Ignee A, Cui X, Schuessler G, Dietrich C F
Z Gastroenterol. 2015 May;53(5):385-90. doi: 10.1055/s-0034-1398796. Epub 2015 May 12.
Percutaneous transhepatic cholangiography and drainage (PTCD) is a common procedure for the diagnosis and treatment of benign and malignant biliary diseases. Ultrasound (US) is frequently used for the guidance of PTCD. Conventional fluoroscopy is applied to evaluate the biliary system, but delivers significant X-ray dosage to the patient and the interventional team. The purpose of this study is to test the ability of extravascular contrast-enhanced ultrasound (EV-CEUS) in US-guided PTCD to reduce or replace fluoroscopy.
38 patients underwent PTCD. 2 - 4 mL doses of a SonoVue dilution were repeatedly injected to demonstrate correct needle and drainage positions in the biliary system and in the intestine during the intervention and during follow-up to screen for complications. The results were compared to those of conventional radiography.
The success rate for cholangiography was 100 % for EV-CEUS and fluoroscopy each. 27/38 patients (71 %) received a ring catheter, 5/38 patients (13 %) received a metal stent. Only external drainage was possible in 6/38 patients (16 %) in the first session. In 50 % of them (3/38, 8 %) internalization was possible in the second attempt. With EV-CEUS the level of obstruction could be correctly diagnosed in 100 % of the patients. The degree of obstruction (complete/incomplete) could be correctly diagnosed in 37/38 patients (97 %). EV-CEUS was not able to demonstrate the guide wire. In 1/38 patient a hematoma appeared which was managed conservatively. Dislodgement was diagnosed in 2/38 (5 %) patients during follow-up by injecting EV-CEUS solution into the drain. Pleural injury with fistula could be demonstrated in 1/38 (3 %) patients.
EV-CEUS can monitor the success of insertion of needle and catheter, demonstrate or exclude complications, and therefore significantly reduce fluoroscopy time in US-guided PTCD. Fluoroscopy is needed whenever subtle wire steering is necessary as in most cases when the intestinal position of the drain is sought. If only external drainage is necessary fluoroscopy can be omitted.
经皮肝穿刺胆管造影及引流术（PTCD）是诊断和治疗良恶性胆道疾病的常用方法。超声（US）常被用于PTCD的引导。传统荧光透视用于评估胆道系统，但会给患者和介入团队带来大量X线辐射剂量。本研究的目的是测试血管外对比增强超声（EV-CEUS）在超声引导下PTCD中减少或替代荧光透视的能力。
38例患者接受了PTCD。在介入过程中及随访期间，反复注射2 - 4 mL剂量的声诺维稀释液，以显示针和引流管在胆道系统及肠道内的正确位置，用于筛查并发症。将结果与传统放射成像结果进行比较。
EV-CEUS和荧光透视胆管造影的成功率均为100%。38例患者中，27例（71%）置入环形导管，5例（13%）置入金属支架。首次操作时，38例患者中有6例（16%）仅可行外引流。其中50%（3/38，8%）的患者在第二次尝试时可实现内引流。使用EV-CEUS，100%的患者可正确诊断梗阻部位。38例患者中有37例（97%）可正确诊断梗阻程度（完全/不完全）。EV-CEUS无法显示导丝。38例患者中有1例出现血肿，经保守治疗。随访期间，38例患者中有2例（5%）通过向引流管内注射EV-CEUS溶液诊断为移位。38例患者中有1例（3%）显示有胸膜损伤伴瘘管形成。
EV-CEUS可监测针和导管置入的成功率，显示或排除并发症，因此可显著减少超声引导下PTCD的荧光透视时间。在大多数需要确定引流管在肠道内位置等需要精细导丝操作的情况下，仍需要荧光透视。如果仅需要外引流，则可省略荧光透视。
