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J Korean Radiol Soc. 1976 Dec;12(2):255-266. Korean. Original Article. https://doi.org/10.3348/jkrs.1976.12.2.255
Choo DW , Han MC .
Abstract

It is no longer debatable that percutaenous transhepatic cholangiography is the most valuable diagnostictechnique to differentiate surgical janundice from hepatocellular jaundice and to search the cause of theobstructive jaundice. Whild percutaneous transhepatic cholangiography using a polyethylone catheter over a guidehas a low suscess rate and a high risk, PTC using a special neddle (Chilba needle) has a high sucess rate in notonly surgical jaundice cases but also midical problems of the liver and has a low risk. Even if the bile duct isnot entered and the procedure is marked as failure, the fact that repeated trials failed proved of significance indifferentiating intrahepatic from extrahepatic cholestasis. We have used their technique in more than 100 patientswith various hepatobiliary disease during 3 years form June 1973 to August 1976 at the department of radiology ofSNUH. The following are the result of cases in the aspects of sucess rate, complication rate, distribution ofvarious hepatobiliary disease, the causes of the obstruction at the level of common bile duct and common hepaticduct. 1. Good cholangiography can be obtained in 103 cases among 111 cases. so over all sucess rate is 93%. Of 111cases 93 cases show dilated bile duct and 18 cases show nondilated bile duct. 2. The sucess rate of dilated casesis 97% or 90 cases out of 93 cases and nondilated cases is 72% or 13 cases out of 18 cases. 3. To make thediagnosis the findings of hypotonic duodenography as well as the site and morphology of obstruction in PTC arevaluable. 4. Courvoisier law is well appliciable to differentiation choledocholithiasis from malignant diseasewhich obstruct the common bile duct. 5. The obstruction site by bile duct stone is at CBD n 22 cases and at commonhepatic 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 hepatic duct in 8 cases. 22 casesshow complete obstruction. The findings of hypotonic duodenography are abnormal in 24 cases and in 16 casestypical findings for pancreas cancer are present. 7. Bile duct cancer develops at CBD in 10 cases and atbifuration area and common hepatic duct in 10 cases and at hepatic duct in 3 cases. Bile duct cancer arising atthe bifurcation area is mainly infiltrative type while mass type is predominent at CBD. 8. Ampulla of Vater isdisplaced downwardly as CBD dilates. 9. Major complication such as bile leakage, hemoperiotoneum, bileperitonitis, septicemia is occured in 7% but no complication happens in nondilated cases.

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