经皮穿肝胆道引流术PercutaneousTranshepatic课件

Purpose當膽道因結石或腫瘤造成阻塞，膽汁無法流到十二指腸，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。Purpose當膽道因結石或腫瘤造成阻塞，膽汁無法流到十二指

Anatomy

Anatomy经皮穿肝胆道引流术PercutaneousTranshepatic课件经皮穿肝胆道引流术PercutaneousTranshepatic课件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)膽汁的流向肝細胞分泌膽汁→DiameterofcommonbileductNormalpatient----lessthan4mm.Obstructivejaundice---greaterthan11mm.Highlysuspicious---between7to11mm.ButifC/Pgreaterthan1---significantofobstructivejaundiceDiameterofcommonbileductNoGallbladder底部（fundus）體部（body）頸部（neck）GallbladderGallbladderwallthicknessNormaldistendedGB------1-2mmasingleechogeniclayerPhysiologicallycontractedGB3-4mmGallbladderwallthicknessNormPathology

阻塞性黃疸原因：良性結石膽管炎或術後造成的狹窄膽道出血惡性CBDtumorPancreaticheadcaAmpularvatercaHCC(tumorthrombus)PathologyChiefcomplainYellowishskinTeacolorurineClaycolorstoolSkinitchingLabdataTotalbilirubinAlkaline-PWBCChiefcomplainLabdataIndication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Indication因結石或腫瘤引起的膽道阻塞。Contraindication凝血功能不佳腹水廣泛轉移性肝腫瘤造成阻塞性黃膽癌末病人Contraindication凝血功能不佳PreparationVisitingpatientandchecklab.Data.Reviewpreviousradiologicalexamination.Antibioticprophylaxis(IV).permitAnalgesic/sedativepremedicationNPO4~6hoursPreparationVisitingpatientanMaterialsN/SXylocaineAIC對比劑MaterialsN/SXylocaineAIC對比劑chibaneedleTelfon-needle/sheath6#cruiserchibaneedleTelfon-needle/sheaPTCD包GuildeWireConnectingtubePTCD包GuildeWireConnectingtubDilatorPig-tailPTCSDilatorPig-tailPTCSTie橡皮管小腿尿袋Tie橡皮管小腿尿袋Pre-PTCDimagingstudyChestfilmPlainKUBSonographyComputedtomographyERCPMRCPPre-PTCDimagingstudyChestfiMethods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Methods穿刺右葉肝內膽管SkinPleuraPeritoneumLivercapsuleBileductSkinProcedure超音波定位plainfilm消毒局部麻醉Procedure超音波定位穿刺達定位後拔內針打顯影劑找膽道抽Bile放GuideWire穿刺打顯影劑做膽道攝影放pig-tail引流袋固定打顯影劑做膽道攝影PostprocedurecareBedrestCheckBpandvitalsignWoundcareRecordbiledrainedamountRecordbilecolorchangeCheckserumbilirubin

PostprocedurecareBedrestComplicationsBleedingSepsisBileleakage,bileperitonitisHepaticarterialinjuryPneumothorax,biliarypleuralfistulaDeathComplicationsBleedingPTCD的優缺點優點易執行取結石缺點疼痛出血、感染PTCD的優缺點優點Case69歲女性Pancreaticca.Case69歲女性Pancreaticca.经皮穿肝胆道引流术PercutaneousTranshepatic课件经皮穿肝胆道引流术PercutaneousTranshepatic课件71歲男性71歲男性经皮穿肝胆道引流术PercutaneousTranshepatic课件79歲女性PTGBD79歲女性PTGBD56歲女性56歲女性经皮穿肝胆道引流术PercutaneousTranshepatic课件References醫用解剖學(劉紹東等人編譯)膽道結石症之介入性放射檢查(姜仁惠)台北榮民總醫院放射線部。放射診療訓練暨作業手冊.tw.tw/38806.htmReferences醫用解剖學(劉紹東等人編譯)ThankYouforYourAttention!ThankYouforYourAttention!Purpose當膽道因結石或腫瘤造成阻塞，膽汁無法流到十二指腸，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。Purpose當膽道因結石或腫瘤造成阻塞，膽汁無法流到十二指

Anatomy

Anatomy经皮穿肝胆道引流术PercutaneousTranshepatic课件经皮穿肝胆道引流术PercutaneousTranshepatic课件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)膽汁的流向肝細胞分泌膽汁→DiameterofcommonbileductNormalpatient----lessthan4mm.Obstructivejaundice---greaterthan11mm.Highlysuspicious---between7to11mm.ButifC/Pgreaterthan1---significantofobstructivejaundiceDiameterofcommonbileductNoGallbladder底部（fundus）體部（body）頸部（neck）GallbladderGallbladderwallthicknessNormaldistendedGB------1-2mmasingleechogeniclayerPhysiologicallycontractedGB3-4mmGallbladderwallthicknessNormPathology

阻塞性黃疸原因：良性結石膽管炎或術後造成的狹窄膽道出血惡性CBDtumorPancreaticheadcaAmpularvatercaHCC(tumorthrombus)PathologyChiefcomplainYellowishskinTeacolorurineClaycolorstoolSkinitchingLabdataTotalbilirubinAlkaline-PWBCChiefcomplainLabdataIndication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Indication因結石或腫瘤引起的膽道阻塞。Contraindication凝血功能不佳腹水廣泛轉移性肝腫瘤造成阻塞性黃膽癌末病人Contraindication凝血功能不佳PreparationVisitingpatientandchecklab.Data.Reviewpreviousradiologicalexamination.Antibioticprophylaxis(IV).permitAnalgesic/sedativepremedicationNPO4~6hoursPreparationVisitingpatientanMaterialsN/SXylocaineAIC對比劑MaterialsN/SXylocaineAIC對比劑chibaneedleTelfon-needle/sheath6#cruiserchibaneedleTelfon-needle/sheaPTCD包GuildeWireConnectingtubePTCD包GuildeWireConnectingtubDilatorPig-tailPTCSDilatorPig-tailPTCSTie橡皮管小腿尿袋Tie橡皮管小腿尿袋Pre-PTCDimagingstudyChestfilmPlainKUBSonographyComputedtomographyERCPMRCPPre-PTCDimagingstudyChestfiMethods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Methods穿刺右葉肝內膽管SkinPleuraPeritoneumLivercapsuleBileductSkinProcedure超音波定位plainfilm消毒局部麻醉Procedure超音波定位穿刺達定位後拔內針打顯影劑找膽道抽Bile放GuideWire穿刺打顯影劑做膽道攝影放pig-tail引流袋固定打顯影劑做膽道攝影PostprocedurecareBedrestCheckBpandvitalsignWoundcareRecordbiledrainedamountRecordbilecolorchangeCheckserumbilirubin

PostprocedurecareBedrestComplicationsBleedingSepsisBileleakage,bileperitonitisHepaticarterialinjuryPneumothorax,biliarypleuralfistulaDeathComplicationsBleedingPTCD的優缺點優點易執行取結石缺點疼痛出血、感染PTCD的優缺點優點Case69歲女性Pancreaticca.Case69歲女性Pancreaticca.经皮穿肝胆道引流术PercutaneousTranshepatic课件经皮穿肝胆道引流术PercutaneousTranshepatic课件71歲男性71歲男性经皮穿肝胆道引流术Perc