Precautions in PTC Surgery

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 Therefore, when the needle enters the bile duct to extract bile, bile should be withdrawn as far as possible to achieve decompression. If there is pressure measuring equipment, the injection of contrast media should not exceed the amount of bile withdrawn, and the bile should be extracted first, mixed in the syringe, and then slowly injected.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

2. Prevention and treatment of needle duct biliary fistula when puncture enters the larger lumen, there is always obvious emptiness, which should be aspirated immediately. If blood is easily aspirated, the needle should be withdrawn immediately.

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to avoid misdiagnosis caused by thick bile, a small amount of normal saline can be injected slowly to dilute, and then withdrawn and diluted, repeatedly, until the bile color is reduced, contrast medium is injected for angiography.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

4. Pay attention to the concentration and uniformity of contrast medium in bile, which can cover up small stones; Too light, show not clear, can be misdiagnosed.

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