超声引导下经皮肝穿刺胆道引流培训.ppt

按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。,Purpose,当,胆道,因结石或肿瘤造成,阻塞,，,胆汁无法引流到十二指肠，为避免胆汁滞留而造成感染，必須將胆汁,引流,。,经皮穿肝胆道引流术即在超音波或X光透視下，在上腹经过皮肤及肝脏放置一条引流管到肝內的胆管或胆囊，来达到引流胆汁的目的。,Anatomy,胆汁的流向,肝,细胞,分泌,胆汁,微,胆管,胆,小管,胆,管,左右肝管,总,肝管,胆囊,管,总胆,管,胰管,肝胰壺腹,開口於十,二指腸乳頭,(,歐迪氏括約,肌,),Diameter of common bile duct,Normal patient-less than 4 mm.,Obstructive jaundice-greater than 11 mm.,Highly suspicious-between 7 to 11 mm.,Gallbladder,底部（fundus）,体部（body）,颈部（neck）,Gallbladder wall thickness,Normal distended GB-1-2 mm a single echogenic layer,Physiologically contracted GB 3-4 mm,Pathology,阻塞性黃疸,原因：,良性,结石,胆管炎或术后造成的狭窄,胆道出血,恶性,CBD tumor,Pancreatic head ca,Ampular vater ca,HCC(tumor thrombus),Chief complain,Yellowish skin,Tea color urine,Clay color stool,Skin itching,Lab data,Total bilirubin,Alkaline-P,WBC,Indication,因,结石或肿瘤引起的胆道阻塞。,外傷或开刀引起的胆道挫傷及胆汁外漏。,放置金属支架之前置步骤。,胆管內置放射线治疗之前置步骤。,外科取石,Contraindication,凝血功能不佳,腹水,广泛转移性肝肿瘤造成阻塞性黄疸,癌末病人,Preparation,Visiting patient and check lab.Data.,Review previous radiological examination.,Antibiotic prophylaxis(IV).,Analgesic/sedative premedication,NPO 46 hours,Materials,N/S,Xylocaine,AIC,造影剂,chiba needle,Telfon-needle/sheath,6#cruiser,PTCD包,Guilde Wire,Connecting tube,Tie,橡皮管,引流袋,Pre-PTCD imaging study,Chest film,Plain KUB,Sonography,Computed tomography,ERCP,MRCP,Methods,穿刺右,叶肝內胆管,穿刺左葉肝內,胆管,穿刺,胆囊方法,內留置管引流法,Procedure,超音波定位,plain film,消毒,局部麻醉,Procedure,穿刺,达定位后拔內针,打造影剂找胆道,抽Bile,放Guide Wire,打,造影剂做胆道造影,放pig-tail,引流袋固定,Post procedure care,Bed rest,Check Bp and vital sign,Wound care,Record bile drained amount,Record bile color change,Check serum bilirubin,Complications,Bleeding,Sepsis,Bile leakage,bile peritonitis,Hepatic arterial injury,Pneumothorax,biliary pleural fistula,Death,PTCD,的,优缺点,优点,易执行,取结石,缺点,疼痛,出血、感染,Thank You for Your Attention!,