The use of modern techniques of biliary tract monitoring in percutaneous drainage.

The aim of this work is to assess the usefulness of current imaging techniques of biliary tracts in percutaneous transhepatic biliary drainage (PTBD). In the period from January 1996 to March 2003 44 cases of PTBD were carried out under ultrasonographic and X-ray control in 34 patients who could not have a bypass or endoscopic prothesis of the bile duct. The effectiveness of the method was evaluated in relation to the extent of the intra-hepatic bile ducts, the usefulness of simultaneous monitoring (ultrasonography and X-ray) and the possibility of preoperative contrasting of the bile ducts. Correct drainage of bile ducts was achieved in 43 PTBD. In 6 cases branches of the portal vein were pierced during drainage, but thanks to X-ray visualisation this was detected and the bile ducts were then drained correctly. During 4 PTBD the grooved probe slipped from bile ducts while the catheter was being introduced and a repeated prick was necessary. Total cholestasis caused by a tumour does not always bring about extension of bile ducts. However, simultaneous ultrasonographic and X-ray imaging of the bile ducts enables PTBD to be performed even in patients with a slight extension of the duct.