基于磁共振胆胰管成像图像测量的改良型经皮肝穿刺胆管引流用胆管引流管设计研究

Design of an improved percutaneous transhepatic cholangio drainage tube based on MRCP imaging data

目的利用磁共振胆胰管成像(MRCP)图像的测量信息为设计制备改良型经皮肝穿刺胆管引流术(PTCD)用胆管引流管提供数据参考。方法描述性研究。收集郑州大学附属肿瘤医院放射科自2015年7月至2020年7月2300例患者3.0 T上腹部MRI及MRCP的影像资料,筛选出肝门部胆管结构显示清晰,且为胰头癌、胆总管癌或壶腹部癌所致的胆管梗阻且合并肝内外胆管扩张的患者381例,对这些患者MRCP图像中的左右肝管、肝总管的长度进行测量,根据测量结果对PTCD用胆管引流管进行改良设计。结果测量出恶性肿瘤致胆管梗阻状态下左肝管自起始部至左右肝管汇合部中心点的距离为(15.9±3.8)mm,右肝管自起始部至左右肝管汇合部中心点的距离为(12.4±3.2)mm,自胆囊管汇入部至左右肝管汇合部中心点的长度为(34.0±8.1)mm,根据测量结果完成了PTCD用胆管引流管的引流侧孔分布位置及长度的改良设计,并完成实物化制作。结论MRCP图像胆管测量是获取扩张状态下胆管长度数据的有效方法,根据胆管测量结果制备的改良用PTCD用胆管引流管贴合BismuthⅡ、Ⅲ型高位胆管癌所致的胆管梗阻的引流需求。

Objective Quantified MRCP imaging data was used as a reference for design and preparation of a modified percutaneous transhepatic cholangio drainage(PTCD)tube.Methods 3.0 T upper abdominal MR and MRCP imaging data of 2300 patients treated from July 2015 to July 2020 at the Department of Radiology of the Affiliated Cancer Hospital of Zhengzhou University were screened and a total of 381 patients diagnosed with biliary duct structures were identified.Causative etiologies among these patients included pancreatic adenocarcinoma(pancreatic head),cholangiocarcinoma,ampullary carcinoma,as well as intrahepatic and/or extrahepatic bile duct dilation.An improved PTCD tube was designed based on MRCP quantification of left and right hepatic and common hepatic duct length.Results In the setting of biliary obstruction caused by malignancy,the distance of the left hepatic duct from its origin to the point of left and right hepatic duct confluence was 15.9±3.8 mm,while the distance of the right hepatic duct from its origin to the point of left and right hepatic duct confluence was 12.4±3.2 mm;the length of the bile duct from its origin to the point of left and right hepatic duct confluence was 34.0±8.1 mm.The improved PTCD tube design incorporated an altered length of the drainage orifice.Conclusion MRCP imaging of the biliary tract is effective for measuring biliary tract length in the setting of pathological dilation.Based on our biliary tract measurements,a modified PTCD tube was designed to more effectively meet drainage requirements and manage biliary obstruction caused by Bismuth-Corlette typeⅡandⅢmalignancies.