活体肝移植供体术中胆管三维超声造影的初步应用

Intraoperative three dimensional contrast-enhanced ultrasonic cholangiography in adult living liver donors

目的初步探讨活体肝移植供体术中胆管三维超声造影对胆管树的显示能力及评价胆管变异的可行性。方法在8例活体肝移植供体手术中进行术中胆管三维超声造影，评价所获得的三维图像的质量，并与术中X线胆管造影作比较，评估显示的肝内胆管分支级别、形态拟合度及胆管变异情况。结果8例肝移植供体术中胆管三维超声造影均能显示立体胆管树状结构，右肝内胆管图像质量平均分（2．8±0．7）优于左肝（2．3±0．7）（P=0．033）；术中胆管三维超声造影可清晰显示（3．9±0．8）级肝内胆管，而X线胆管造影则为（3．7±0．9）级，两者显示能力相当（P=0．443）；而且术中胆管三维超声造影对比X线胆管造影，其形态拟合度均可达优；其中术中胆管三维超声造影发现2例肝内胆管变异，均得到X线胆管造影及手术证实；术中胆管三维超声造影平均操作时间为（10．5±3．1）min；且所有进行术中胆管三维超声造影检查的供体和受体术中及术后随访中均未发生与造影剂相关的不良反应。结论术中胆管三维超声造影是一种全新的胆管树显示方法，能够发现胆管变异，可以作为术中X线胆管造影有益补充。

Objective To assess the feasibility of intra-operative three dimensional contrast enhanced ultrasonic cholangiography （IO-3D-CEUSC） in adult living liver donors. Methods IO-3D-CEUSC was performed in 8 adult living liver donors. Image quality of IO-3D-CEUSC was evaluated. The visualization of branching orders,coincidence of morphous and biliary variation in IO 31）-CEUSC were compared with those of intraoperative cholangiography using fluoroscopy （IOC）. Results The three dimensional biliary tree structures were visualized in all 8 IO-3D-CEUSC. The image quality in the right livers was higher than that of the left livers （ P = 0. 033）. The maximum visualization of branching orders in IO-3D-CEUSC was 3.9± 0.8, which was equal to the result of IOC （3.7 ± 0.9, P = 0.443）. The coincidence of morphous was excellent when compared the images between IO-3D-CEUSC and IOC. Two cases with biliary anatomical variation were detected by IO-3D-CEUSC and confirmed by IOC and surgical finding. The time consumption of IO-3D〉CEUSC was （10.5 ± 3.1 ） minutes. No adverse reactions to SonoVue occurred in the donors or recipients during the operation and follow-up. Conclusions IO-3D-CEUSC is a new technique which may be an useful supplement to IOC in evaluation of biliary anatomy and variation before graft harvesting in living donor liver transplantation.