Percutaneous Transhepatic Cholangiography and Drainage Anatomy Diameter of

經皮穿肝膽道引流術 Percutaneous Transhepatic Cholangiography and Drainage

Anatomy

Diameter of common bile duct l l Normal patient ---- less than 4 mm. Obstructive jaundice --- greater than 11 mm. Highly suspicious --- between 7 to 11 mm. But if C/P greater than 1 --- significant of obstructive jaundice

Gallbladder l 底部（fundus） l 體部（body） l 頸部（neck）

Gallbladder wall thickness l Normal distended GB-----1 -2 mm a single echogenic layer l Physiologically contracted GB 3 -4 mm

Pathology 阻塞性黃疸 原因： 良性 l 結石 l 膽管炎或術後造成的 狹窄 l 膽道出血 惡性 l CBD tumor l Pancreatic head ca l Ampular vater ca l HCC (tumor thrombus)

Chief complain l l Yellowish skin Tea color urine Clay color stool Skin itching Lab data l l l Total bilirubin Alkaline-P WBC

Preparation l l l Visiting patient and check lab. Data. Review previous radiological examination. Antibiotic prophylaxis (IV). permit Analgesic / sedative premedication NPO 4~6 hours

Materials l N/S • AIC • 對比劑 • Xylocaine

l chiba needle • Telfon-needle/sheath • 6#cruiser

Guilde Wire l PTCD包 Connecting tube

l Dilator Pig-tail PTCS

Pre-PTCD imaging study l l l Chest film Plain KUB Sonography Computed tomography ERCP MRCP

l l l Skin Pleura Peritoneum Liver capsule Bile duct

Procedure l 超音波定位 l plain film l 消毒 l 局部麻醉

Post procedure care l Bed rest Check Bp and vital sign Wound care Record bile drained amount Record bile color change l Check serum bilirubin l l

Complications l l l Bleeding Sepsis Bile leakage, bile peritonitis Hepatic arterial injury Pneumothorax, biliary pleural fistula Death

Case l 69歲 女性 Pancreatic ca.

l 79歲 女性 PTGBD

Thank You for Your Attention!