What Is a Percutaneous Cholangiogram?

Percutaneous transhepatic cholangiography (PTC) is a more advanced method for the diagnosis and treatment of hepatobiliary diseases.

Name: Percutaneous transhepatic cholangiography

category: Special inspection

Normal percutaneous transhepatic cholangiography

Staple bile above the obstruction site drains out of the body.

Clinical significance of percutaneous transhepatic cholangiography

Abnormal results: The silted bile above the obstruction site was not drained out of the body. Need to check the population: patients with obstructive jaundice to understand the location, scope and cause of biliary obstruction.

Precautions for percutaneous transhepatic cholangiography

Unsuitable people: severe obstacles to the coagulation mechanism; severe acute suppurative obstructive cholangitis; poor liver and kidney function; patients who are too old and with poor general conditions should be refilled; iodine allergy. Contraindications during inspection: (1) Avoid bile duct hypertension caused by contrast medium injection, which can cause contrast medium and bile to leak into the abdominal cavity around the needle, causing local biliary peritonitis. Therefore, when the puncture needle enters the bile duct to extract bile, the bile should be withdrawn as much as possible to achieve decompression. If there is a pressure measuring device, the injection of contrast agent should not exceed the amount of bile withdrawn, and the bile should be drawn out first and mixed in a syringe, and then slowly injected. After the radiography, the bile should be withdrawn as much as possible. less. (2) Prevention and treatment of needle duct gall blood fistula When puncturing into a large lumen, there is often a clear sense of emptiness. Suction should be performed immediately, and those who are easy to extract blood prove that the needle tip is in the blood vessel, and the needle should be withdrawn immediately. When re-entering the bile duct, PTCD should not be made from the original needle channel, and another puncture should be performed. (3) Avoid the influence of thick bile on the contrast. When bile duct obstruction and infection, the bile viscosity increases and it is not easy to mix with the contrast agent. In order to avoid misdiagnosis caused by thick bile, a small amount of physiological saline can be slowly injected for dilution, and then discarded and diluted. Repeatedly until the color of the bile fades, and the contrast medium is injected for imaging. If bile cannot be withdrawn or diluted, it is not appropriate to perform an immediate angiography. The drainage tube can be inserted 3-5 days later, and the biliary dilution will be performed again. (4) Pay attention to the concentration and uniformity of the contrast agent in the bile. The contrast agent is too thick, which can conceal the small stones. When it is too light, the display is unclear and can be misdiagnosed.

Percutaneous transhepatic cholangiography

First, after transcutaneously puncturing the intrahepatic biliary tract under ultrasound guidance, inject contrast medium under X-ray fluoroscopy to show the condition of the biliary tract. According to the biliary obstruction, choose to place an external drainage tube to drain the stagnant bile above the obstructed site. At the same time, combined with percutaneous gastrostomy, the drained bile is returned to the stomach, which reduces the jaundice symptoms of the patient and restores the physiological needs of the digestive tract for bile. In addition, after the successful puncture of the patient, a biliary metal stent can be placed in the narrow place for internal drainage according to the situation to restore the local biliary patency and maximize the restoration of the physiological condition of the biliary tract. An internal and external drainage tube can also be placed under the guidance of a guide wire to drain the narrowed proximal bile to the intestinal cavity, which can achieve the effect of local stent placement.