3. Percutaneous Transhepatic Drainage of Intrahepatic Biliary Cysts After Hepatic Portoenterostomy for Biliary Atresia : With Special Attention to Technical Aspects

Shunsuke Nosaka, Osamu Miyazaki, Yoshiyuki Okada, Toshiro Honna1）, Tatsuo Kuroda1） Mikiko Miyasaka, Kyoko Kashima, Yoshiyuki Tsutsumi, Masayuki Kitamura
Hidekazu Masaki

Department of Radiology and Surgery1）, National Center for Child Health and Development

Abstract
　　Purpose : To demonstrate technical aspects of percutaneous transhepatic drainage of intrahepatic biliary cysts after hepatic portoenterostomy for biliary atresia (BA).
　　Materials : In the recent 3 years, 5 patients underwent percutaneous transhepatic procedures. Of these, 3 patients with 4 lesions underwent percutaneous aspiration and contrast injection, and the remaining 2 patients with 3 lesions underwent percutaneous drainage catheter placement. The latter 2 patients are the materials of this study.
　　The way of drainage procedure : 1. Determine the lesions to be punctured using ultrasound. Then, puncture of the cyst with use of sheathed needle under ultrasound guidance. 2. Confirm the content of the cyst. 3. Place a guidewire into the cyst through the needle sheath and dilate the tract. 4. Place drainage catheter.
　　Modifications of the technique : There is various equipment available to enhance the success of the technique. These include use sheathed puncture needle with clear sheath, angiography sheath introducer, J-curved metallic guidewire, and pigtail catheter with locking system. Use of such equipment is effective for catheter exchange as well.
　　Conclusions : To achieve successful drainage of intrahepatic biliary cysts after hepatic portoenterostomy, combined use of the above described equipment allows technical improvement not only for catheter placement but also for catheter exchange.

Keywords：Biliary atresia, Intrahepatic biliary cysts, Percutaneous transhepatic drainage