What is Percutaneous Transhepatic Biliary Drainage? A Treatment Technique

There are many serious diseases, such as severe acute biliary infection and severe obstructive jaundice, which actually require percutaneous transhepatic biliary drainage for treatment. Percutaneous transhepatic biliary drainage is an important treatment technology in current biliary surgery and has been widely used in clinical practice. So what exactly is percutaneous transhepatic biliary drainage? Let's take a closer look.

Percutaneous transhepatic biliary drainage (PTCD) is a method of bile duct drainage using PTC. It is an important treatment technique in current biliary surgery and has been widely used in clinical practice. This method is invasive and may cause complications such as bile leakage, bleeding, and biliary infection. Coagulation function should be checked and vitamin K should be injected for 2-3 days before surgery. Antibiotics should be used when necessary, especially for those with symptoms of infection. All preparations for laparotomy should be made to prepare for timely treatment of emergency complications such as bile peritonitis and bleeding. In recent years, PTCD has been greatly improved and developed in technology and equipment. It has become a common method for current biliary treatment.

Percutaneous transhepatic biliary drainage can clearly show the condition of the intrahepatic and extrahepatic bile ducts, and can be used for preoperative preparation for severe obstructive jaundice and emergency non-surgical treatment of severe acute biliary infection; it is beneficial for the diagnosis and differential diagnosis of biliary diseases, especially jaundice. This method is easy to operate, has a high success rate, and can understand the location, nature, scope and degree of the lesion. It is more likely to succeed in patients with bile duct dilation. The results are not affected by liver function and blood bilirubin concentration, and there are fewer complications.
1. Indications:
1. Palliative biliary drainage is performed for malignant biliary obstruction caused by advanced tumors.
2. Preoperative preparation for patients with severe jaundice (including benign and malignant lesions).
3. For acute biliary infection, such as acute obstructive suppurative cholangitis, emergency biliary decompression and drainage are performed to convert emergency surgery into elective surgery.
4. Benign bile duct stricture, after multiple bile duct repairs, bile duct reconstruction and bile-enteric anastomotic strictures, etc.
5. Chemotherapy, radiotherapy, lithotripsy, cytological examination and percutaneous fiberoptic choledochoscopy for stone removal through the drainage tube.
2. Contraindications:
1. Similar to PTC, patients are allergic to iodine, have severe coagulation disorders, severe heart, liver, and kidney failure, and a large amount of ascites.
2. The intrahepatic bile duct is divided into multiple cavities by the tumor, which cannot drain the entire bile duct system.
3. Ultrasound examination confirmed the presence of a large fluid level in the liver and the Casoni test was positive, indicating hepatic echinococcosis.
3. Surgical steps:
1. Preoperative preparation, puncture method and PTC.
2. Perform PTC angiography using a 22-gauge fine needle to determine the location and nature of the lesion.
3. According to the angiography results, select a thicker, straighter, and horizontal bile duct for internal drainage cannulation.
4. Make a puncture point at the 8th-9th intercostal space on the right midaxillary line. After local anesthesia, use a sharp knife to poke a small hole in the skin. Ask the patient to hold his breath. Under television monitoring, quickly insert the needle into the pre-selected bile duct. After a breakthrough feeling of entering the bile duct, pull out the needle core. After the bile flows out smoothly, insert the guide wire, rotate and change the direction continuously, so that the guide wire passes through the obstruction end or stenosis segment into the distal bile duct or duodenum, withdraw the puncture needle, use the dilator to dilate the channel, and pass the multi-side hole catheter with the guide wire through the obstruction end or stenosis segment, so that the side hole of the catheter is located above or below the obstruction end or stenosis segment. Fix the catheter. After the bile flows out smoothly from the catheter, inject contrast agent and take a film.
5. After one week of drainage, angiography is performed again to observe the position of the catheter and the drainage effect.
IV. Clinical significance
1. PTCD can reduce pressure, jaundice, relieve symptoms, improve overall condition, perform elective surgery, increase surgical safety, reduce complications, and reduce mortality. It is particularly suitable for elderly patients, patients with physical weakness, poor overall condition, major organ dysfunction, and severe shock.
2. Flushing through the drainage tube, instillation of antibiotics, and multiple angiography can be performed.
3. Through the indwelling catheter, compound orange oil emulsion can be infused for lithotripsy, chemotherapy, radiotherapy, cytological examination, and trans-sinus cholangiofiberoscopy can also be used to remove stones.
The above is the relevant content about what percutaneous transhepatic biliary drainage is. If you use it in the future, you will have some understanding of it. Knowing more about medical methods is also a treasure for us.