PTCD术中运用经胆管超声造影的临床价值

Clinical value of intra-biliary contrast-enhanced ultrasound in percutaneous transhepatic cholangial drainage

目的:研究经胆管超声造影(IB-CEUS)对经皮肝穿刺胆道引流术(PTCD)的指导意义。方法:对36例拟行PTCD的患者术中经超声引导置管,所有患者在置管前均行常规超声检查,置管后先行常规超声检查,后行IB-CEUS检查,比较IBCEUS检查前后患者胆管显示范围及引流管末端显示率。结果:所有患者在超声引导下均成功置管,IB-CEUS成功率为100%。常规超声及IB-CEUS对肝内一级胆管的显示率均为100%(72/72),对二级胆管的显示率分别为94%(135/144)、97%(140/144),对三级胆管的显示率分别为52%(151/288)、96%(276/288)。IB-CEUS对引流管末端的显示率为100%(41/41),明显优于常规超声的显示率(22%(9/41))(P<0.001)。结论:IB-CEUS对肝内胆管及引流管末端的显示优于常规超声检查,可实时评价PTCD的有效引流范围,为疗效评价提供依据。

Objective:To investigate the guiding significance of intra-biliary contrast-enhanced ultrasound(IB-CEUS)in percutaneous transhepatic cholangial drainage(PTCD).Methods:Thirty-six patients who were to undergo PTCD were treated with ultrasound-guided catheterization.All patients underwent conventional ultrasound examination before catheterization,followed by another conventional ultrasound examination and IB-CEUS assessment after catheterization.Comparisons were made between the visualization range of the bile duct and the visualization rate of the drainage tube endpoint before and after IBCEUS.Results:All patients were successfully catheterized under ultrasound guidance and the success rate of IB-CEUS was 100%.The visualization rates of primary bile duct by conventional ultrasound and IB-CEUS were both 100%(72/72),and the visualization rates of secondary bile duct were respectively 94%(135/144)and 97%(140/144).The percentage of 52%(151/288)and 96%(276/288)represented the visualization rates of tertiary bile duct by conventional ultrasound and IB-CEUS,severally.The visualization rate of IB-CEUS for catheter end was 100%(41/41),which was significantly better than that of conventional ultrasound(22%(9/41))(P<0.001).Conclusion:The results of IB-CEUS on the intrahepatic biliary and the drainage tube endpoint are superior to those of conventional ultrasound examination,which can evaluate the effective drainage range of PTCD in real time and lay a solid foundation for assessing therapeutic effects.