超声引导下经皮肝穿刺胆道引流课件

超声引导下经皮肝穿刺胆道引流

PercutaneousTranshepatic

Cholangiographyand

Drainage夏喜刚杨志奇孙振纲申报科室：肝胆外科2012年12月12日超声引导下经皮肝穿刺胆道引流

PercutaneousT1Purpose当胆道因结石或肿瘤造成阻塞，胆汁无法引流到十二指肠，为避免胆汁滞留而造成感染，必須將胆汁引流。经皮穿肝胆道引流术即在超音波或X光透視下，在上腹经过皮肤及肝脏放置一条引流管到肝內的胆管或胆囊，来达到引流胆汁的目的。Purpose当胆道因结石或肿瘤造成阻塞，胆汁无法引流到十二2

Anatomy

Anatomy3超声引导下经皮肝穿刺胆道引流课件4超声引导下经皮肝穿刺胆道引流课件5胆汁的流向肝细胞分泌胆汁→微胆管→胆小管→胆管→左右肝管→总肝管→胆囊管→总胆管→胰管→肝胰壺腹→開口於十二指腸乳頭(歐迪氏括約肌)胆汁的流向肝细胞分泌胆汁→6DiameterofcommonbileductNormalpatient----lessthan4mm.Obstructivejaundice---greaterthan11mm.Highlysuspicious---between7to11mm.DiameterofcommonbileductNo7Gallbladder底部（fundus）体部（body）颈部（neck）Gallbladder8GallbladderwallthicknessNormaldistendedGB------1-2mmasingleechogeniclayerPhysiologicallycontractedGB3-4mmGallbladderwallthicknessNorm9Pathology

阻塞性黃疸原因：良性结石胆管炎或术后造成的狭窄胆道出血恶性CBDtumorPancreaticheadcaAmpularvatercaHCC(tumorthrombus)Pathology10ChiefcomplainYellowishskinTeacolorurineClaycolorstoolSkinitchingLabdataTotalbilirubinAlkaline-PWBCChiefcomplainLabdata11Indication因结石或肿瘤引起的胆道阻塞。外傷或开刀引起的胆道挫傷及胆汁外漏。放置金属支架之前置步骤。胆管內置放射线治疗之前置步骤。外科取石Indication因结石或肿瘤引起的胆道阻塞。12Contraindication凝血功能不佳腹水广泛转移性肝肿瘤造成阻塞性黄疸癌末病人Contraindication凝血功能不佳13PreparationVisitingpatientandchecklab.Data.Reviewpreviousradiologicalexamination.Antibioticprophylaxis(IV).Analgesic/sedativepremedicationNPO4~6hoursPreparationVisitingpatientan14MaterialsN/SXylocaineAIC造影剂MaterialsN/SXylocaineAIC造影剂15chibaneedleTelfon-needle/sheath6#cruiserchibaneedleTelfon-needle/shea16PTCD包GuildeWireConnectingtubePTCD包GuildeWireConnectingtub17超声引导下经皮肝穿刺胆道引流课件18Tie橡皮管引流袋Tie橡皮管引流袋19Pre-PTCDimagingstudyChestfilmPlainKUBSonographyComputedtomographyERCPMRCPPre-PTCDimagingstudyChestfi20Methods穿刺右叶肝內胆管穿刺左葉肝內胆管穿刺胆囊方法內留置管引流法Methods穿刺右叶肝內胆管21Procedure超音波定位plainfilm消毒局部麻醉Procedure超音波定位22ProcedureProcedure23穿刺达定位后拔內针打造影剂找胆道抽Bile放GuideWire穿刺24打造影剂做胆道造影放pig-tail引流袋固定打造影剂做胆道造影25PostprocedurecareBedrestCheckBpandvitalsignWoundcareRecordbiledrainedamountRecordbilecolorchangeCheckserumbilirubin

PostprocedurecareBedrest26ComplicationsBleedingSepsisBileleakage,bileperitonitisHepaticarterialinjuryPneumothorax,biliarypleuralfistulaDeathComplicationsBleeding27PTCD的优缺点优点易执行取结石缺点疼痛出血、感染PTCD的优缺点优点28ThankYouforYourAttention!ThankYouforYourAttention!29超声引导下经皮肝穿刺胆道引流

PercutaneousTranshepatic

Cholangiographyand

Drainage夏喜刚杨志奇孙振纲申报科室：肝胆外科2012年12月12日超声引导下经皮肝穿刺胆道引流

PercutaneousT30Purpose当胆道因结石或肿瘤造成阻塞，胆汁无法引流到十二指肠，为避免胆汁滞留而造成感染，必須將胆汁引流。经皮穿肝胆道引流术即在超音波或X光透視下，在上腹经过皮肤及肝脏放置一条引流管到肝內的胆管或胆囊，来达到引流胆汁的目的。Purpose当胆道因结石或肿瘤造成阻塞，胆汁无法引流到十二31

Anatomy

Anatomy32超声引导下经皮肝穿刺胆道引流课件33超声引导下经皮肝穿刺胆道引流课件34胆汁的流向肝细胞分泌胆汁→微胆管→胆小管→胆管→左右肝管→总肝管→胆囊管→总胆管→胰管→肝胰壺腹→開口於十二指腸乳頭(歐迪氏括約肌)胆汁的流向肝细胞分泌胆汁→35DiameterofcommonbileductNormalpatient----lessthan4mm.Obstructivejaundice---greaterthan11mm.Highlysuspicious---between7to11mm.DiameterofcommonbileductNo36Gallbladder底部（fundus）体部（body）颈部（neck）Gallbladder37GallbladderwallthicknessNormaldistendedGB------1-2mmasingleechogeniclayerPhysiologicallycontractedGB3-4mmGallbladderwallthicknessNorm38Pathology

阻塞性黃疸原因：良性结石胆管炎或术后造成的狭窄胆道出血恶性CBDtumorPancreaticheadcaAmpularvatercaHCC(tumorthrombus)Pathology39ChiefcomplainYellowishskinTeacolorurineClaycolorstoolSkinitchingLabdataTotalbilirubinAlkaline-PWBCChiefcomplainLabdata40Indication因结石或肿瘤引起的胆道阻塞。外傷或开刀引起的胆道挫傷及胆汁外漏。放置金属支架之前置步骤。胆管內置放射线治疗之前置步骤。外科取石Indication因结石或肿瘤引起的胆道阻塞。41Contraindication凝血功能不佳腹水广泛转移性肝肿瘤造成阻塞性黄疸癌末病人Contraindication凝血功能不佳42PreparationVisitingpatientandchecklab.Data.Reviewpreviousradiologicalexamination.Antibioticprophylaxis(IV).Analgesic/sedativepremedicationNPO4~6hoursPreparationVisitingpatientan43MaterialsN/SXylocaineAIC造影剂MaterialsN/SXylocaineAIC造影剂44chibaneedleTelfon-needle/sheath6#cruiserchibaneedleTelfon-needle/shea45PTCD包GuildeWireConnectingtubePTCD包GuildeWireConnectingtub46超声引导下经皮肝穿刺胆道引流课件47Tie橡皮管引流袋Tie橡皮管引流袋48Pre-PTCDimagingstudyChestfilmPlainKUBSonographyComputedtomographyERCPMRCPPre-PTCDimagingstudyChestfi49Methods穿刺右叶肝內胆管穿刺左葉肝內胆管穿刺胆囊方法內留置管引流法Methods穿刺右叶肝內胆管50Procedure超音波定位plainfilm消毒局部麻醉Procedure超音波定位51ProcedureProcedure52穿刺达定位后拔內针打造影剂找胆道抽Bile放GuideWire穿刺53打造影剂做胆道造影放pig-tail引流袋固定打造影剂做胆道造影54PostprocedurecareBedrestCheckBpandvitalsignWoundcareRecordbiledrainedamountRecordbilecolorchangeCheckserumbilirubin

PostprocedurecareBedrest55Compl