术中超声与超声造影在肝内胆管结石术中的应用  

Clinical application of intraoperative ultrasound and contrast-enhanced ultrasound in cholelithiasis

作　　者：吴鹏[1] 殷军[1] 宋鑫[1] 郭廷华[1] 隆洪木[2] 

机构地区：[1]重庆市涪陵中心医院超声科,408000 [2]重庆市涪陵中心医院肝胆外科,408000

出　　处：《临床超声医学杂志》2010年第2期102-104,共3页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨术中超声和超声造影在多发性肝胆管结石手术治疗中的应用价值。方法使用术中超声探头,在48例肝内胆管结石患者行肝胆管结石手术中进行超声检查,并行经胆总管插管超声造影/或经肝内胆管穿刺超声造影,且与手术及病理结果对照。结果48例肝胆管结石患者,术中超声诊断35例为肝内胆管结石,其中5例术前超声未查出,13例为肝内胆管结石合并肝外胆管结石。10例合并胆管炎症、胆管壁纤维化。13例肝内外胆管均有结石的患者中,4例合并胆总管下段癌变,均经手术及病理证实。结论术中超声检查可对术前超声检查的漏误诊予以纠正。术中肝胆管超声造影,可提高对胆道疾病的检出,同时伴有冲洗胆道结石的作用,可以减少胆道结石的残留。术中超声定位结合术中胆道超声造影,可作为肝胆管结石手术治疗的重要辅助手段。Objective To explore the clinical value of intraoperative uhrasonography （IOUS） and contrast - enhanced ultrasound （CEUS） in treatment of multiple cholelithiasis. Methods Forty eight patients with hepatolithiasis were examined by color Doppler ultrasound during the operation, CEUS was performed with cannula in the common bile duct or puncture in the intrahepatic bile duct. Then the results were compared with those of operation and pathology. Results In 48 patients with hepatolithiasis, there were 35 cases of intrahepatie lithiasis diagnosed by intraoperative ultrasound, 5 cases of those hadn＇t been found before operation. There were 13 cases of intrahepatic lithiasis combined with extrahepatic lithiasis, 10 cases combined with cholangitis with tubal wall fibrosis. Cholangiocarcinoma in the lower segment of the bile common duct was diagnosed in 4 of 13 case, the results were confirmed by surgery and pathology. Conclusion The intraoperative ultrasound can redress the misdiagnosis and missed diagnosis before operation. CEUS combined with IOUS can improve the detection rate of biliary tract disease, and washout the biliary tract to lessen calculi. So IOUS combined with CEUS is an important adjunctive method in cholelithiasis operation.

关 键 词：结石 肝胆管 超声检查 术中 造影剂 

分 类 号：R657.3[医药卫生—外科学] R445.1[医药卫生—临床医学]