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Interventional treatment of obstructive jaundice
Interventional treatment of obstructive jaundice. Jaundice is a clinical manifestation of yellow staining of the sclera, skin, mucous membranes, and body fluids caused by increased plasma bilirubin concentration during bilirubin metabolism disorders.
Jaundice is a clinical manifestation of yellow staining of the sclera, skin, mucous membranes, and body fluids caused by increased plasma bilirubin concentration during bilirubin metabolism disorders. Bilirubin comes from aging red blood cells in the body, and its production, metabolism and excretion are closely related to the liver. Any obstacle in any link can lead to increased blood bilirubin concentration and cause jaundice. Jaundice is divided into obstructive jaundice, hepatocellular jaundice and hemolytic jaundice due to different causes.
Obstructive jaundice, as the name implies, is mainly caused by gallstones, various benign and malignant tumors compressing the biliary tract, resulting in a series of pathological changes such as biliary stenosis, blockage, cholestasis, and elevated bilirubin:
In recent years, interventional therapy has been widely carried out clinically due to its safety, minimal invasiveness and effectiveness. Interventional treatment of obstructive jaundice caused by malignant tumor compression is generally divided into three steps:
1. Percutaneous transhepatic biliary drainage (PTCD)
1. External drainage is first performed percutaneous transhepatic puncture of the bile duct. Under the guidance of the guide wire, a drainage tube with multiple side holes (the number and position of the side holes depends on the puncture point and the obstruction site) is inserted into the expanded bile duct Internally, the tip of the catheter is placed above the obstruction, which can drain bile to the body, reduce the pressure in the biliary system, and relieve jaundice.
2. On the basis of external drainage, or under the guidance of the guide wire after puncture, the tip of the drainage catheter should be directly passed through the narrow obstruction area and placed in the bile duct or duodenum at the distal end of the obstruction. The side hole of the drainage catheter flows into the bile duct at the lower end of the obstruction and into the duodenum. The number and location of the same side holes must be determined according to the narrow part. Close the drainage tube left outside the body to achieve the purpose of internal drainage. Internal drainage avoids the ills of loss of bile.
2. Percutaneous transhepatic bile duct stent drainage (EMBE)
After PTCD drainage for 1-2 weeks, the symptoms and signs caused by the patient’s jaundice have basically subsided, and the laboratory indicators have basically returned to normal. At this time, the bile duct stent can be placed in the narrow bile duct through the PTCD drainage tube to restore the natural bile duct system . After the jaundice is clearly relieved, the bile duct stent is replaced.
3. Combined Hepatic Artery Chemoembolization (TACE)
Through femoral artery puncture, insert a catheter into the common hepatic artery or superior mesenteric angiography, show the main blood supply artery of the tumor, tumor location and number, and then perform perfusion chemotherapy. If there is a clear tumor supply artery, use superselective catheter after chemotherapy Embolization was performed after superselection of the blood supply branch of the tumor. So that the tumor shrinks, the degree of bile duct stricture is reduced, and the occurrence of restenosis is reduced.
(source:internet, reference only)