Surgical Procedures For PTC
Sep 14, 2022
2. The puncture site of the transabdominal puncture method was selected under the right costal margin, the puncture point was 2cm below the xiphoid process, 2cm to the right of the midabdominal line, and the puncture point was at a 40° Angle with the mesa, and the puncture point was directly stabbed to the liver. The appropriate puncture needle should be 12cm long. This method is applicable to patients with liver enlargement.
3. Extraperitoneal puncture is performed through the bare area behind the liver. Because this bare area remains constant even when the liver is enlarged; There is no injury to vital organs, biliary peritonitis or intraperitoneal hemorrhage. Right phrenic nerve block was performed before angiography. Methods: the anterior margin of sternocleidomastoid muscle was 2 ~ 3cm above the right clavicle, and the range of motion was decreased with 2% increase, indicating that phrenic nerve block was effective.
Then the patient was placed in the prone position, and conventional local anesthesia was performed at the upper edge of the right 11 ribs, 6-7cm from the posterior median line. The liver was punctured with a 15cm-long puncture needle, with the needle slightly pointing inward. When the needle penetrated 10-12cm, the needle was withdrawn by the above method, and bile was extracted to indicate successful puncture [FIG. 1].
The injection of contrast medium and the procedure of film taking were the same as before.
This approach is far less successful than the transaxillary approach.
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