胆管内超声造影在经皮经肝胆道引流术中的应用价值

The application of intra-biliary contrast-enhanced ultrasonography during percutaneous transhepatic cholangial drainage

目的探讨胆管内超声造影在超声引导下经皮经肝胆道引流术(PTCD)中的应用价值。方法 100例因梗阻性黄疸行超声引导下PTCD的患者中,64例患者经PTCD胆道引流管注入超声造影剂(SonoVue)行胆管内超声造影检查,观察引流管是否位于胆管腔内及引流管末端位置,并与常规超声比较。在胆管内超声造影指导下,判断肝门部梗阻患者需要留置的PTCD胆道引流管数目。所有患者均行X线胆道造影或CT胆道造影证实。结果胆管内超声造影判断引流管是否在胆管腔内的准确率和引流管末端的显示率均为100%(64/64),均优于常规超声的89.1%(57/64)和54.7%(35/64),差异有统计学意义(P=0.013和χ2=37.495,P<0.001)。35例肝门部梗阻患者中的17例患者根据胆管内超声造影的结果留置了2条以上的胆道引流管,以达到充分引流效果。结论胆管内超声造影技术弥补了常规超声的不足,可以在PTCD术中常规应用。

Objective To investigate the value of intra-biliary contrast-enhanced ultrasonogrphy (CEUS) during the ultrasound guided percutaneous transhepatic cholangial drainage (PTCD). Methods One hundred patients with obstructive jaundice underwent ultrasound guided PTCD, and 64 patients of them were employed to intra-biliary CEUS via injected ultrasound contrast agent (SonoVue) into the drainage tubes. The drainage tubes in or out of the biliary ducts and the position of distal ends of the drainage tubes were observed, and the results were compared with those of routine ultrasound. The amounts of drainage tubes detained into the biliary ducts in the patients with hilar obstruction were judged by intra-biliary contrast enhanced ultrasound. All the patients were undergone X-ray cholangiography or CT cholangiography to confirm the results. Results As to intra-biliary contrast enhanced ultrasound, the accuracy of diagnosing drainage tubes in or out of the biliary ducts was 100% (64/64), and the rate of displaying the distal ends was 100% (64/64), too. Both of them were superior to the rates of 89.1% (57/64) and 54.7% (35/64) in routine ultrasound. The differences were significant ( P=0.013 and χ 2=37.495, P<0.001). According to the results of intra-biliary contrast enhanced ultrasound, 17 of 35 patients with hilar obstruction were detained more than two drainage tubes to achieve sufficient drain effect. Conclusion Intra-biliary CEUS could complement the insufficiency of routine ultrasound and may become a general method during ultrasound guided PTCD in the future.