螺旋CT下T管造影胆道成像的临床应用

Clinical application of spiral CT cholangiography via T-tube

目的探讨螺旋CT下T管造影胆道成像(spiral CT cholangiography,SCTC)技术的临床应用及其价值。方法2013年1月至2015年1月,98例行胆总管探查术及T管引流胆道手术患者,术后三周以后行肝胆胰螺旋CT平扫,然后经T管5%泛影葡胺50~100 ml进行螺旋CT胆道造影,三维重建方法。隔日再行10%泛影葡胺T管常规X线造影。结果 SCTC显示肝内外胆管,胆管树形态,发现肝内胆管残石、肝内胆管树显示SCTC优于T管常规造影(P<0.05);肝外胆管残石与T管常规造影相似(P>0.05)。残石的发现与纤维胆道镜检查结果相当。结论 CT下T管造影胆道成像,结合常规T管CT断层可同时观察胆道内外病变,弥补单纯T管造影不足;螺旋CT下三维成像显示肝内外胆管立体构象结构,同时显示肝脏、胰腺结构,为外科临床工作提供客观放射解剖学资料,也是评价手术方式的客观指标之一。

Objective To investigate the clinical application and value of the T-tube spiral CT angiography biliary imaging( spiral CT cholangiography,SCTC). Methods From Jan 2013 to Jan 2015,98 cases of patients with the common bile duct exploration run the spiral CT scanning three-dimensional reconstruction by dripping 50-100 ml of 5% meglumine diatrizoate into T-tube after operation for 3 weeks and take the conventional X-ray imaging of the T-tube,Results The SCTC is better than T-tube conventional angiography in the bileduct,biliary tree morphology,intrahepatic bileductremnant stone( P < 0. 05),but it is similar to conventional angiography with T-tube in the extrahepatic bile duct remnant stone( P > 0. 05),and the results of residual stones found Choledochofiberscope. Conclusion SCTC make up for lack of asimple T tube angiographyandshow bile duct three-dimensional conformation structure,display liver,pancreas structure at the same time,surgery work to provide objective radiological anatomy information,but also one of the objective indicators to evaluate the surgical approach.