术前床旁超声在原发性肝癌手术中的应用  

Application of preoperative bedside ultrasound in surgical operation of primary liver cancer

作　　者：蒋小峰[1] 张大伟[1] 卢海武[1] 温子龙[1] 郑强[1] 刘颂航[1] 杨学伟[1] 曹良启[1] 彭和平[1] 薛平[1] Jiang Xiaofeng;Zhang Dawei;Lu Haiwu;Wen Zilong;Zheng Qiang;Liu Songhang;Yang Xuewei;Cao Liangqi;Peng Heping;Xue Ping(Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China)

机构地区：[1]广州医科大学附属第二医院肝胆外科,510260

出　　处：《中华肝脏外科手术学电子杂志》2018年第6期499-502,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省科技计划项目(2014A020212511)

摘　　要：目的探讨术前床旁超声在原发性肝癌(肝癌)手术中的应用价值。方法回顾性分析2016年10月至2017年5月广州医科大学附属第二医院23例肝癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男15例,女8例;年龄27~73岁,中位年龄53岁。术前对患者行床旁超声检查,从剑突下、右肋缘下、肋间对肝脏进行扫描和彩色多普勒超声检查,与术前影像学资料进行对比。结果所有患者均在术前24 h内完成床旁超声检查。剑突下扫查可清楚显示第二肝门肝左、肝中和肝右静脉结构,并可进一步显示左半肝病灶所在肝段。右肋缘下扫描可显示第一肝门部解剖关系,显示门静脉解剖。肋间扫描可显示右半肝病灶位置,确定肝中、肝右静脉及右侧门静脉的肝内分布和病灶关系。病灶分布情况:肝Ⅱ、Ⅲ段6例,Ⅳ段5例,Ⅴ段2例,Ⅴ、Ⅷ段3例,Ⅵ段7例。术前床旁超声检查与术前CT、MRI检查不一致并停止手术1例,更改手术方案1例。结论术前床旁超声检查能为肝脏手术提供了更多解剖信息和病灶分布情况,可节约手术中探查的时间,并能及时调整手术方案。Ohjective To explore the application value of preoperative bedside ultrasound in the surgical operation of primary liver cancer （PLC）. Methods Clinical data of 23 patients with PLC in the Second Affiliated Hospital of Guangzhou Medical University from October 2016 to May 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among 23 patients, 15 cases were male and 8 female, aged from 27 to 73 years with a median age of 53 years. Bedside ultrasound examination was performed in the patients. The liver was scanned and examined by Doppler ultrasound via the xiphoid process, the right costal margin and the intercostal space, and the results were compared with the preoperative imaging data. Results All the patients received bedside ultrasound examination within preoprative 24 h. The left, middle and right hepatic venous structures of the second porta could be displayed clearly by the scaning from xiphoid process, and the left hepatic segment where the lesions located could be further displayed. The scan form right costal margin showed the anatomical relationship of primary porta and the anatomy of portal vein. The scan from intercostal space could identify the position of lesions in the right lobe and determine the intrahepatie distribution of middle and right hepatic veins and right portal vein, and their relationship with lesions. The lesions located in segment Ⅱ and Ⅲ of 6 cases, segment Ⅳ of 5 cases, segment V of 2 cases, segment Ⅴ and Ⅷ of 3 cases and segment Ⅵ of 7 cases. The findings of preoperative bedside ultrasound was inconsistent with that of preoperative CT and MRI. The operation was aborted in 1 case and operative plan was changed in 1 case. Conclusions Preoperative bedside ultrasound can provide more anatomical information and lesion distribution for liver surgery, which can shorten the intraoperative exploration time and adjust the surgical plan timely.

关 键 词：超声检查 肝肿瘤 肝切除术 

分 类 号：R735.7[医药卫生—肿瘤]