胆管内乳头状瘤的双重超声造影表现及PTCD策略探讨  

Double CEUS findings and PTCD strategy in intraductal papillary neoplasm of bile ducts

作　　者：马力[1] 谢晓燕[2] 王伟[2] 李晓菊[2] 刘红梅 周苏晋[1] Ma Li;Xie Xiaoyan;Wang Wei;Li Xiaoju;Liu Hongmei;Zhou Sujin(Department of Medical Ultrasonics,Guangdong Second Provincial General Hospital,Guangzhou 510310,China;Department of Medical Ultrasonics,Institute of Diagnostic and Interven-tional Ultrasound,the First Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510080,China)

机构地区：[1]广东省第二人民医院超声科,广州510310 [2]中山大学附属第一医院超声医学科中山大学超声诊断与介入超声研究所,广州510080

出　　处：《中国医师杂志》2018年第8期1187-1189,共3页Journal of Chinese Physician

摘　　要：目的总结分析胆管内乳头状瘤的超声造影表现,探讨超声造影诊断胆管内乳头状瘤的临床价值及经皮肝穿刺胆道引流术(PTCD)策略。方法回顾性分析32例经手术证实的胆管内乳头状瘤的二维超声、经血管超声造影、经胆道超声造影特征,统计分析常规超声及超声造影对胆管内乳头状瘤的诊断符合率;总结胆管内乳头状瘤的PTCD经验。结果常规超声及其联合超声造影对胆管内乳头状瘤的诊断符合率分别为43.8%(14/32)、93.8%(30/32),两者比较差异有统计学意义(P=0.037)。结论常规超声联合经血管和经胆道双重超声造影明显提高胆管内乳头状瘤诊断符合率;超声引导下PTCD实时、便捷,选择尽量粗的胆道引流管且反复冲管可保持胆汁引流通畅,可有效减黄,保护肝功能。ObjectiveTo summarize and analyze the contrast-enhanced ultrasonographic findings of intraductal papilloma and to explore the clinical value and percutaneous transhepatic cholangial drainage （PTCD） strategy of contrast-enhanced ultrasonography in the diagnosis of intraductal papilloma.MethodsWe retrospectively analyzed 32 cases with intraductal papilloma confirmed by surgery, conventional ultrasound, transvascular contrast-enhanced ultrasound, intrahepatic contrast echocardiography to gather the diagnostic coincidence rate of conventional ultrasound and contrast-enhanced ultrasound in bile duct papilloma, thus making a summary of PTCD experience of intraductal papilloma.ResultsThe diagnostic accuracy of conventional ultrasound and contrast-enhanced ultrasound in the diagnosis of intraductal papilloma were 43.8%（14/32） and 93.8%（30/32） respectively, and the differences were statistically significant （P=0.037）.ConclusionsConventional ultrasound combined with double contrast ultrasound and cholangiography can improve the diagnostic accuracy of intraductal papilloma. Ultrasound-guided PTCD is a real-time, convenient procedure. Choosing a biliary drainage tube as thick as possible and repeatedly doubling the tube can maintain bile drainage and smooth flow, thus can effectively improve the efficacy of serum bilirubin reduction and protect liver function.

关 键 词：胆管肿瘤 超声检查 外科学 乳头状瘤 管内 超声检查 外科学 穿刺术 引流术 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.8[医药卫生—诊断学]