经皮经肝穿刺胆道超声造影的方法及临床意义  

Percutaneous transhepatic contrast-enhanced cholangio-ultrasonography： methodology and significances

作　　者：章建全[1] 陈佳彬[1] 刘灿[1] 蔡清萍[2] 陈学云[2] 

机构地区：[1]第二军医大学附属长征医院超声诊疗科,上海200003 [2]第二军医大学附属长征医院普通外科,上海200003

出　　处：《中华超声影像学杂志》2008年第6期513-516,共4页Chinese Journal of Ultrasonography

基　　金：基金项目：第二军医大学附属长征医院“三重三优”学科和人才建设专项基金（20050316）

摘　　要：目的建立经皮经肝穿刺胆道超声造影（percutaneous transhepatic contrast—enhanced cholangio—ultrasonography，PTCECUS）的方法，探讨其可行性、安全性及临床价值。方法对21例梗阻性黄疸患者行经皮经肝胆管（17例）、胆囊（4例）穿刺引流术，术中经引流管向胆管／胆囊内注射浓度为0．94％的SonoVue水溶液50ml，在对比脉冲序列模式下观察胆管、胆囊及十二指肠内SonoVue微泡的流动和充填情况，判断胆管的梗阻程度。部分病例与常规超声、胰管胆管磁共振成像（MRCP）、经皮经肝穿刺胆道x线造影（PTC）进行对照。结果 ①PTCECUS生成对比良好的胆管树造影声像图；②PTCECUS判断胆管梗阻程度比常规超声准确，与MRCP和PTC一致，可指导正确实施胆汁引流方案；③PTCECUS克服了PTC穿刺与造影异地实施的烦琐，减少环节，提高效率；④全部患者穿刺及造影过程中均无并发症，14例经1～8个月肝胆超声随访未见不良反应。结论PTCECUS过程安全，能突出显示胆道系统的走行及其管腔通畅度，对梗阻性黄疸的引流方案具有指导意义。Objective To establish the method and assess the safety, feasibility and clinical efficacies of percutaneous transhepatic contrast-enhanced cholangio-ultrasonography （PTCECUS）. Methods Twenty-one patients aged （58.5 ± 16.65） years （range 27-93） with biliary obstruction or stricture underwent percutaneous transhepatic cholangiodrainage or cholecystodrainage. A dose of more than 50 ml of 0.94% SonoVue （Bracco, Itay） solution was injected into their bile ducts（ n = 17） and cholecysts（ n = 4） through the drainage catheter. Their biliary tracts,cholecysts and duodenums were scanned under contrast pulsed sequencing mode （CPS,Sequoia 512,Siemens） to achieve related contrast-enhanced ultrasonograms. Severity of biliary obstruction were assessed according to the PTCECUS findings with a comparison to conventional ultrasonography （CVUS）, magnetic resonance cholangiopancreatography（MRCP） and percutaneous transhepatic cholangiography （PTC） in a part of the patients. Results ①PTCECUS gave rise to good-quality contrast-enhanced ultrasonograms of biliary tracts. ② PTCECUS was superior to CVUS and in consistence with MRCP and PTC in evaluating the severity of biliary tract obstruction. This method helped to make a proper design for biliary drainage. ③ PTCECUS was more efficient than PTC in that PTC had the patients receive transhepatic puncture and cholangiography in separated departments. ④Neither any complications immediate from transhepatic puncture and administration of SonoVue in all the 21 patients,nor those 1 to 8 months late during ultrasound follow-up in 14 patients were found. Conclusions PTCECUS, characterized in bettering the display of biliary tracts, especially the severity of obstruction of biliary tracts,is safe through the procedure and valuable in supervising biliary drainage against obstructive jaundice.

关 键 词：超声检查 微气泡 黄疸 阻塞性 胆管造影术 

分 类 号：R686[医药卫生—骨科学]