Precautions during surgery for PTC

1. Avoid biliary hypertension caused by contrast agent injection because contrast agent and bile can leak into the abdominal cavity along the needle, resulting in local biliary peritonitis. Therefore, when the puncture needle enters the bile duct to extract bile, the bile should be extracted as far as possible to achieve decompression. If there is a pressure measuring equipment, the injection of contrast agent should not exceed the amount of bile extracted, and the bile should be extracted first, mixed in the syringe and then injected slowly. After angiography, the bile should be extracted as far as possible, even if there is a biliary blood fistula, the bile into the blood is less.

2. When puncture for prevention and treatment of needle duct biliary blood fistula enters a larger lumen, there is often an obvious sense of emptiness, which should be immediately aspirated. If it is easy to aspirate blood to prove that the needle tip is in the blood vessel, the needle should be withdrawn immediately.

3. Avoid the influence of viscous bile on angiography when biliary obstruction and infection, the viscosity of bile increases, and it is not easy to mix with contrast agent. In order to avoid misdiagnosis of viscous bile, a small amount of normal saline can be slowly injected to dilute, then withdrawn and diluted, repeated repeatedly until the color of bile is reduced, and contrast agent is injected for angiography. If the bile cannot be extracted or diluted, it is not suitable for immediate angiography. The drainage tube can be inserted 3-5 days later, and then angiography can be performed when the bile is diluted.

4. Pay attention to the concentration and uniformity of contrast agent in bile. Contrast agent is too strong, which can cover up small stones; Too light, the display is not clear, can be misdiagnosed.