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논문 기본 정보

자료유형
학술저널
저자정보
주동운 (서울대학교 의과대학 방사선과학교실)
저널정보
대한영상의학회 대한방사선의학회지 대한방사선의학회지 제12권 제2호
발행연도
1976.1
수록면
255 - 266 (12page)

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It is no longer debatable that percutaneous transhepatic cholangigraphy is the most valuable diagnositc technique to differentiate surgical janundice from hepatocellular jaundice and to search the cause of the obstructive jaundice. While percutaneous transhepatic cholangiography using a polyethylone catheter over a guide has a low sucess rate and a high risk, PTC using a special needle (Chilba needle) has a high success rate in not only surgical jaundice cases but also medical problems of the liver and has a low risk. Even if the bile duct is not entered and the procedure is marked as failure, the fact that repeated trials failed proved of significance in differentiating intrahepatic from extrhepatic cholestasis. We have used their technique in more than 100 patients with various hepatobiliary disease during 3 years from June 1973 to August 1976 at the department of radiology of SNUH. The following are the result of cases in the aspects of success rate complication rate, distr bution of various hepatobiliary disease, the causes of the obstruction at the level of common bile duct and common hepatic duct. 1. Good cholangiography can be obtained in 103 cases among 111 cases. So over all success rate is 93%. Of 111 cases 93 cases show dilated bile duct and 18 cases show nondilated bile duct. 2. The success rate of dilated cases is 97% or 90 cases out of 93 cases and nondilated cases is 72% or 13 cases out of 18 cases. 3. To make the diagnosis the findings of hypotonic duodenography as well as the site and morphology of obstruction in PTC are valuable. 4. Courvoisier law is well appliciable to differentiation choledocholithiasis from malignant disease which obstruct the common bile duct. 5. The obstruction site by bile duct stone is at CBD in 22 cases and at common hepatic duct in 5 cases. 17 cases show multiple stones and 20 cases out of 27 cases partially obstruct bile duct. 6. The obstructive site by pancreas cancer is at CBD in 18 cases and at common hepati duct in 8 cases. 22 cases show complete obstruction. The findings of hypotonic duodenography are abnormal in 24 cases and in 16 cases typical findings for pancreas cancer are present. 7. Bile duct cancer develops at CBD in 10 cases and at bifurcation area and common hepatic duct in 10 cases and at hepatic duct in 3 cases. Bile duct cancer arising at the bifurcation area. is mainly infiltrative type while mass type is predominent at CBD. 8. Ampullar of Vater is displaced downwardly as CBD dilates. 9. Major complication such as bile leakage, hemoperitoneum, bile peritonitis, septicemia is occured in 7% but no complication happens in nondilated cases.

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