胆道系统探查中术中超声的应用及临床价值

目的:探讨胆管系统探查中术中超声(intraoperative ultrasound,IOUS)的应用及临床价值。方法:2007年3月至2014年8月应用术中超声对胆道系统进行探查的病例资料58例,对其术前影像学表现、手术过程、术中超声所见以及术中和术后诊断进行分析,研究术中超声对胆道探查的应用价值。结果:(1)58例应用术中超声病人中,肝内外胆管结石35例、肝门部胆管癌及胆总管癌11例,急性胆囊炎8例,胃癌1例,先天性胆总管囊肿1例,胆总管炎性狭窄1例,胰腺癌1例。术中超声确认取净结石或胆总管未见明显异常34例,定位肝内胆管残余结石6例,发现胆总管内尚有结石2例,术中超声确诊胆管癌2例;另发现胆总管先天性解剖异常2例;(2)在发现胆管结石方面,与术前MRCP无显著性差异(P=0.643);与术前CT、B超比较有显著差异(P0.05),诊断率分别为B超74.3%,MRCP 91.4%,CT 77.1%,IOUS 94.3%。结论:术中超声胆道系统的探查可以在广泛的疾病中得到应用,可以对术前影像学检查起到验证和补充的作用,且在术中引导各种介入操作中起到独特作用。

Application and Clinical Value of Intra-operative Ultrasound in Biliary Duct Exploration

Objective:To explore the application value of intra-operative ultrasound (IOUS) in the hepatolithiasis.Methods:IOUS was applied to detect the biliary system for clinical data of 58 patients from March 2007 to August 2014. Preoperative imaging findings, surgical procedure, IOUS examination materials and postoperative dignosis were analyzed. Exploding application value of intraoperative ultrasonography for the exploration of biliarytract.Results:(1) In all the 58 cases where IOUS was applied, we found 35 cases of hepatolithiasis, 11 cases of bile duct-carcinoma, 8 cases of acute cholecystitis, 1 case of gastric cancer, 1 case of congenital cyst of common bile duct, 1 case of inflammatory stenosis in common bile duct, and 1 case of pancreatic carcinoma. IOUS confirmed 34 cases of non-residual biliary stone intra-operation, location of intrahepatic bile duct residual stones in 6 cases, 2 cases of residual stones in common bile duct, and diagnosed 2 cases of biliary carcinoma. In addition, IOUS identified 2 cases of congenitally abnormal bile duct in anatomy; (2) According to the effectiveness of diagnosing hepatolithiasis, there was no significant difference compared with MRCP, and there was significant difference compared with the preoperative examining methods of B ultrasound and CT, diagnostic rate respectively, B ultrasound 74.3%, MRCP 91.4%, CT 77.1%, and IOUS 94.3%.Conclusion:Intraoperative exploration of biliary tract system can be applied in a wide range of diseases, and it plays the role of verifying and complement to preoperative examinations. In intra-operation, IOUS also functioned well in various kinds of intervention remedy.