三维超声胆道造影显示肝内胆管的可行性和临床价值

Three-dimensional contrast-enhanced ultrasonic cholangiography in cadaver liver

目的探讨三维超声胆道造影技术显示肝内胆管的可行性和应用价值。方法对6例肝移植术切除的尸肝样本行三维超声胆道造影,经胆总管插管,注入1∶20稀释的超声造影剂SonoVue后,评价其图像质量、可显示的最高胆管分支级别和胆管显示度,并与X线胆道造影相比较,同时对照X线胆道造影评价其胆管树形态拟和度。结果三维超声胆道造影的图像质量稍劣于X线胆道造影,且有统计学差异。所有6例尸肝三维超声胆道造影均能显示立体胆管树状结构,最高可显示至(3.67±0.52)级肝内胆管,X线胆道造影则为(4.00±0.63)级,两者比较无显著性差异(P=0.465)。三维超声胆道造影第1、2级的胆道显示度评分与X线胆道造影比较均无统计学差异,而第3级胆道的显示度评分低于X线胆道造影,两者之间的差异有统计学意义(P<0.05)。其两者的形态拟合度均可达优。结论三维超声胆道造影技术可能成为一种显示胆管树解剖结构的新方法。

Objective To assess the feasibility of three-dimensional contrast-enhanced ultrasonic cholangiography（3D-CEUSC） in cadaver liver. Methods The 3D-CEUSC was performed in 6 cases of cadaver liver. Image quality of 3D-CEUSC was evaluated. The visualization of branching orders,the degree of visibility and coincidence of morphous were compared with those of cholangiagraphy using fluoroscopy. Results The imaging quality of 3D-CEUSC was inferior to that of cholangiography with significant difference. The three-dimensional biliary tree structures were visualized in all 6 3D-CEUSC. The maximum visualization of branching orders in 3D-CEUSC was （3.67±0.52）,which was equal to the results（4.00±0.63）by cholangiography （P=0.465）. The degrees of visibility of biliary tree were equivalent with those by cholangiography in the first and second order with significant difference. The coincidence of morphous was excellent compared the images of 3D-CEUSC with direct X-ray cholangiography. Conclusion 3D-CEUSC is a new technique as a useful supplement to cholangiography in evaluation of biliary anatomy and variation before graft harvesting in LDLT.