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Hauv kev ua haujlwm niaj hnub ntawm kev cuam tshuam hluav taws xob thiab kev phais mob hepatobiliary, ob daim ntawv thov tseem ceeb ntawm PTC koob (Chiba- hom) yog kuaj Percutaneous Transhepatic Cholangiography (PTC) thiab tsim kom muaj kev nkag mus rau biliary rau kev kho mob Percutaneous Transhepatic Cholangial Drainage (PTCD). Rau PTC koob manufacturers, muab cov qauv kev qhia ua haujlwm nrog rau cov khoom lag luam yog lub hauv paus tseem ceeb hauv kev txhim kho kev txaus siab rau kev kho mob thiab hom kev tshaj lij.

Kev ntsuam xyuas ua ntej thiab kev npaj:​ Patients must be screened for iodine contrast allergy and severe coagulopathy (INR >1.5 los yog PLT<50×10⁹/L). Vitamin K₁ and prophylactic antibiotics are administered preoperatively. Manufacturers typically recommend equipping with a 22G×150 mm or 200 mm Chiba needle (with stylet), accompanied by a 0.018″ micro-guidewire, dilators, and subsequent pigtail drainage catheters-forming a complete PTC/PTCD kit.

Puncture Pathway Xaiv:​ Txoj hauv kev zoo feem ntau xaiv txoj cai nruab nrab - kab axillary ntawm 8-9th intercostal qhov chaw, tsom mus rau dilated txoj cai anterior lossis posterior hepatic duct ceg. Txoj kev sab laug siv lub subxiphoid me ntsis sab laug puncture ntawm sab laug hepatic duct (superficial, unobstructed los ntawm tav, haum rau ultrasound kev taw qhia). Cov neeg tsim khoom tuaj yeem suav nrog schematic daim duab ntawm cov txheej txheem puncture nyob rau hauv cov khoom siv phau ntawv los pab cov neeg ua haujlwm me hauv kev ceev cov txheej txheem.

Duab Qhia thiab Puncture:​ Ultrasound tiag - lub sijhawm qhia tau pom zoo. Lub Chiba koob taub zoo nkaus li ib qho hyperechoic "comet-tail" artifact ntawm ultrasound. Ua ntej ntawm txoj kab kev taw qhia, tus neeg teb xov tooj hnov ​​​​qhov kev xav tsis zoo (me ntsis indentation ntawm cov phab ntsa ntawm cov phab ntsa ntawm cov kua tsib + cia li poob ntawm rab koob), tom qab ntawd tshem tawm cov stylet los soj ntsuam cov kua tsib rov qab los - lees paub qhov ua tiav puncture. Cov kauj ruam no yog rhiab heev rau cov lus sib tsoo zoo: tus hwm PTC koob, nrog precision bevel sib tsoo thiab electropolishing, muaj kev paub meej meej thiab kev ua haujlwm tsawg; ib tug inferior koob nrog ib tug dov ntug quab yuam rov sim dua, ua rau muaj kev pheej hmoo ntawm daim siab mob.

Contrast Txhaj Tshuaj thiab Kev Tswj Xyuas Tom ntej:​ Maj mam txhaj tshuaj uas tsis yog- ionic qis-concentration contrast (iohexol 20%–30%) los ntawm Chiba koob lumen- zam kev txhaj tshuaj cua. Raws li DSA fluoroscopy, tag nrho cov biliary tsob ntoo raug nthuav tawm - qhov chaw thaiv, qhov twg, thiab kev sib txuas lus ntawm sab laug thiab sab xis kab mob ua kom pom tseeb. Yog tias yuav tsum tau PTCD, ua ntej 0.018 "micro-cov lus qhia los ntawm Chiba koob lumen (ceeb toom: 22G Chiba koob puab lub cheeb yog kwv yees li . 0.41} hli, haum tsuas yog tsawg dua lossis sib npaug rau 0.018" cov lus qhia; xav tau 0.035 ″), latent cov xov hlau yog punctured. xaim, thiab tso cov kua dej catheter.

Cov neeg tsim khoom ntxiv-Cov Lus Pom Zoo:PTC koob manufacturers muab tau: ① Chiba koob nyob rau hauv ntau yam ntev / specifications (20G-23G, 150/200/250 mm); ② PTC cov khoom siv pib ua ntej nrog 0.018 "hydrophilic-coated micro-cov lus qhia; ③ Cov lus qhia rau adapter compatibility nrog ultrasound puncture sojntsuam qhia; ④ Ob hom lus (Suav-English) daim npav txheej txheem (nrog rau cov contraindications, ceeb toom siab rau kev txhaj tshuaj sib txawv). Qhov "cov khoom lag luam + kev daws teeb meem" qauv no muaj kev sib tw ntau dua li tsuas yog muag cov koob thiab txo cov neeg siv khoom tsis txaus siab tshwm sim los ntawm kev siv tsis raug (xws li clogging lub lumen nrog cov lus qhia loj loj).

Nws yog tsim nyog hais tias Chiba - hom PTC koob nws tus kheej tsis ncaj qha tso dej catheter; nws tus nqi tseem ceeb nyob hauv kev nyab xeeb tsim kom muaj kev nkag mus rau thawj zaug, ua raws li kev sib pauv xaim rau kev kho tom ntej. Qhov no "zoo- koob thawj- dhau" lub tswv yim yog qhov tseeb ntawm qhov Chiba koob txo PTC / PTCD cov teeb meem. Cov neeg tsim khoom yuav tsum rov hais dua lub tswv yim no rau cov kws kho mob thaum lub sijhawm nce qib, tiv thaiv cov neeg siv los ntawm kev ntseeg yuam kev tias cov koob zoo "tseem" tsawg dua li cov trocars ntxhib-qhov tseeb, nplua- koob thawj- hla + pauv yog txoj hauv kev nyab xeeb pom zoo los ntawm cov txheej txheem niaj hnub no.