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The purpose of real-time CEUS technology and new contrast agent SonoVue (SonoVue) a combination of both used in percutaneous catheterization bile duct drainage (percutaneous transhepatic cholangial drainage, PTCD) in. Observed after injection of contrast agent biliary tree display, and percutaneous transhepatic bile duct X-ray angiography (percutaneous transhepatic cholangiography, PTC) a comparative study to explore the ultrasound-guided percutaneous transhepatic bile duct contrast-enhanced ultrasound (ultrasound-guided percutaneous the clinical value of of tra-nshepatic cholangioultrasonography, UG-PTCUS) surgery in patients with obstructive jaundice PTCD. Materials and methods from August 2008 to April 2010 due to biliary disease in Shandong Provincial Hospital hospitalized patients in 37 cases, including 24 males and 13 females, aged 40-81 years, mean 69 years. By imaging and pathological diagnosis system hilar tumors in 18 cases, including four cases of primary liver cancer, liver cancer and biliary tumor thrombus in 3 cases, hilar cholangiocarcinoma in 8 cases, 3 cases of metastatic lymph nodes; extrahepatic bile duct tumors in 12 cases, in which the common bile duct tumor in 5 cases, the head of the pancreas tumor in 5 cases, Periampullary tumors two cases; hilar tumor seven cases, including four cases of primary liver cancer, 2 cases of metastatic liver cancer, bile duct cells carcinoma. Preoperative color Doppler observation of bile duct dilatation, the site of obstruction, the selected puncture site, the initial surgical plan. Preoperative preparation, routine disinfection, shop towels hole, anesthesia, ultrasound-guided needle puncture - the guide wire - Dilatation Catheter - drainage tube into the expansion of the bile duct in turn. Take 0.2ml SonoVue 20-40ml of 0.9% sterile saline formulated into 1:100-200 SonoVue solution. Start the harmonic contrast control mode, the preparation of a good SonoVue solution starts immediately through the needle or the drainage tube slowly injected into the injection of the contrast agent, while the built-in time measurement device, the continuous multi-section observation of the bile duct, gallbladder and duodenum SonoVue microbubbles flow and filling. Bile duct through the the SonoVue microbubbles trajectory judge the degree of obstruction and effective drainage tube drainage range, further develop an appropriate drainage plan, that according to the site of obstruction and bile duct patency left hepatic or right hepatic or bilateral or left and right hepatic duct branch expansion bile duct PTCD surgery. Observation items include: bile duct branch level, the degree of bile duct filling, the left and right hepatic duct is the same, whether complete obstruction, gall bladder, bowel developing and drainage tube position. At the same time the real-time continuous image can be digitized storage readily available for retrospective analysis and comparison with other imaging. All cases were in 2-12 hours of X-ray after bile duct diatrizoate contrast, in some cases postoperative CT three-dimensional reconstruction of bile duct. Results (1) percutaneous transhepatic biliary ultrasound contrast (PTCUS) and percutaneous transhepatic bile duct X-ray angiography (PTC) in determining the 30 patients with hilar and extrahepatic bile duct obstruction extent: PTCUS diagnosis obstruction in 13 cases, incomplete obstruction in 17 cases; the PTC diagnosis of complete obstruction of the 11 cases, 19 cases of complete obstruction. Both determine the degree of obstruction, the difference was not statistically significant (chi-square value = 0.5,0.50 gt; P GT; 0.25); (2) PTCUS the display of the intestinal tract, gallbladder rate lower than the PTC, the difference was statistically significance (chi-square values ??were 0.5,7.11, P lt; 0.50); ??(3) 7 patients with hilar intrahepatic tumor-induced bile duct obstruction cases, because of the infiltration of intrahepatic space-occupying lesions, squeeze around the bile duct cholestasis, bile duct dilatation, intrahepatic bile ducts normal walking line is damaged, in which case SonoVue contrast agent injected through the needle clear bile duct obstruction location, extent, developed further by understanding the scope of drainage catheter drainage program; intraoperative PTCUS on drainage range of display and postoperative PTC compared the results of the two; bile duct (4) intraoperative ultrasound contrast can clearly show the 3.5 ± 0.8 grade intrahepatic bile duct, bile duct X-ray contrast compared to 3.7 ± 0.9, both display capabilities quite a (t = 0.697, P gt; 0.25); (5) PTCUS. postoperative total bilirubin decreased significantly (t = 4.437, P lt; 0.0005), clinical improvement; in all patients PTCUS intraoperative and postoperative The follow-up did not occur with the contrast agent-related adverse reactions. The biliary tree conclusion PTCUS to generate good contrast sonographic contrast agent flow direction dynamic, clear, bile duct patency visible. PTCUS with PTC controlled studies have shown both in the degree of bile duct obstruction, bile duct branch level difference was not statistically significant. Judgment the degree of obstruction of the bile duct at all levels in order to properly develop biliary drainage scheme. The puncture PTCUS established drainage program has real-time guidance. PTCUS just kind of imaging equipment, ultrasound-guided puncture and ultrasound imaging diagnosis to be completed at the same time, reducing the operational links, improve diagnosis and treatment efficiency. In short, simple PTCUS methods, the process is safe, for the surgeon to provide a more accurate real-time diagnostic information, and provides a reliable protection so as to achieve the most effective drainage of the bile duct.
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