Tamada K, Ohashi A, Tomiyama T, Wada S, Satoh Y, Higashizawa T, Ido K, Sugano K
Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan.
J Gastroenterol Hepatol. 2001 Jan;16(1):100-3. doi: 10.1046/j.1440-1746.2001.02384.x.
An imaging modality that can be used to identity small stones after a biliary lithotripsy is required. Intraductal ultrasonography was evaluated by using percutaneous transhepatic cholangioscopy as the gold standard.
Lithotripsy, under percutaneous transhepatic cholangioscopy guidance, was performed in 20 patients. A thin-caliber ultrasonic probe (2.0 mm in diameter and 20 MHz frequency) was inserted into the bile duct through the percutaneous tract after lithotripsy, and residual stones were identified. This was followed by percutaneous transhepatic cholangioscopy.
In the extrahepatic bile ducts, intraductal ultrasonography provided images of all the stones demonstrated on cholangioscopy (n = 11). The sensitivity was superior to that of cholangiography (P < 0.005). However, in the intrahepatic bile ducts, intraductal ultrasonography only visualized the stones located in the cannulated lobe. Extrahepatic stones smaller than 5.0 mm in diameter or in a common hepatic duct larger than 15.0 mm in diameter were missed by cholangiography, but were visualized by the use of intraductal ultrasonography (P < 0.05).
Intraductal ultrasonography is equivalent to cholangioscopy in the extrahepatic bile ducts. Cholangiography and intraductal ultrasonography should be used in combination to image intrahepatic and extrahepatic stones.
需要一种可用于在胆道碎石术后识别小结石的成像方式。以经皮经肝胆道镜检查作为金标准对胆管内超声检查进行评估。
在20例患者中，于经皮经肝胆道镜引导下进行碎石术。碎石术后，将一根细口径超声探头（直径2.0 mm，频率20 MHz）通过经皮通道插入胆管，识别残余结石。随后进行经皮经肝胆道镜检查。
在肝外胆管中，胆管内超声检查提供了胆道镜检查所显示的所有结石的图像（n = 11）。其敏感性优于胆管造影（P < 0.005）。然而，在肝内胆管中，胆管内超声检查仅能显示位于插管叶的结石。直径小于5.0 mm的肝外结石或直径大于15.0 mm的肝总管结石在胆管造影中未被发现，但在胆管内超声检查中可见（P < 0.05）。
在肝外胆管中，胆管内超声检查与胆道镜检查效果相当。胆管造影和胆管内超声检查应联合使用以对肝内和肝外结石进行成像。
