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中华肝脏外科手术学电子杂志 ›› 2013, Vol. 02 ›› Issue (06) : 379 -382. doi: 10.3877/cma.j.issn.2095-3232.2013.06.008

所属专题: 文献

临床研究

经胆管腔内超声造影的临床应用价值
许尔蛟1, 张曼1, 任杰1, 郭欢仪1, 郭光辉1, 李凯1, 苏中振1,(), 郑荣琴1   
  1. 1. 510630 广州,中山大学附属第三医院超声科
  • 收稿日期:2013-07-18 出版日期:2013-12-10
  • 通信作者: 苏中振
  • 基金资助:
    广东省医学科研基金(B2013137); 广东省科技计划项目(2009B060700026)

Clinical application value of intra-biliary contrast-enhanced ultrasound

Er-jiao XU1, Man ZHANG1, Jie REN1, Huan-yi GUO1, Guang-hui GUO1, Kai LI1, Zhong-zhen SU1,(), Rong-qin ZHENG1   

  1. 1. Department of Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2013-07-18 Published:2013-12-10
  • Corresponding author: Zhong-zhen SU
  • About author:
    Corresponding author: SU Zhong-zhen, Email:
引用本文:

许尔蛟, 张曼, 任杰, 郭欢仪, 郭光辉, 李凯, 苏中振, 郑荣琴. 经胆管腔内超声造影的临床应用价值[J]. 中华肝脏外科手术学电子杂志, 2013, 02(06): 379-382.

Er-jiao XU, Man ZHANG, Jie REN, Huan-yi GUO, Guang-hui GUO, Kai LI, Zhong-zhen SU, Rong-qin ZHENG. Clinical application value of intra-biliary contrast-enhanced ultrasound[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2013, 02(06): 379-382.

目的

探讨经胆管腔内超声造影(IB-CEUS)的临床应用价值。

方法

本前瞻性研究对象为2008年1月至2011年12月在中山大学附属第三医院接受诊治的10例壶腹部梗阻患者。其中男6例,女4例,年龄30~83岁,中位年龄57岁。所有患者均签署知情同意书,符合伦理学规定。患者先行经皮经肝胆道引流术(PTCD),然后分别行IB-CEUS和X线胆道造影检查。分别观察IB-CEUS和X线胆道造影对引流管、胆囊、肠管、肝外胆管和肝内各级胆管的显影效果。两种检查方法的显示率比较采用Fisher确切概率法,所能显示的肝内胆管分支最高级别比较采用秩和检验。

结果

两种检查方法均能显示胆管树结构。IB-CEUS对引流管、胆囊、肠管及肝外胆管的显示率分别为100%、78%、30%、100%,X线胆道造影为100%、89%、40%、100%,差异无统计学意义(P>0.05)。IB-CEUS对肝内一、二、三级胆管分支数的显示率分别为100%、98%、98%,X线胆道造影为100%、100%、100%,差异无统计学意义(P>0.05)。IB-CEUS对所能显示的肝内胆管分支最高级别为3.5(3.0~5.0)级,X线胆道造影为4.5(4.0~5.0)级,差异有统计学意义(Z=-3.000,P<0.05)。

结论

IB-CEUS是一种重要的胆管腔内成像技术,其显像效果与X线胆道造影接近,可作为X线胆道造影的一种重要替代方法。

Objective

To investigate the clinical application value of intra-biliary contrast-enhanced ultrasound (IB-CEUS).

Methods

Ten patients with ampullary obstruction in the Third Affiliated Hospital of Sun Yat-sen University from January 2008 to December 2011 were enrolled in this prospective study. There were 6 males and 4 females with age ranging from 30 to 83 years old and a median age of 57 years old. The informed consents of all patients were obtained and the ethical committee approval was received. The patients underwent percutaneous transhepatic cholangial drainage (PTCD) firstly and then received IB-CEUS and X-ray cholangiography. The visualization effects of drainage tubes, gall bladders, intestines, extrahepatic bile ducts and all orders of intrahepatic bile ducts by IB-CEUS and X-ray cholangiography were observed. The visualization rates of two methods were compared by Fisher′s exact probability test. The highest orders of intrahepatic biliary branches that could be visualized were compared by rank sum test.

Results

The biliary tree structure could be visualized both by two examination methods. The visualization rates of drainage tubes, gall bladders, intestines and extrahepatic bile ducts were 100%, 78%, 30%, 100% by IB-CEUS, and were 100%, 89%, 40%, 100% by X-ray cholangiography respectively, where no significant difference was observed (P>0.05). The visualization rates of first-, second-, third-order intrahepatic biliary branch number by IB-CEUS were 100%, 98%, 98% and were 100%, 100%, 100% by X-ray cholangiography respectively, where no significant difference was observed (P>0.05). The highest order of intrahepatic biliary branches that could be visualized was 3.5(3.0-5.0) by IB-CEUS, and was 4.5(4.0-5.0) by X-ray cholangiography, where significant difference was observed (Z=-3.000, P<0.05).

Conclusions

IB-CEUS is an important intra-biliary imaging modality with similar visualization effects as X-ray cholangiography, which could be an important substitutional method of the X-ray cholangiography.

表1 两种检查方法对引流管、胆囊、肠管及肝外胆管的显示率比较
表2 两种检查方法对肝内各级胆管的显示分支数比较
[1]
吴恩惠.医学影像学. 5版.北京:人民卫生出版社, 2006: 1-392.
[2]
Ford JA,Soop M,Du J, et al. Systematic review of intraoperative cholangiography in cholecystectomy. Br J Surg, 2012, 99(2): 160-167.
[3]
Ueno K,Ajiki T,Sawa H, et al. Role of intraoperative cholangiography in patients whose biliary tree was evaluated preoperatively by magnetic resonance cholangiopancreatography. World J Surg, 2012, 36(11): 2661-2665.
[4]
Thompson WM. The optimal radiographic technique for operative and T-tube cholangiography. Crit Rev Diagn Imaging, 1986, 26(2): 107-176.
[5]
Morcos SK,Thomsen HS. Adverse reactions to iodinated contrast media. Eur Radiol, 2001, 11(7): 1267-1275.
[6]
Piscaglia F,Nolsøe C,Dietrich CF, et al. The EFSUMB guidelines and recommendations on the clinical practice of contrast enhanced ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med, 2012, 33(1): 33-59.
[7]
Xu EJ,Zheng RQ,Su ZZ, et al. Intra-biliary contrast-enhanced ultrasound for evaluating biliary obstruction during percutaneous transhepatic biliary drainage: a preliminary study. Eur J Radiol, 2012, 81(12): 3846-3850.
[8]
张艳玲,许尔蛟,郑荣琴,等.经皮二维胆道超声造影的临床应用.中国医学影像技术, 2011, 27(6): 1205-1208.
[9]
Luyao Z,Xiaoyan X,Huixiong X, et al. Percutaneous ultrasound-guided cholangiography using microbubbles to evaluate the dilated biliary tract: initial experience. Eur Radiol, 2012, 22(2): 371-378.
[10]
许尔蛟,苏中振,郑荣琴,等.经静脉联合经胆道超声造影在肝门部胆管癌分型诊断中的价值.中华超声影像学杂志, 2013, 22(4): 325-328.
[11]
吕明德,董宝玮.临床腹部超声诊断与介入超声学.广州:广东科技出版社, 2001:1-325.
[12]
许尔蛟,郑荣琴,陆敏强,等.活体肝移植供体术中胆道三维超声造影的初步应用.中华超声影像学杂志, 2009, 18(8): 680-683.
[13]
Xu EJ,Mao R,Zheng RQ, et al. Three-dimensional contrast-enhanced ultrasonic cholangiography: a new technique for delineation of the biliary tract in a liver donor. Liver Transpl, 2009, 15(9): 1154-1156.
[14]
Zheng RQ,Chen GH,Xu EJ, et al. Evaluating biliary anatomy and variations in living liver donors by a new technique: three-dimensional contrast-enhanced ultrasonic cholangiography. Ultrasound Med Biol, 2010, 36(8): 1282-1287.
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