改进T管胆道造影方法研究

目的：探讨改良传统的T管胆道造影方法。方法：使用两种加入地塞米松和利多卡因的不同浓度的造影剂，取不同体位给病人造影．另取一传统方法造影组对照。结果改良型T管造影显像优秀率100％，术中患者不适率5％．诊断符合率86％；传统法T管造影显像优秀率70％，术中患者不适率27％，诊断符合率57％。结论：改良型T管造影可明显提高显像优秀率、诊断符合率，降低术中患者不适率。     

CO2血管造影的现状

1971年 Hawkins 首先使用 CO_2作周围血管造影。当时采用单片减影技术取得了理想的显影效果。DSA 的出现极大地提高了血管内气体的显示力,从而扩展了这一技术的应用范围。更由于气体专用注射器的问世,血管扩张剂的应用,以及图像后处理软件的改进等,使 CO_2血管造影发展成为安全而可靠的血管成像方法。一、CO_2在血管内的动力学特征CO_2注入血管后,一开始是将血液推移而不是与血液混合,在气液之间维持着一个界面。     

术中经胆囊管插管胆道造影并发胆汁漏原因分析及预防

我科1990年1月至1995年12月，采用术中经胆囊管插管胆道造影38例，插管造影成功28例，占73．7％。术后并发胆汁漏2例，占5 3％。外院同方     

T形管胆道造影远距离遥控推药装置的研制与应用

以往进行Ｔ形管逆行胆道造影的操作时通常是由医生手持注射器 ,在暴露于Ｘ射线照射的情况下将造影剂经Ｔ形管推入到胆道系统内。这种操作方法对医生的身体健康会造成一定的损害。为此 ,笔者结合临床实际的需要 ,研制了Ｔ形管逆行胆道造影的遥控推药装置。一、材料和方法1 装置结构和工作原理 :本装置由以下部分组成 (见图1) :①动力装置 :为一台微型交流罩极式电动机 ,电压 2 2 0Ｖ 5 0Ｈｚ,转速为 2 5 0 0ｒ·ｍｉｎ- 1 ,功率 30Ｗ。②减速装置 :采用减速齿轮箱 ,箱内蜗杆和蜗轮为工程塑料制成 ,外壳为精铸铝 ,经减速后转速为 5 0ｒ·ｍｉ…     

胆道假性梗阻

胆道手术后，由于种种因素而再次手术，其中以残余结石为最多见，分别占68％－75．4％（1，2），术后“T”形管造影（以下简称“T”管造影）仍是目前临床诊断的常用方法和主要根据，因而正确分析术后“T”管造影的各种X线表现，对临床决定治疗方针极为重要。如对造影的各种改变不加识别，则可引起误诊甚至不必要的手术探查。     

术中胆道造影的应用价值

胆石病包括发生在胆囊和胆管的结石,是常见病、多发病,随着人民生活水平的提高,胆道结石的发病率有明显增高的趋势。胆管结石尤其是肝内胆管结石严重影响着患者的生活质量。超声显像是诊断胆囊结石的首选方法,其诊断胆囊结石准确率达95％左右,但误诊率仍为2.07％,而对于胆管结石的误诊率可能会更高。术中胆道造影是胆道手术中了解有无结石残留的重要手段之一。笔者对近几年48例术中胆道造影进行分析,探讨其应用价值。     

重视CO2血管造影研究拓展临床应用新领域

气体作为血管造影的对比剂的探索可追溯到1个世纪以前。在尝试过不同的气体后，纯度为99．9％的二氧化碳(CO2)在20多年前成功地应用于血管造影。CO2与其他气体的不同之处在于能迅速溶解于血液内，不易产生气栓和对呼吸功能影响较小。在这漫长的探索中，虽未曾有高潮迭起的研究热潮，但却延绵不断，持续至今。人们对这种气体阴性对比剂的物理特性、成像原理、优势和缺陷，以及并发症预防和处理等方面逐渐有了比较全面的认识和理解，临床应用不断扩展。     

DSA引导下经T管调管并二次置入胆道引流管治疗肝胆术后胆汁漏4例

目的探讨利用导丝调整异常T管的位置并二次置入胆道引流管治疗肝胆手术术后胆汁漏的有效性及安全性。 方法回顾性分析2018年1月至2020年1月于我院在DSA引导下经T管调管并二次置入胆道引流管治疗肝胆术后胆汁漏的4例患者资料。经T管引入导丝导管,导丝导管配合,调整异常的T管并进入肝内胆管内,经导丝引入8.5F COOK胆道外引流管置于肝内胆管,行胆道负压外引流。总结评价治疗效果。 结果术后4例患者负压引流管引流通畅,胆汁漏逐渐停止,腹腔内感染得到控制。术后1个月复查造影,见引流管位置正常,无造影剂外溢至腹腔,2个月拔除T管及胆道引流管后,患者无特殊不适。随访1年,患者病情未再反复。 结论DSA引导下经T管调管并二次置入胆道引流管是治疗肝胆手术术后胆汁漏的安全有效的方法,可避免再次外科手术,减轻患者痛苦。     

胆道T管造影中对比剂注入方法对不良反应及周围血内毒素的影响

目的 探讨胆道T管造影术中采用不同对比剂注入方式对不良反应及周围血内毒素变化的影响.资料与方法 对163例胆道术后患者行胆道T管造影,随机分为两组,即推注组和输注组.对两组患者出现的不良反应及周围血内毒素水平变化进行观察.结果 两组均成功完成胆道造影;不良反应的发生在输注组明显减少(P<0.01),其中腹痛、发热两组有显著差别;胆道基础压力两组无差别,而推注组胆道内最高压力明显高于输注组(P<0.01);输注组血内毒素水平与术前相比差异无统计学意义(P>0.05),而推注组血内毒素水平比术前升高(P<0.01),术后两组周围血内毒素水平有显著性差异(P<0.05).结论 输注法胆道T型管造影同样可以成功进行胆道造影,胆道内压力波动小,对周围血内毒素水平影响小,且可降低不良反应发生率.     

Placement of biliary endoprosthesis through T-tube tract—case report

We report a case of obstructive jaundice in which the tract of a surgically placed T-tube was used as a route for easy access to stent a neoplastic stenosis of the common bile duct.     

Novel use of a T-tube access to perform an internal/external biliary drainage

We report a case of post-surgical temporary functional stenosis of the sphincter of Oddi and biliary leak in a patient with a previous Billroth II reconstruction who had undergone cholecystectomy, surgical choledocotomy and sphincterotomy for biliary calculi. The patient was treated by creation of an internal/external biliary drainage using the T-tube access with an unreported technique.     

MSCT胆管成像对高位胆管癌的诊断价值

目的：探讨MSCT胆管成像对高位胆管癌的诊断价值,为临床对高位胆管癌术前分型提供新的方法和依据。方法：利用16层螺旋CT对25例高位胆管癌患者行胆管成像检查,在工作站通过VR、MIP技术重组胆管树三维图像,对肿瘤类型作出评估,并与手术结果进行对照分析,评价MSCT胆管成像在高位胆管癌的应用价值。结果：25例患者经手术探查,在判断肿瘤分型上,诊断符合率为100%,术前评估结果与手术结果一致性极好。结论：MSCT胆管成像检查对胆管癌分型具有很高的准确性,在高位胆管癌术前评估以及制订手术治疗方案等方面具有重要的参考价值。     

阴性法螺旋CT胆管造影在胆管梗阻疾病中的应用

目的评估阴性法螺旋CT胆管造影(N-CTC)对胆管梗阻疾病的诊断价值。方法68例经B超检查提示有肝外胆管梗阻的病例用血管对比剂行增强扫描后,对扫描原始数据作二次重建获得轴面源像(ASI),然后运用三维软件对ASI进行编辑处理,获得最小强度投影(MinIP)及表面遮盖法显示(SSD)图像。3位资深放射科医师采用盲法,根据MinIP、SSD像及ASI对梗阻病变作出部位、性质诊断,并与手术和病理结果作比较。结果68例中,25例经1次屏气完成扫描;43例经2次屏气完成检查。对照手术和病理结果,MinIP、SSD像定位准确率均为100.0%,ASI为98.5%,N-CTC与ASI间差异无显著性意义(χ2=0.00,P＞0.05);整体定性准确率分别为82.4%,79.4%及92.6%,MinIP像与ASI间差异无显著性意义(χ2=3.27,P＞0.05),而SSD像与ASI间差异有显著性意义(χ2=4.92,P＜0.05);三者综合定性准确率为95.6%。结论N-CTC作为一种无创、便捷的检查方法,对胆管梗阻部位识别的准确率高。MinIP、SSD像结合ASI能对大多数疾病作出定性诊断。     

Multislice CT cholangiography without biliary contrast agent: technique and initial clinical results in the assessment of patients with biliary obstruction

Our objective was to describe our technique for multislice CT cholangiography without cholangiographic contrast agent, and to present our preliminary clinical results. Thirty-seven patients with suspected biliary obstruction were studied. A multislice CT unit was used with the following technical parameters: 2.5-mm collimation; 7.5-mm/s table speed; pitch 6; 0.8-s rotation time; 300 mA; 120 kVp; 18- to 24-s scan time; scan volume ranging from the hepatic dome to below the pancreatic head; 70-s delay after injection of 150 ml of iodinated contrast agent at 4 ml/s. No biliary contrast material was given; oral iodinated contrast agent was administered to opacify bowel loops. Axial, multiplanar reformatted, and minimum intensity projection images were evaluated. The CT findings were compared with the gold standard techniques: endoscopic retrograde cholangiography (ERCP) in 30 patients, percutaneous transhepatic cholangiography in 5, and intraoperative cholangiography in 2. In 5 patients with ampullary lesions biopsy was made during ERCP, 9 underwent surgery, and 11 US-guided fine-needle aspiration. Bile ducts appeared hypodense within the surrounding enhanced structures. Regarding the site of obstruction, agreement between multislice CT and conventional cholangiography was observed in all cases. One patient presented negative findings on both CT and ERCP. In 31 of 36 (86%) patients, multislice CT cholangiography without cholangiographic contrast agent correctly assessed the cause of bile duct obstruction. Multislice CT cholangiography without cholangiographic contrast agent seems to be a promising diagnostic tool in the assessment of patients with bile duct obstruction. Electronic Publication     

Bypass of obstructing bile duct calculus by an endoprosthesis inserted via a T-tube track

A surgically introduced biliary endoprosthesis in a patient with a cholangiocarcinoma prevented extraction of a calculus in the lower common bile duct through a T-tube track. The problem was solved by the introduction of a second endoprosthesis across the ampulla of Vater through the T-tube track in order to prevent obstruction of the common bile duct by the calculus.     

T管造影在肝内胆管结石Ⅱ期手术中的应用

目的:探讨肝内胆管结石经胆总管切开取石术后T管造影在Ⅱ期手术中的应用.方法:对96例手术后T管引流患者,经T管注入30%泛影葡胺,动态、多角度观察肝内胆管的影像特征并摄取点片.结果:96例患者中39例未见异常,拔除管后治愈.余57例有不同程度的肝内胆管狭窄与扩张,残余结石17例,肝内胆管不显影5例,变异15例,胰管显影16例.全部结果均经US、CT、胆道镜及手术证实.结论:肝内胆管结石术后行T管造影简单易行,能清晰显示结石有否残留以及在肝胆管的分布、肝胆管的狭窄与扩张以及胆管的变异等,从而为外科Ⅱ期手术的制订提供重要依据.     

Contrast-enhanced MR cholangiography with Gd-EOB-DTPA in patients with liver cirrhosis: visualization of the biliary ducts in comparison with patients with normal liver parenchyma

The purpose of this study was to assess the quality of biliary duct visualization using Gd-EOB-DTPA-enhanced magnetic resonance cholangiography (EOB-MRC) in patients with liver cirrhosis. Forty adult patients with liver cirrhosis (cirrhosis group) and 20 adult individuals with normal liver parenchyma (control group) underwent EOB-MRC using T1-weighted GRE imaging up to 180 min after Gd-EOB-DTPA administration. Two observers assessed the visualization of each biliary structure and the overall anatomical visualization of the biliary tree. Child-Pugh, MELD score and laboratory findings were compared. The grade of visualization for each evaluated biliary structure was statistically different in the two groups (P = 0.004 to <0.001). The overall EOB-MRC quality was rated as sufficient for anatomical visualization of the biliary tree in all individuals of the control group 20 min after Gd-EOB-DTPA application, but in only 16/40 patients (40%) of the cirrhosis group within 30 min after application. Analysis of the ROC curves revealed that the cut-off values, for non-sufficient visualization of the biliary tree 20 min after Gd-EOB-DTPA application, were MELD scores > or =11 and total serum bilirubin levels > or =30 micromol/l. Consecutively, EOB-MRC in patients with liver cirrhosis resulted in a decreased or even non-visualization of the biliary tree in a substantial percentage of patients.