Intraoperative cholangiography

Although X-ray examination is a common method for the diagnosis of biliary diseases, some patients cannot be clearly displayed on ordinary X-ray films. This requires the use of medical contrast agents to enter the biliary tract through certain methods and channels, so that the contours and lesions of the cholangiography site The image can be clearly displayed on the X-ray film. This method is cholangiography. Intraoperative cholangiography is the implementation of cholangiography during surgery. Treatment of diseases: biliary tract biliary stones Indication 1. Relative indications with common bile duct incision. 2. Biliary malformations. 3. The biliary tract is severely adhered, and the anatomical relationship is unclear. 4. It is not certain that the biliary stones have been removed. 5. Biliary stenosis, constrictive cholangitis, some tumors around the ampulla. Surgical procedure 1. Preparation: Prepare a small, portable x-ray machine. The patient is supine or the special operating table is used. A raft or a disinfectant towel with a film is placed between the operating table and the back of the upper right biliary region of the patient to wrap the x-ray film to be placed behind the patient's biliary area. At the time of angiography, the surgical field should be removed from the device that is not transparent to the x-ray [Fig. 1]. 2. Contrast agent: 12.5% sodium iodide or potassium iodide solution, 35% iodine sharp solution, 50% diatrizoate (diluted to about 20% is appropriate). 3. Imaging pathway (1) gallbladder puncture method: direct injection of contrast agent into the gallbladder, mostly used for gallbladder normal or no need to remove the gallbladder. (2) Intubation through the cystic duct: those with gallbladder fistula can be used for angiography, especially for those who must remove the gallbladder, separate the gallbladder, ligature the distal end, cut the cystic duct at the proximal bile duct, insert a metal catheter Or a thin plastic tube to the common bile duct, do not insert into the duodenum, after taking bile injection, can avoid leakage. (3) common bile duct puncture method: in the gallbladder has been removed or cystic duct obstruction, can be directly puncture or catheter insertion into the common bile duct, or through the cystic duct puncture of the common bile duct. (4) After the t-tube method: it can be used after the common bile duct has been cut and the t-shaped tube is placed. (5) intrahepatic bile duct puncture method: used in the biliary tract have congenital malformations, cancer and so on. (6) Duodenal retrograde method: When the extrahepatic biliary tract is narrow, the anatomical relationship is unclear, and the anatomical relationship is unclear, and the gallbladder is removed, or when the Russian sphincter incision is required, the duodenal retrograde intubation can be performed. 4. Photographing: Pay attention to the air in the catheter or syringe, slowly inject about 5ml of contrast medium, and control the patient's breathing during filming. After the first shot, inject 10-15ml for the second shot.

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