Percutaneous hepatic puncture cholangiography (PTC) and percutaneous hepatic puncture choledochotomy (PTCD)
[Indications
1, obstructive jaundice.
2.High obstructive jaundice, severe cholangitis and unresectable cancer of the biliary system.
Contraindications
1.Allergic to iodine.
2.People with bleeding tendency.
Preoperative preparation
1.Check the bleeding and clotting time and prothrombin time.
2.Iodine allergy test.
3.Patients with biliary tract infection should be treated with antibiotics first, and PTC should be performed after the symptoms disappear.
4.Allay the patient’s fear and obtain the patient’s cooperation.
5.Give sedative and atropine sulfate 0.5mg 30 minutes before the examination.
Puncture instruments and drugs
1.PTC, PTCD special puncture needle, guide wire, dilating catheter, polyethylene drainage tube.
2.Syringe.
3.Contrast agent: commonly used pantopamine, generally diluted to about 25% concentration.
4.Local anesthetic drugs.
5, skin disinfection appliances, disinfection gloves, gauze, disinfection wipes, adhesive tape, etc.
【Method】
1.PTC:
(1) Body position: supine on the X-ray table, take the right hand holding the head position.
(2) Puncture site and direction: enter the needle between the 7th and 8th ribs in the right axillary midline, suspend the patient’s breathing while entering the needle, with the needle parallel to the X-ray table, and stop 1 cm from the right edge of the 12th thoracic vertebra; slowly withdraw the needle while injecting the contrast agent; after confirming that the contrast agent enters the hepatobiliary duct, fix the position of the puncture needle and continue to inject the appropriate amount of contrast agent until the hepatic duct and common bile duct are satisfactorily filled, and take pictures.
2.PTCD:
Under TV surveillance, feed the thick trocar needle in the direction of PTC, confirm that the trocar needle enters the hepatobiliary duct, pull out the needle core, insert the J-type guidewire along the trocar, and then the trocar gradually penetrates deeper along the guidewire to make the trocar insert into the common bile duct as far as possible, or into the duodenum, and properly fix the catheter to prevent postoperative prolapse. If long-term drainage is needed, the catheter should be flushed every other day and the dressing should be changed.
Postoperative treatment
1. Stay in bed for 24 hours after surgery.
2.Fast, monitor blood pressure and pulse for 12 hours.
3.Watch the abdominal condition.
4.If postoperative intra-abdominal hemorrhage, shock or severe biliary peritonitis occurs, prompt surgical exploration should be performed.