超声对提高胆管疾病诊断率的研究——注射Ceosunin及纵、横旋转扫查法的意义  

Ultrasound Study of Common Bile Duct in the Diagnosis of Periampullary Carcinoma Using an Injection of Ceosunin and a Rotational Scanning Technique

作　　者：陈敏华[1] 王彬[1] 朱强[1] 李建国[1] 王旻[1] 孟昭敏[1] 严昆[1] 董宝玮[1] 黄信孚[1] 丁子清[2] 佐藤幸彦[2] 岸本理和[2] 藤田信行[2] 

机构地区：[1]北京医科大学临床肿瘤学院,100034 [2]日本北海道大学医学部放射线科

出　　处：《中国医学影像学杂志》1993年第1期28-32,共5页Chinese Journal of Medical Imaging

摘　　要：对肝外胆管扩张(7—15mm)42例施行了Ceosunin注射后(利胆法)超声观察。被证实胆管有梗阻性病变18例中,72％(13例)胆管增宽,16％(3例)无明显变化,12％(2例)缩小;胆管径均值从9.8mm增宽达11.7mm。非梗阻组24例中92％(22例)胆管径缩小,8％(2例)无明显变化,无1例增宽;胆管径均值从9.6mm缩小至6.3mm。梗阻组中9例壶腹周围癌(其中6例肿瘤径≤2cm)经利胆法后胆管径均增宽,采用胆管纵旋转扫查法及横旋转扫查法,使8例肿瘤得以显示。利胆法及旋转扫查法的应用使胆管下段病变显示率从41％提高到88％。对胆管扩张病例施行利胆法,以管径没有缩小为疑诊胆管梗阻的标准,其Sensitivity为89％,Specificity为92％;Accuracy为90％。本方法对判断胆管轻度扩张的病理意义有较高临床价值。为壶腹周围肿瘤的早期诊断提供了无创伤的手段。A total of 42 patients with mild dilatation (7-15mm in diameter) of common bile duct (CBD) were studied by B-mode real-time ultrasound in pre-and post-injection of ceosunin. Of 18 patients who had obstructing lesions of CBD, 13 (72%) cases showed an increase in diameter of CBD after an injection of the cholagogue, 3 (16%) no change and 2 (12%) a decrease. In 24 patients with no obstruction of CBD, 22 (92%) cases presented a contraction of the lumen and 2 (8%) had no reaction following the administration. When CBD had no alteration or a luminal dilatation after the injection, an obstructive disease distally located was strongly suspected, with a sensitivity of 89%, a specificity of 92% and an accuracy of 90%. Furthermore, this ultrasonic method plus employing a rotational scanning technique on the surface of abdomen enabled the clear visualization of 8 periampullary carcinoma foci, of which 6 ones were less than or equal to 20mm in diameter. The paper, therefore, demonstrates that this ultrasonography could differentiate an obstructive from a non-obstructive moderate dilatation of CBD, so that it makes possible the early diagnosis of distal CBD's or periampullary carcinoma.

关 键 词：旋转 胆管疾病 诊断率 肝外胆管扩张 壶腹周围肿瘤 梗阻性病变 壶腹周围癌 超声观察 胆管梗阻 临床价值 病理意义 早期诊断 利胆法 管径 增宽 注射后 显示率 无创伤 均值 

分 类 号：R657.4[医药卫生—外科学] R711.75[医药卫生—临床医学]