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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2021, Vol. 10 ›› Issue (06): 604 -607. doi: 10.3877/cma.j.issn.2095-3232.2021.06.015

临床研究

胆道超声造影在肝胆手术中的应用
蒋小峰1,†(), 胡远兴1, 吴心强1, 黄镇辉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, 胡以则1, 薛平1, 宋月云1, 黄嘉文1, 王丹1   
  1. 1. 510260　广州医科大学附属第二医院肝胆外科
  • 收稿日期:2021-08-23 出版日期:2021-09-23
  • 通信作者: 蒋小峰
  • 基金资助:
    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)

Application of intraoperative contrast-enhanced ultrasound cholangiography in hepatobiliary surgery

Xiaofeng Jiang1,†(), Yuanxing Hu1, Xinqiang Wu1, Zhenhui Huang1, Dawei Zhang1, Haiwu Lu1, Zilong Wen1, Qiang Zheng1, Songhang Liu1, Xuewei Yang1, Liangqi Cao1, Heping Peng1, Yize Hu1, Ping Xue1, Yueyun Song1, Jiawen Huang1, Dan Wang1   

  1. 1. Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
  • Received:2021-08-23 Published:2021-09-23
  • Corresponding author: Xiaofeng Jiang
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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。

关键词: 胆道, 超声检查，介入性, 外科手术
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.

Key words: Biliary tract, Ultrasonography, interventional, Surgical procedures, operative
图1 肝胆手术中胆道超声造影图注：a、b为1例开腹超声造影显示肝左叶肝内胆管（LHBD），a示肝左外叶S2、S3段胆道，b示S4段胆管的S4a、S4b支；c为1例腹腔镜下超声造影清晰显示右前支胆管（RAHD）、右后支胆管（RPHD），S5、S6、S7、S8段胆管，S5a、S8a、S8c亚段胆管
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