Clinical Study Of Percutaneous Transhepatic Contrast-enhanced Cholangioultrasonography

ObjectiveCombining the real-time gray-scale ultrasonography and contrast-agents (SonoVue) to investigate the clinical value in the ultrasound-guided percutan-eous transhepatic cholangial drainage (UG-PTCD) in obstructive jaundice patie-nts.Methods37 patients with obstructive jaundice were enrolled in this study.Among them, there were 24 male and 13 female, and ages range from 40 years to 81 years. The average age was 69 years.Included 18 patients with imaging and pathological diagnosis of hilar mass,12 cases were diagnosed as extra-hepatic bile ducts mass,and 8 cases were diagnosed above hilar mass.Preoperative,a baseline US of the bile ducts,using the gray scale and color Doppler flow imaging (CDFI) was performed to identify the lesions'location,observe and measure the bile ducts dilatation and help to make a preliminary design for biliary drainage. According to the state of the bile ducts dilatation,then chose a suitable puncture point.Generally,there were three puncture approaches:via a right sided intercostal or subcostal approach;via a median xiphoid process approach.All the patients underwent ultrasound-guided percutaneous transhe-patic cholangial drainage (PTCD).The aimed bile duct was punctured with a 18-21G Chiba needle,we used a regular probe with a needle guidance aperture,to allow suitable angulations of the needle.The puncture was performed using ultrasound guidance to aim directly into the bile ducts.In all enlarged bile ducts the pass of the needle into the bile duct could be monitored.Put 0.2ml SonoVue (Bracco,Italy) into 0.9% stroke-physiological saline solution 20-40ml. Afterw-ards,the contrast agent solution was administrated from the transfixion pin or drainage tube slowly.Their biliary tracts,obstructive level and cause of obstructive, duodenum and cholecysts. were scanned under contrast pulsed sequencing mode to achieve related contrast-enhanced ultrasonograms.The entire examination was recorded on digital video clips.After postoperative 2-12h,the percutaneous transhepatic cholangiography (PTC) were carried out in each patient.Severity and accuracy of biliary obstruction were assessed accor-ding to the PTCUS findings with a comparison to conventional PTC. And in a part of the patients were compared with three-dimensional reconstruction CT of the bile ducts after therapy.Result(1) There were some difference in the judgement on 30 cases block of porta and extra-hepatic bile ducts between diagnosis of PTCUS and PTC: According to PTCUS, there were 13 cases of complete obstruction and 17cases of incomplete obstruction;While according to PTC, there were 11 cases of complete obstruction and 19 cases of incomplete obstruction. But there were no statistics difference in the judgement of block level (Chi-square value=0.5, 0.50>P>0.25).(2) PTCUS has a lower display rate in intestinal tract and gall bladder than PTC. The difference has statistics value (Chi-square value is 0.5,7.11 respect-ively, P<0.50).(3) There were 7 cases whose bile ducts obstructions were caused by tumor above hilar. Because tumor in liver had occupancy pathological changes soakage and pressed the bile ducts around to cholestasis and cholangiectasis. The normal shapes of bile ducts were destroyed. In this situation, the SonoVue contrast agent poured through puncture needle fix the narrow position and level of bile duct. Then according to the knowledge of water-spreading range, make further plan of placing tube;Compared the display of PTCUS to water-spreading range in operation with PTC after operation, the result were same.(4) The maximum visualization of branching orders in PTCUS was 3.5±0.8, which was equal to the result of PTC (3.7±0.9),(t=0.697, P>0.25).(5) After the PTCUS,the level of total bilirubin(TBIL) decreased obvio-usly (t=4.437,P<0.0005).No adverse reactions to SonoVue occurred in the pati-ents during the operation and follow-up. ConclusionsPTCD was a concise,safe and feasible method of biliary tract radiography, and dynamic display the flow of contrast agent clearly. For PTCUS and PTC, there was no statistical significance in the judgement of bile ducts'obstruction level and the maximum visualization of branching orders. Make a precise diagnosis for the block level of bile ducts was to put the drainage program into practice, and the PTCUS diagnosis result was very important for making the drainage program.PTCUS realized the carrying out of ultrasound-guided percutaneous transhepatic drainage and real-time ultrasonography in operation at the same time, offer more and accurate diagnosis information to operators.At last, the effectively drainage was to be realized.