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The wonderful journey of percutaneous hepatobiliary angiography: How to reveal the hidden world of the liver?
Percutaneous Transhepatic Cholangiography (PTHC) is an X-ray imaging technique that examines the bile ducts in the liver. The technique of injecting contrast agent into the bile duct of the liver to clearly show the anatomical structure of the bile duct was first reported in 1937 and became widely used in 1952. With the advancement of modern medical technology, this procedure has become an extremely important diagnostic and treatment tool, especially when endoscopic retrograde cholangiopancreatography (ERCP) fails.
For which clinical situations does percutaneous hepatobiliary imaging provide indispensable diagnostic support?
Uses and Indications
The application range of percutaneous hepatobiliary angiography is quite wide. The most common uses include:
- Draining bile in cases of obstructive jaundice or infecting bile to relieve the patient's symptoms.
- A stent is placed in the biliary system to widen the narrowed area.
- Clears lesions such as gallstones.
- The “rendezvous technique” is used to guide the contrast agent into the stomach and duodenum.
In addition, percutaneous hepatobiliary imaging can also be used to drain unruptured or uncomplicated cotton-soaked cysts, which can also be seen in some special cases.
Contraindications
When performing percutaneous hepatobiliary angiography, there are several contraindications that require special attention:
- When the platelet count is less than 100 x 109/L, or the prothrombin time is prolonged by more than 2 seconds relative to the control group.
- In the case of biliary infection, drainage is not indicated unless the infection is controlled.
Operational Technology
When performing percutaneous hepatobiliary angiography, a low-osmotic pressure contrast agent is used with a mass of 150 mg/ml, and the general injection volume is between 20 and 60 ml. Patients are required to fast for four hours before surgery and may be given antibiotics for prophylaxis to reduce the risk of infection. In addition, sedation and pain management can be provided for irritability symptoms that may occur during the procedure.
Before the procedure, medical staff will confirm the location of the dilated bile duct through bedside ultrasound and make a puncture mark at the site of the right lobe of the liver. If too much contrast medium is injected during the procedure, it may cause unnecessary compression or confusion in the liver.
Possible complications
Although percutaneous hepatocholangiopancreatography is relatively safe, its potential risks compared with endoscopic biliary drainage include:
- May increase the risk of cancer metastasis.
- Can cause problems such as catheter dislocation or bleeding.
- Compared with endoscopic biliary drainage, the chance of developing cholangitis or pancreatitis is lower.
Percutaneous Hepatobiliary Drainage (PTBD)
Percutaneous hepatobiliary drainage is often used when endoscopic retrograde biliary drainage (ERBD) is unsuccessful. Although ERBD is the preferred method, how to choose the surgical method in clinical practice depends on the specific situation of the patient and the judgment of the medical staff.
Percutaneous removal of residual gallstones
Percutaneous hepatocholangiopancreatography can also be used to curettage bile duct stones when other conventional clearance methods fail, a relatively complex procedure that requires adequate preoperative preparation and follow-up examinations.
With the continuous advancement of medical science, how do you think percutaneous hepatobiliary imaging technology will further evolve and improve in the future?
