肝区管道结构异常的超声诊断与鉴别方法

Identification and Differentiation of Tube-like Structure in the Liver by Ultrasound

通过对103例患者分别采用二维超声（103例，100％）、双氧水肝脏声学造影（19例，18.44％）、彩色多普勒血流显像（23例，22.33％）及经T型管注水彩色多普勒观察（4例，3.88％）检查。结果表明：二维超声一般能清楚判断肝内外胆管扩张，但对复杂肝区管道异常现象约有44.66％不能作出明确定性诊断，而需借助其它方法作进一步证实；双氧水肝脏声学造影对于鉴别门脉系或其它管道异常具有特异性；彩色多普勒血流显像是鉴别复杂肝区管道异常的最好方法，除了能判断异常来自血管或胆管外，还能清楚分辨为动脉还是静脉；经T型管注水彩色多普勒观察，对于各种胆道术后留置T管者不失为首选的检查方法。因其除了通过观察注水后胆总管变化的动态过程而能明确诊断外，同时还有冲洗胆道、疏通胆总管下段的治疗作用。

103 patients were examined by two-dimensional ultrasound (in all patient,100％ ),liver acoustic contrast hepatosonography with hydrogen peroxide (in 19 patients,18.4％ ),color Doppler blood flow imaging (in 23 patients,22.3％) and the color Doppler observation with injection of water through the T-tube (in 4 patients,3.88％).The results were as follows:Common abnormal tube-like tructures could be recognized by two-dimen-sional ultrasound,but about 44.66% of complex abnormalities could not be diagnosed clear ly and has to be confirmed further by other methods.Liver acoustic contrast with hydrogen peroxide can be used to distinguish portal tubes from other tubes specifically.Color Doppler blood flow imaging was the best means to evaluate complex abnormal tube-like structures in the liver.It could differentiate blood vessels from binary tract and arteries from veins.For patients with retained T-tube after bile duct operation,color Doppler imaging with injection of water through T-tube may be the first choice because it is not only helpful for establishing diagnosis by observing dynamic change of binary tract,but also useful in treatment by flush- ing bile ducts and draining the inferior part of common bile duct.