Recently, Liu Bin, an ultrasound doctor at Tai’an Hospital of Traditional Chinese Medicine, completed a difficult case of percutaneous transhepatic biliary drainage (PTCD), marking a new level of ultrasound intervention in the hospital.
Patient Li, 60 years old, suffering from liver metastases from gastric cancer, the size of the intrahepatic tumor is about 60×58×40mm, the biliary system is dilated, the jaundice is obvious, the appetite is decreased, and the liver function: total biliary redness 216 umol/L of direct bilirubin, 175.2 umol/L of direct bilirubin, 40.8 umol/L of indirect bilirubin, 210 U/L of alanine aminotransferase, and 291 U/L of aspartate aminotransferase. After multidisciplinary consultation, it was decided to perform bedside PTCD to relieve the patient’s jaundice, improve liver function, relieve the patient’s symptoms, and create conditions for later stent placement. Comprehensive patient data, excluding contraindications, the patient meets the indications for PTCD surgery. Ultrasonography revealed that the intrahepatic bile duct and blood vessels ran abnormally due to tumor compression, the blood vessels in front of the bile duct in the right hepatic lobe were disordered, and the lower border of the lung was too low to avoid the costophrenic angle, and there was no safe puncture path; although the width and location of the bile duct in the left hepatic lobe were suitable for puncture , but tortuous and unfavorable for later stent placement.
Through the above analysis, it is concluded that the operation has the following difficulties:The tumor is large, resulting in abnormal course of intrahepatic blood vessels and bile ducts, especially at the confluence of the left and right hepatic ducts. It is in a right-angle relationship, and it is difficult for the drainage tube to enter the common bile duct; the operation needs to avoid the tumor and important blood vessels.
After the ultrasound interventional evaluation, it was decided to implement PTCD. The right midclavicular line intercostal puncture was selected as the body surface puncture point, and the left and right hepatic ducts into the liver were selected as the target bile duct puncture point. Head Office. At the same time, in order to avoid the tumor, choose to puncture the gap between the tumor and the gallbladder, and make a small detour.
The highlights of this operation are: 1. Non-linear puncture path, fine-tuning the puncture needle, small adjustment to bypass the tumor, and walking along the narrow gap between the tumor edge and the gallbladder. 2. The target bile duct puncture point is selected at the confluence of the left and right hepatic ducts, and the drainage tube directly enters the common hepatic duct and common bile duct, which is convenient for later stent placement. 3. The puncture point of the target bile duct is deep, the puncture path is long, and the distance from the skin is about 11cm.
The patient’s general condition improved rapidly after PTCD, the jaundice was significantly relieved, and the blood indexes such as “bilirubin and transaminase” decreased significantly 5 days after the operation. It laid the foundation for the follow-up further treatment.
PTCD is a tertiary surgery, which is a relatively difficult technique in ultrasound interventional therapy. It requires the ultrasound interventionist to be extremely precise in intrahepatic bile duct puncture to reduce bleeding and bile leakage. risk.
Under normal circumstances, most patients with biliary obstruction need various treatments to relieve jaundice, improve liver function, create opportunities for subsequent treatment, and provide access. Ultrasound-guided PTCD can monitor the entire surgical process in real time, with less trauma, short duration, low cost, and no radiation. It is the preferred surgical method at present.
Liu Bin, an ultrasound doctor at Tai’an Hospital of Traditional Chinese Medicine, can now independently perform techniques such as biopsy of various parts, catheterization and drainage (sclerosis), and bedside surgery for some critically ill patients. Interventional surgery reduces the risk of repeated patient movement and transportation. In particular, the successful implementation of bedside highly difficult PTCD not only meets the patient’s requirements for refined and minimally invasive medical treatment, but also promotes the development of related disciplines. The Ultrasound Department will continue to carry out various ultrasound interventional technologies to provide convenience for clinical practice and precise treatment for patients!
Ultrasound intervention is currently engaged in the following businesses:
1. Needle biopsy: biopsy of abdominal organs such as liver and kidney tumor biopsy, breast needle biopsy , Thyroid fine needle and coarse needle biopsy, lymph node and various types of surface mass biopsy.
2. Intubation and drainage: abscesses in various parts (such as liver abscess, suppurative cholecystitis, abdominal abscess, etc.), percutaneous transhepatic biliary drainage (PTCD), Percutaneous transhepatic puncture and drainage of the gallbladder (PTGD), diagnostic puncture and drainage of thoracoabdominal microfluid, puncture and drainage of irregularly distributed encapsulated effusion (pus) in the thoracic and abdominal cavity, peripheral vein puncture and catheterization Wait.
3. Cyst sclerosis: liver cyst, kidney cyst, chocolate cyst, ovarian cyst, thyroid cyst, etc.
4. Tumor ablation categories: thyroid nodules, liver tumors, breast nodules, etc.
Address: Ultrasound Department, Second Floor, Tai’an Hospital of Traditional Chinese Medicine
Tel: 0538—6111263 (Correspondent: Zhang Nan)
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