Clinical studies on selective percutaneous transhepatic left cholangio-drainage (s-PTLD) - A procedure for prevent spontaneous slippage of the catheter.:A Procedure for Prevent Spontaneous Slippage of the Catheter

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The left hepatic duct shows a comparatively regular distribution and is the largest of all the intrahepatic ducts. It tends to en large at the earliest stage of extrahepatic duct obstruction.From our radiological and ultrasonographical anatomic studies, the left hepatic duct is midway between a position immediately superior to the apex of the duodenal bulb and the cardio-phrenic angle on the line of right paravertebra, and this relationship is maintained regardless of the icteric grade. In addition, the falciform ligament is at the line of the right paravertebra.So aiming at the prevention of spontaneous slippage of the PTCD catheter, s-PTLD was attempted by placement in the left hepatic duct for paracentesis on the line of the right paravertebra, at which the catheter passes through the falciform ligament, under ultrasonography or X-ray control.The rate of success registered by the present method in 179 patients with obstructive jaundice was 99%, and spontaneous slippage of the catheter was seen in only 3 (1.6%). As PTCD using the present method is relatively simple and reliable with a very low rate of slippage of the catheter, it was regarded as a most useful method for PTCD in cases of obstructive jaundice.
財団法人日本消化器病学会の論文