1、超聲引導下經皮肝穿刺膽道引流 Percutaneous Transhepatic Cholangiography and Drainage夏喜剛 楊志奇 孫振綱申報科室：肝膽外科2012年12月12日Purpose當膽道因結石或腫瘤造成阻塞，膽汁無法引流到十二指腸，為避免膽汁滯留而造成感染，必須將膽汁引流。經皮穿肝膽道引流術即在超音波或X光透視下，在上腹經過皮膚及肝臟放置一條引流管到肝內的膽管或膽囊，來達到引流膽汁的目的 。 Anatomy 膽汁的流向肝細胞分泌膽汁微膽管膽小管膽管左右肝管總肝管膽囊管總膽管胰管肝胰壺腹開口於十二指腸乳頭(歐迪氏括約肌)Diameter of common bi

2、le ductNormal patient - less than 4 mm.Obstructive jaundice - greater than 11 mm.Highly suspicious - between 7 to 11 mm.Gallbladder底部（fundus）體部（body）頸部（neck） Pathology 阻塞性黃疸原因：良性結石膽管炎或術后造成的狹窄膽道出血惡性CBD tumorPancreatic head caAmpular vater caHCC (tumor thrombus)Indication因結石或腫瘤引起的膽道阻塞。外傷或開刀引起的膽道挫傷及膽汁外

3、漏。放置金屬支架之前置步驟。膽管內置放射線治療之前置步驟。外科取石PreparationVisiting patient and check lab. Data.Review previous radiological examination.Antibiotic prophylaxis (IV).Analgesic / sedative premedicationNPO 46 hoursMaterialsN/SXylocaineAIC造影劑chiba needleTelfon-needle/sheath6#cruiserPTCD包Guilde WireConnecting tubePre-P

4、TCD imaging studyChest filmPlain KUBSonographyComputed tomographyERCPMRCPMethods穿刺右葉肝內膽管穿刺左葉肝內膽管穿刺膽囊方法 內留置管引流法 Procedure穿刺達定位后拔內針打造影劑找膽道抽Bile放Guide WirePost procedure careBed restCheck Bp and vital signWound careRecord bile drained amountRecord bile color changeCheck serum bilirubin ComplicationsBleedingSepsisBile leakage, bile peritonitisHepatic arterial injuryP