Percutaneous transhepatic biliary drainage (PTCD)

1. Malignant biliary obstruction caused by advanced tumors, palliative biliary drainage. 2. Preoperative preparation of patients with deep jaundice (including benign and malignant lesions). 3. Acute biliary tract infection, such as acute obstructive suppurative cholangitis, emergency biliary decompression and drainage, so that emergency surgery is converted to elective surgery. 4. Benign biliary stricture, multiple biliary repair, biliary reconstruction and biliary anastomotic stricture. 5. Through the drainage tube, chemotherapy, radiotherapy, lava, cytology and percutaneous fiber choledochoscopy. Treatment of diseases: hemolytic jaundice, cholestasis, jaundice Indication 1. Malignant biliary obstruction caused by advanced tumors, palliative biliary drainage. 2. Preoperative preparation of patients with deep jaundice (including benign and malignant lesions). 3. Acute biliary tract infection, such as acute obstructive suppurative cholangitis, emergency biliary decompression and drainage, so that emergency surgery is converted to elective surgery. 4. Benign biliary stricture, multiple biliary repair, biliary reconstruction and biliary anastomotic stricture. 5. Through the drainage tube, chemotherapy, radiotherapy, lava, cytology and percutaneous fiber choledochoscopy. Contraindications 1. Same as PTC, allergic to iodine, severe coagulopathy, severe heart, liver, kidney failure and a large number of ascites. 2. The intrahepatic bile duct is divided into multiple cavities by the tumor, and the entire bile duct system cannot be drained. 3. Ultrasound examination confirmed that there was a large fluid level in the liver, the Casoni test was positive, and the suspected hepatic echinococcosis. Preoperative preparation 1. Clean the enema one night before the angiography and give a sedative. 2. Give sedatives one hour before angiography, but morphine is forbidden to avoid confusion caused by Oedic sphincter spasm. 3. Before the angiography of the abdomen, observe whether there is an inflatable bowel under the liver to avoid accidental injury during puncture. 4. For iodine allergy test. 5. For the determination of prothrombin, such as prolongation should be given vitamin K to correct. 6. Preparing puncture needle: 5 or 6 slender needle, or puncture needle with length 15cm, outer diameter 0.7mm, inner diameter 0.5mm, needle bevel 30°, with strong magnetic needle core, or 76- 2 type plastic outer casing puncture needle, length 25 ~ 28cm, outer diameter 1.3mm, inner diameter 0.9mm. Surgical procedure 1. Preoperative preparation and puncture method and PTC. 2. First use the 22nd fine needle for PTC angiography to determine the location and nature of the lesion. 3. According to the angiographic results, a thicker, straight, horizontal bile duct is selected for use in the internal drainage cannula. 4. Another puncture point is made from the 8th intercostal space on the right side of the midline. After the local anesthesia, poke a small hole on the skin with a sharp knife. The paralyzed patient pauses breathing, and under the supervision of TV, the thick needle is quickly penetrated into the preselected bile duct. After the breakthrough feeling of entering the bile duct, the needle core is pulled out, and the guide wire is inserted after the bile flows smoothly, and the direction is continuously rotated and changed. The guide wire enters the distal bile duct or the duodenum through the obstructed end or the stenotic segment, exits the puncture needle, and after dilating the passage with the dilatation tube, the multi-lateral hole catheter is passed along the guide wire through the obstruction end or the narrow section, so that the side hole of the catheter is located The catheter is fixed above and below the obstructive or stenotic segment, and the bile is smoothly discharged from the catheter, and then the contrast agent is injected. 5. After one week of drainage, re-contrast to observe catheter position and drainage effect. complication At the same time, targeted and timely and effective care for patients with complications after surgery. Results Through a series of targeted nursing measures for patients, all patients' postoperative complications disappeared and they were discharged from hospital. Conclusions Cholangiocarcinoma often has various complications after PTCD. Effective, timely and targeted nursing methods can effectively treat postoperative complications.