经胆管腔内超声造影的临床应用价值

Clinical application value of intra-biliary contrast-enhanced ultrasound

目的探讨经胆管腔内超声造影(IB-CEUS)的临床应用价值。方法本前瞻性研究对象为2008年1月至2011年12月在中山大学附属第三医院接受诊治的10例壶腹部梗阻患者。其中男6例,女4例,年龄30～83岁,中位年龄57岁。所有患者均签署知情同意书,符合伦理学规定。患者先行经皮经肝胆道引流术(PTCD),然后分别行IB-CEUS和X线胆道造影检查。分别观察IB-CEUS和X线胆道造影对引流管、胆囊、肠管、肝外胆管和肝内各级胆管的显影效果。两种检查方法的显示率比较采用Fisher确切概率法,所能显示的肝内胆管分支最高级别比较采用秩和检验。结果两种检查方法均能显示胆管树结构。IB-CEUS对引流管、胆囊、肠管及肝外胆管的显示率分别为100%、78%、30%、100%,X线胆道造影为100%、89%、40%、100%,差异无统计学意义(P>0.05)。IB-CEUS对肝内一、二、三级胆管分支数的显示率分别为100%、98%、98%,X线胆道造影为100%、100%、100%,差异无统计学意义(P>0.05)。IB-CEUS对所能显示的肝内胆管分支最高级别为3.5(3.0～5.0)级,X线胆道造影为4.5(4.0～5.0)级,差异有统计学意义(Z=-3.000,P<0.05)。结论 IB-CEUS是一种重要的胆管腔内成像技术,其显像效果与X线胆道造影接近,可作为X线胆道造影的一种重要替代方法。

Objective To investigate the clinical application value of intra-biliary contrast-enhanced ultrasound （IB-CEUS）. Methods Ten patients with ampullary obstruction in the Third Affiliated Hospital of Sun Yat-sen University from January 2008 to December 2011 were enrolled in this prospective study. There were 6 males and 4 females with age I＇anging from 30 to 83 years old and a median age of 57 years old. The informed consents of all patients were obtained and the ethical committee approval was received. The patients underwent percutaneous transhepatic cholangial drainage （PTCD） firstly and then received IB-CEUS and X-ray cholangiography. The visualization effects of drainage tubes, gall bladders, intestines, extrahepatic bile ducts and all orders of intrahepatic bile ducts by IB-CEUS and X-ray cholangiography were observed. The visualization rates of two methods were compared by Fisher＇s exact probability test. The highest orders of intrahepatic biliary branches that could be visualized were compand by rank sum test. Results The biliary tree structure could be visualized both by two examination methods. The visualization rates of drainage tubes, gall bladders, intestines and extrahepatic bile ducts were 100%, 78%, 30%, 100% by IB-CEUS, and were 100%, 89%, 40%, 100% by X-ray cholangiography respectively, where no significant difference was observed （P〉0.05）. The visualization rates of first-, second-, third-order intrahepatic biliary branch number by IB-CEUS were 100%, 98%, 98% and were 100%, 100%, 100% by X-ray cholangiography respectively,where no significant difference was observed （P〉0.05）. The highest order of intrahepatic biliary branches that could be visualized was 3.5（3.0-5.0） by IB-CEUS, and was 4.5（4.0-5.0） by X-ray eholangiography, where significant difference was observed （Z=-3.000, P〈0.05）. Conclusions IB-CEUS is an important intra-biliary imaging modality with similar visualization effects as X-ray cholangiography, which could be an important substitutional method of the X-ray cholangiography.