What Is an Intraoperative Cholangiogram?

Intraoperative biliary angiography is a medical method used to examine and treat bile ducts.

Intraoperative biliary angiography

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Intraoperative biliary angiography is a medical method used to examine and treat bile ducts.

Chinese name

Intraoperative biliary angiography

Foreign name

Laparoscopic intraoperative cholangiography, LIOC

figure 1

1. Relative indications for common bile duct incision.

2. Bile duct malformations.

3. Severe adhesion of biliary tract and unclear anatomical relationship.

4. Can not be sure that the bile duct stones have been removed.

5. Biliary stenosis, constrictive cholangitis, and some periampullary tumors.

1. Prepare a small mobile x-ray machine. The patient is lying on the operating table on his back or a special operating table. A wooden box or disinfection towel containing a soft film is wrapped between the operating table and the back of the patient's right upper abdomen biliary region to cover the x-ray film, which is placed behind the patient's biliary region when the film is taken. X-ray opaque instruments should be removed from the surgical field during imaging [Figure 1].

2. Contrast agent 12.5% sodium iodide or potassium iodide solution, 35% iodine solution, 50% diatrizoate (it is appropriate to dilute to about 20%).

3. Imaging approach

Gallbladder puncture: Inject the contrast agent directly into the gallbladder. It is mostly used for those with normal gallbladder or without gallbladder resection.

Transcatheter intubation of the gallbladder tube: those who have a gallbladder fistula can undergo fistula angiography, which is mostly used for those who must remove the gallbladder, isolate the gallbladder, ligate its distal end, cut a small hole of the gallbladder tube near the common bile duct and insert a metal catheter Or the thin plastic tube reaches the common bile duct. Do not insert the duodenum. After the bile is drawn, the radiograph is injected to avoid bile leakage [Figure 2].

(3) Common bile duct puncture method: In cases where the gallbladder has been removed or the bile duct is obstructed, the common bile duct can be directly punctured or inserted into the common bile duct, or the common bile duct can be punctured through the bile duct.

The T-shaped tube method after bile operation: can be used after the common bile duct has been cut and the t-shaped tube has been placed.

Intrahepatic bile duct puncture: used in biliary tract with congenital malformations and cancer.

Transduodenal retrograde method: When the extrahepatic biliary tract is narrow and the anatomical relationship is unclear, the person with cholecystectomy or Oedi sphincterotomy is required, the duodenal retrograde intubation can be performed.

4. Pay attention to taking out the air in the catheter or syringe and slowly injecting about 5ml of contrast medium to control the patient's breathing when taking the picture. After the first shot, 10 ~ 15ml was injected for the second shot.

1. The air bubbles in the catheter and syringe should be discharged first, so as to prevent the air bubbles from being injected into the biliary tract and being mistaken for stones.

2. The lower end of the bile duct is more common in T-tube angiography, which may be related to the injection of the medicine too fast and the contrast agent to stimulate the Oedipal sphincter. The injection rate should be completed within 10 to 20 seconds. Do not use morphine drugs before and during the operation.

3. Contrast concentration is too high, if it is more than 20%, small stones can be masked and not found.

4. Both intraoperative biliary angiography and common bile duct incision can have false positives or false negatives, so they should be used in combination to improve the accuracy of the conclusion.

The value of cholangiography during operation is that normal angiography can avoid unnecessary common bile duct incision, reduce the rate of residual bile duct stones, correctly judge the anatomical relationship of the bile duct, and avoid bile duct injury. The diagnosis and management of biliary tract stenosis, local narrowing of the biliary tract, and periampullary carcinoma of the uterus have certain value. The method is simple and does not increase the patient's pain.