Indications Of PTCD

Palliative care of malignant biliary tumors

Obstructive jaundice can be caused by pancreatic head cancer, ampullary cancer, and biliary malignancy. Most of these patients are elderly, or accompanied by basic heart, brain and lung diseases, and most of them are found in the late stage, unable to tolerate surgery or have no opportunity for surgery. Biliary obstruction can cause increased biliary pressure, resulting in yellow skin sclera staining; It can also cause swelling of liver cells, resulting in impaired liver cell function and even multiple organ dysfunction. At this time, bile drainage can reduce the biliary pressure, improve liver function, relieve the pain of patients, improve the quality of life of patients. Bile drainage methods include percutaneous puncture, endoscopic bile drainage (EPD) and choledojejunostomy. Among them, PTCD is widely used. PTCD can drain bile through internal and external drainage. For patients with malignant obstructive jaundice, the guide wire is not easy to narrow during the operation, and simple external drainage is more common. The distal end of the multi-lateral fora catheter can achieve internal drainage through stenosis, which is similar to physical bile drainage. Compared with external drainage, this method has less bile loss and less impact on intestinal function, so it is more respected. Stent placement through PTCD tube can also achieve internal drainage through the narrow segment, which has become an important palliative therapy for the treatment of biliary malignancy. In addition, further radiotherapy after PTCD implantation with I particles through catheter is also clinically effective.

Biliary decompression in acute suppurative cholangitis

Acute suppurative cholangitis (AOSC) is a serious threat to the life of patients, and the most common disease is bile duct calculi, followed by tumor. Once diagnosed, biliary obstruction should in principle be removed urgently and the pressure in the bile duct should be reduced. PTCD, EBD or surgical treatment can relieve biliary obstruction, achieve biliary decompression, to achieve the purpose of treatment. Among them, PTCD can make many high-risk, elderly, unable to tolerate surgery through the risk period, creating conditions for elective surgery, thus greatly reducing the case fatality rate of elective surgery, because of its relatively simple operation, small damage, the curative effect is worthy of praise and other advantages, PTCD treatment of AOSC is worth promoting.

Preoperative preparation for biliary tract disease

Due to cholestasis, patients with biliary calculi or tumors may have poor liver function, jaundice, low plasma protein, poor coagulation and immune function, even cholangitis, pancreatitis and other manifestations, which may delay the time of surgery and affect the outcome of surgery. PTCD and other preoperative bile drainage methods can relieve cholestasis, improve liver function, regulate coagulation and immune function, and reduce the time of preoperative preparation.

The fibrous sinus tract formed by PTCD tube can be treated by percutaneous transhepatic choledochoscopy (PTCS) for patients with inoperable intrahepatic and intrahepatic bile duct calculi. It usually takes 4 to 6 weeks to form mature fibrous sinus tract after catheterization.

According to the above contents and the quality improvement guidelines of PTCD in 2010, the indications were summarized: (1) Malignant obstructive jaundice requires palliative biliary decompression; (2) Benign biliary stricture or acute cholangitis requires biliary drainage decompression; (3) The biliary tract operation should be prepared before the operation of yellowing; (4) Percutaneous biliary entrance stent implantation, dilatation of narrow biliary tract, removal of stone or foreign body, brachytherapy; (5) Percutaneous biliary entrance cholangiography or pathological biopsy is required for the diagnosis of biliary diseases.