胆道超声造影在肝胆手术中的应用  

Application of intraoperative contrast-enhanced ultrasound cholangiography in hepatobiliary surgery

作　　者：蒋小峰[1] 胡远兴 吴心强 黄镇辉 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] 胡以则[1] 薛平[1] 宋月云[1] 黄嘉文 王丹[1] Jiang Xiaofeng;Hu Yuanxing;Wu Xinqiang;Huang Zhenhui;Zhang Dawei;Lu Haiwu;Wen Zilong;Zheng Qiang;Liu Songhang;Yang Xuewei;Cao Liangqi;Peng Heping;Hu Yize;Xue Ping;Song Yueyun;Huang Jiawen;Wang Dan(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》2021年第6期604-607,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广州医科大学附属第二医院新技术新业务临床研究项目(2020-LCYJ-XJS-01)。

摘　　要：目的探讨术中胆道超声造影在肝胆手术中的应用价值。方法回顾性分析2019年1月1日至2020年3月3日在广州医科大学附属第二医院行肝胆手术的23例患者临床资料。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25~65岁,中位年龄43岁。开腹肝切除8例,开腹胆总管切开取石+胆道探查4例,腹腔镜肝切除6例,腹腔镜胆总管切开取石+胆道探查5例。术中胆囊管推注造影剂,进行胆道超声造影了解肝内胆管解剖情况。结果除起始3例患者为探索性研究,术中胆道超声造影未成功,余20例均成功进行术中胆道超声造影。术中胆道超声造影可清晰显示肝内三、四级胆管结构及病灶情况,显影时间持续3~5 min。无造影相关并发症发生,无死亡病例。术后腹腔积液1例,胆漏1例,经对症处理后患者痊愈出院,术后随访3个月无发生不良反应。结论肝胆手术中行胆道超声造影检查是安全可行的,可清晰显示胆道结构,为肝胆手术提供胆道解剖结构和病灶信息。Objective To evaluate the application of intraoperative contrast-enhanced ultrasound cholangiography in hepatobiliary surgery.Methods Clinical data of 23 patients who underwent hepatobiliary surgery in the Second Affiliated Hospital of Guangzhou Medical University from January 1,2019 to March 3,2020 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,15 patients were male and 8 female,aged 25-65 years,with a median age of 43 years.Open hepatectomy was performed in 8 cases,open choledocholithotomy+biliary exploration in 4,laparoscopic hepatectomy in 6 and laparoscopic choledocholithotomy+biliary exploration in 5 cases.Intraoperatively,contrast agent was injected into the cystic duct.Contrast-enhanced ultrasound cholangiography was performed to observe the anatomy of intrahepatic bile duct.Results Except the initial 3 cases of tentative trial,the contrast-enhanced ultrasound cholangiography of the remaining 20 cases were successfully performed.The structures and lesions of the third and fourth branches of intrahepatic bile ducts could be clearly displayed by intraoperative contrast-enhanced ultrasound cholangiography.The duration of contrast enhancement was 3-5 min.No contrast-related complications or death occurred.Postoperative ascites occurred in 1 case and bile leakage in 1 case.After symptomatic treatments,both patients were recovered and discharged from hospital.No adverse reactions were reported during the postoperative 3-month follow-up.Conclusions Contrast-enhanced ultrasound cholangiography is safe and feasible to clearly display the structure of biliary tract and provide information about anatomical structure and lesions of biliary tract for hepatobiliary surgery.

关 键 词：胆道 超声检查 介入性 外科手术 

分 类 号：R657.4[医药卫生—外科学] R445.1[医药卫生—临床医学]