非血管超声造影指导下穿刺引流上消化道瘘的初步尝试

Values of non-vascular contrast-enhanced ultrasound in guiding percutaneous drainage of upper gastrointestinal fistulas

目的评价口服和经引流管注射等非血管超声造影在引导穿刺治疗上消化道瘘的价值。方法对食管吻合术和毕Ⅰ式胃吻合术形成的13例胸腔食管瘘、2例腹腔胃瘘合并重症感染的患者进行超声引导下脓肿穿刺引流治疗。穿刺术前、术中行口服超声造影及引流腔注射造影,明确瘘腔位置,确定安全穿刺路径,进行彻底引流。结果 13例患者于穿刺术前口服超声造影剂,均明确了真正瘘腔的具体位置,其中2例患者因缺乏安全穿刺路径未能实施穿刺治疗;穿刺术中口服超声造影剂可持续强化穿刺目标,增强穿刺针前进的方位感和准确性;引流腔注射造影可评价穿刺定位的准确性、引流管前端位置是否恰当及干预的有效性。结论非血管超声造影技术对超声引导下上消化道瘘的微创穿刺治疗具有指导价值,弥补了常规超声成像的不足。

Objective To assess the value of non-vascular contrast-enhanced ultrasound（oral contrast-enhanced ultrasound,fistula cavity contrast-enhanced ultrasound,etc.）in guiding percutaneous drainage of the upper gastrointestinal fistulas.Methods Thirteen patients with suppurative pleuro-esophageal fistulas following esophagus-anastomosis/Billroth Ⅰ stomach-anastomosis and two patients with gastric fistulas combined with severe infection underwent percutaneous drainage.Before and during the procedure,oral contrast-enhanced ultrasound and fistula cavity contrast-enhanced ultrasound scanning were conducted to identify the position of fistulas,determine the safe approach for a radical catheterization drainage.Results The actual positions of the upper gastrointestinal fistulas in the 13 patients were identified for puncturing after preoperative oral contrast-enhanced ultrasound.Two of the 13 patients did not receive puncturation due to lack of safe approach.During the operation,oral contrast-enhanced ultrasound maintained the fistula cavity enhanced for a long time,ascertaining a safe approach.Fistula cavity contrast-enhanced ultrasound could be used to evaluate the accuracy of percutaneous drainage,ascertain the location of catheter tip for more effective drainage,and estimate the efficacy of interventions.Conclusion Non-vascular contrast-enhanced ultrasound is valuable in guiding percutaneous drainage for upper gastrointestinal fistulas,which makes for the shortcomings of the conventional ultrasonic imaging.