caused by injecting contrast agent, which can cause contrast agent and bile to leak into the abdominal cavity around the needle, resulting in local biliary peritonitis. Therefore, when the puncture needle enters the bile duct and draws bile, the bile should be discarded as much as possible to achieve decompression. If there is a pressure measuring device, the injection of contrast agent should not exceed the amount of bile discarded, and the bile should be extracted in the syringe and then slowly injected. After the angiography, the bile should be extracted as much as possible. Even if there is gallbladder, the bile enters the blood. less. 2. The prevention and treatment of needle and blood stasis in the large lumen, often have a clear sense of emptiness, should be immediately pumped, easy to suck out the blood to prove that the needle tip is in the blood vessel, the needle should be retracted, the needle has passed through the blood vessel When entering the bile duct, the PTCD should not be used from the original needle, and should be pierced separately. 3. Avoid the influence of viscous bile on contrast. When biliary obstruction and infection, the viscosity of bile increases, and it is not easy to mix with contrast agent. In order to avoid misdiagnosis caused by sticky bile, a small amount of physiological saline can be slowly injected to dilute, then discarded, diluted, repeated many times, after the color of the bile is lightened, the contrast agent is exchanged. If the bile can not be extracted, or can not be diluted, it is not suitable for immediate angiography. After 3 to 5 days of insertion into the drainage tube, the biliary is diluted and then angiographically diluted. 4. Pay attention to the concentration and uniformity of the contrast agent in the bile. The contrast agent is too thick to cover up the small stones; when it is too light, the display is unclear and can be misdiagnosed. Inspection process Firstly, under the guidance of ultrasound, the intrahepatic biliary tract was successfully punctured by the skin. The contrast agent was injected under fluoroscopy to show the biliary tract. According to the biliary obstruction, the external drainage tube was placed, and the accumulated bile above the obstruction site was excreted. At the same time, combined with percutaneous gastrostomy, the bile juice is returned to the stomach, which reduces the symptoms of jaundice in the patient and restores the physiological needs of the digestive tract to bile. In addition, after successful puncture angiography, the biliary metal stent can be placed in the stenosis according to the situation for internal drainage, restore the patency of the local biliary tract, and maximize the recovery of biliary physiology. The inner and outer drainage tubes can also be placed under the guidance of the guide wire, and the bile deposited at the proximal end of the stenosis can be drained to the intestinal lumen, thereby achieving the effect of locally placing the stent. Not suitable for the crowd Unsuitable for the crowd: severely impaired blood coagulation mechanism; severe acute suppurative obstructive cholangitis; poor liver and kidney function; patients with excessive age, poor systemic conditions should be filled with iodine allergy. Adverse reactions and risks 1. When the biliary tract is dilated, it often causes pain. 2. It is easier to have a tendency to bleed.

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