Percutaneous transhepatic cholangiography (PTC) is an invasive radiopaque examination of the bile ducts after they are directly filled with an iodine-containing contrast agent. PTC is indicated to identify the causes of pain syndrome after cholecystectomy, to determine the level, severity and nature of obstruction of the biliary tract in jaundice (concretion, tumor, stricture). Percutaneous puncture of the abdominal wall is performed under local tissue infiltration by anesthetic and X-ray control. A puncture needle is directed to the liver gate and installed in the lumen of the intrahepatic bile duct. After contrast is introduced, polypositional radiographs are performed.
Indications
- Syndrome of mechanical jaundice caused by a tumor lesion of the organs of the hepatobiliary zone (tumors of the pancreas, duodenum, bile duct, gallbladder, etc.);
- Syndrome of mechanical jaundice caused by postoperative cicatricial narrowing (stricture) of the bile duct.
It should be noted that the priority methods of resolving mechanical jaundice are endoscopic (retrograde) methods of treatment, such as endoscopic retrograde cholangio-pancreatography (ERCP), endoscopic papillosphincterotomy (EPST), endostenting of the bile ducts. However, performing these operations is not always possible due to various reasons. These include: previous operations on the stomach and duodenum 12 (gastric resection, gastrectomy, pancreato-duodenal resection, etc.), tumor lesion or deformation of the duodenum 12, the impossibility of retrograde overcoming the narrowing site in the bile duct, anatomical features of the patient’s structure, the extreme severity of the patient’s condition. In such cases, indications are given for performing percutaneous-transhepatic (antegrade) intervention.
Contraindications
- Ascites (presence of free fluid in the abdomen);
- Multiple metastatic liver damage;
- Blood clotting disorder (hypocoagulation);
- Inability to perform (obesity 4 art.).
Methods of conducting
Special preoperative preparation is not required to perform percutaneous transhepatic cholangiography. The patient should not take food and liquids 4-6 hours before the intervention. 30-40 minutes before the start of the operation, the patient is premedicated, including painkillers and sedatives (sedatives). Most often, the intervention is performed under local anesthesia and does not require anesthesia. The only indication for general anesthesia is a polyvalent drug allergy with intolerance to local anesthetics (Novocaine, Lidocaine). The duration of the procedure can vary from 30 minutes to 2 hours.
There are several types of percutaneous transhepatic operations on the biliary tract:
- External drainage of the biliary tract (percutaneous transhepatic cholangiostomy);
- External-internal biliduodenal drainage;
- Rendez-Vous operations;
- Percutaneous transhepatic bilioduodenal stenting.
