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KMID : 0371319770190030077
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Journal of the Korean Surgical Society
1977 Volume.19 No. 3 p.77 ~ p.85
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Percutaneous Transhepatic Cholangiography
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朴興吉/Park, H.G.
白根洙/李燦泳/羅燾憲/金漢錫/Paek, K.S./Lee, C.Y./Rah, D.H./Kim, H.S.
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Abstract
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We have performed percutaneous transhepatic cholangiography(P.T.C) with a fine needle in 139 patients with suspected surgical jaundice or disease during 2 years since November, 1974. They were divided as 94 cases(67. 6%) of surgical group, 28 cases (20.1%) of non-surgical group and 17 cases(12.2%) of failure group. Patients in surgical group were composed of 52 cases of biliary stone, 25 cases of malignant obstruction or disease, 5 cases of benign obstruction, 6 cases of empyema gallbladder, 3 cases of remnant cystic duct, a case of delayed passage of dye and 6 cases of others. Almost all of the non-surgical group and failure group showed improvement with conservative treatment only. Six cases showed anomalous biliary disease such as agenesis of gallbaldder, stenosis of sphincter Oddi, Hour-glass gallbladder, choledochal cyst, multiple liver cyst(non-parasitic) and peculiar location of gallbladder.
In 36 of the patients with low serum bilirubin level(below 3.0mg%), cholecystobiligraphy showed non-visulalization of gallbladder. P.T.C. showed well visualization of gallbladder, in 26 cases of them and non-visualization also in 10. Choledochoascariasis may or may not be a surgical indication, in other words we confirmed a case cured by medical treatment.
Minor complications such as nausea, vomiting, fever, chill, pain, and aggravation of jaundice etc. were easily controlled with bed rest only. Major complications were composed of 8 cases of contrast dye leaking into abdominal cavity, 2 peritonitis due to pus & bile, 2 gallbladder puncture a massive bleeding, a puncture of small intestine and a sudden death of unknown cause. Emergency operation was inevitable only in 2 peritonitis cases.
Correct differentiation between surgical jaundice and medical jaundice was possible on the basis of P.T.C. criteria, so 28 of 139 patients were saved, from unnecessary laparotomy with confidence. P.T.C. is an invaluable tool in the diagnosis and treatment of hepatobiliary disease.
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KEYWORD
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