三维数字减影技术在恶性肿瘤引起的梗阻性黄疸诊疗中的应用

Application of 3 - dimensional digital subtraction in the diagnosis and treatment of the obstructive jaundice caused by the malignant tumours

目的 探讨三维数字减影技术在恶性肿瘤引起的梗阻性黄疸诊疗中的应用.方法 选择晚期恶性肿瘤引起的梗阻性黄疸患者20例,行经超声引导穿刺肝内扩张胆管,注入造影剂,对狭窄病变段进行三维数字减影检查,并将检查得到的三维数字减影图像进行三维成像,观察病变情况.同时随机采集同时间段梗阻性黄疸患者20例未行三维成像的病例,行数据对比分析.结果 三维数字减影可以清晰显示胆管恶性狭窄的位置,精确测量长度,清晰显示狭窄病变段的形态,有助于精确定位及选择合适的治疗方法.三维成像组较未经三维成像组的病例比较,造影剂用量明显减少（P＜0.01）,技术成功时间明显缩短（P＜0.01）,总的曝光剂量明显减少（P＜0.01）.结论 三维数字减影技术对于恶性肿瘤引起的梗阻性黄疸的诊断,病变的精确测量,治疗方法的选择,有着不可替代的作用,并可以明显缩短手术时间及降低造影剂用量和曝光剂量.

Objective To explore the value of 3 -dimensional digital subtraction in the diagnosis and treatment of the obstructive jaundice caused by the malignant tumours. Methods Twenty patients with obstructive jaundice caused by the advanced stage of malignant tumours were examined with 3 - dimensional digital subtraction after the the Ultrasonic Guide Puncture intrahepatic bile duct extension, injecting the contrast material. Then the 3 - dimensional imaging on the inspection results were conducted and pathological changes were observed. At the same time, draw another twenty medical case of this kind of terminal disease without 3 - dimensional digital subtraction images in the corresponding hospitalized treatment period randomly. Next, conduct the comparison and analysis of the observation data with the two groups of patients. Results 3 - dimensional digital subtraction images demonstrated the position, precision length of the bile duct malignant stricture, the shape of the stricture part of the pathological changes clearly, which contributes to the precise localization and the selection of suitable treatment method. And through the comparison, we found that the contrast material and total radiation dosage had been reduced and the operation process had been shortened distinctly in the cases with 3 - dimensional digital subtraction images. Conclusion The 3 - dimensional digital subtraction can reduce the operation time, decrease the dosage of contrast material and radiation. It plays an irreplaceable role in the diagnosis of the obstructive jaundice caused by the malignant tumours,in the precise measurement of the pathological changes,in the selection of the suitable therapy.