Percutaneous transhepatic cholangiogram

定义

A percutaneous transhepatic cholangiogram (PTC) is an x射线 胆管的一部分. 的se are the tubes that carry 胆汁 from the liver to the gallbladder and small intestine.

选择的名字

PTC; Cholangiogram - PTC; PTC; PBD - Percutaneous biliary drainage; Percutaneous transhepatic cholangiography

如何执行测试

的 test is performed in a radiology department by an interventional radiologist.

You will be asked to lie on your back on the x射线 table. 的 provider will clean the upper right and middle area of your belly area and then apply a numbing medicine.

X-rays and ultrasound are used to help the health care provider locate your liver and 胆汁 ducts. A long, thin, flexible needle is then inserted through the skin into the liver. 的 provider injects dye, called contrast medium, into the 胆汁 ducts. Contrast helps highlight certain areas so they can be seen. More x射线s are taken as the dye flows through the 胆汁 ducts into the small intestine. This can be seen on a video monitor.

You will be given medicine to calm you (sedation) for this procedure. Rarely, you may receive general anesthesia, so you will be asleep.

如何准备考试

Inform your provider if you are pregnant or have a bleeding disorder.

You will be given a hospital gown to wear and you will be asked to remove all jewelry.

You will be asked not to eat or drink anything for 6 hours prior to the exam.

Tell your provider if you are taking any blood thinners such as Warfarin (coumadin), Plavix(氯吡格雷), Pradaxa, 或Xarelto.

考试的感觉如何

的re will be a sting as the anesthetic is given. You may have some discomfort as the needle is advanced into the liver. You will have sedation for this procedure.

为什么要进行测试

This test can help diagnose the cause of a 胆汁 duct blockage.

Bile is a liquid released by the liver. It contains cholesterol, 胆汁 salts, and waste products. Bile salts help your body break down (digest) fats. A blockage of the 胆汁 duct can lead to jaundice (yellow discoloration of the skin), 皮肤瘙痒, 或者肝脏感染, 胆囊或胰腺.

当它执行时, PTC is most often the first part of a two-step process to relieve or treat a blockage.

• 的 PTC makes a "roadmap" 胆管的一部分, which can be used to plan the treatment.
• 在路线图完成之后, the blockage can be treated by either placing a stent or a thin tube called a drain.
• 的 drain or stent will help the body get rid of the 胆汁 from the body. That process is called percutaneous biliary drainage (PTBD).

正常的结果

的 胆汁 ducts are normal in size and appearance for the age of the person.

异常结果意味着什么

的 results may show that the ducts are enlarged. This may mean the ducts are at least partially blocked. 的 blockage may be caused by scarring or stones. It may also indicate cancer in the 胆汁 ducts, liver, pancreas, or gallbladder.

风险

的re is a slight chance of an allergic reaction to the contrast medium (iodine). 还有一个小风险是:

• 对附近器官的损害
• 肝脏损伤
• 失血过多
• 血液中毒(败血症)
• 胆管炎胆管炎
• 感染

注意事项

大多数时候, this test is done after an endoscopic retrograde cholangiopancreatography (ERCP) test has been tried first. 的 PTC may be done if an ERCP test cannot be performed or has failed to clear the blockage.

A magnetic resonance cholangiopancreatography (MRCP) is another, 无创成像法, based on magnetic resonance imaging (核磁共振成像). It also provides views 胆管的一部分, but it is not always possible to do this exam. Also, MRCP cannot be used to treat the blockage.

参考文献

卡梅伦J. 胆囊和胆道. In: 卡梅伦J, ed. 目前的外科治疗. 14日艾德. Philadelphia, PA: Elsevier; 2023:chap 8.

詹姆斯二世，男爵TH. Endoscopic and radiologic treatment of biliary disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11日艾德. Philadelphia, PA: Elsevier; 2021:chap 70.

Radkani P, Hawksworth J, Fishbein T. 胆道系统. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. 萨比斯顿外科教科书. 21艾德. St Louis, MO: Elsevier; 2022:chap 55.