术中超声在肝胆外科的应用

本文结合我们的临床经验介绍术中超声（ＯＵＳ）在肝胆外科手术中的应用。为了充分发挥ＯＵＳ的作用，掌握正确的扫查方法非常重要。要点是以肝内脉管为轴心，追踪门静脉和肝静脉走行的系统检查。ＯＵＳ应用目的是进一步准确地诊断病变和帮助设计手术方案、指导手术操作。ＯＵＳ诊断肝胆道病变比术前超声、ＣＴ检查以及术中探查明显敏感，其优越性特别表现在检测出微小病灶方面。对病变的定位ＯＵＳ也较术前影像学检查准确。术中经肝动脉注射ＣＯ２作声学造影不仅可提高诊断微小病变的敏感性，而且在施行肝动脉栓塞术时对确认插管是否正确、判断肿瘤供血多寡、预测栓塞化疗效果等均有帮助。ＯＵＳ导向下的肝切除手术可以正确地认识和处理血管，既能彻底去除病变又最大限度地保存非病变组织或不影响血液回流，有效地保护肝储备功能，ＯＵＳ在此起到了其他手段所不能替代的作用。对肝内外胆管结石症，在ＯＵＳ的动态观察下明确取石器械与结石的空间位置关系，可极大提高取石的准确性，缩短手术时间和尽可能减少残存结石。

Application of the Operative Ultrasonography in the Hepatobiliary Surgery

Operative ultrasonography(OUS)was used in 55 patients undergone hepatobiliary surgery.The scanning techique of OUS was described in detail because master it was very important.On the diagnosis of the liver tumors OUS was significantly sensitive to the preoperative ultrasonography,CT scan and surgical exploration particularly in smaller lesions.It was also more precise in locating lesions compared with preoperative imaging examinations.Intraoperative hepatic arterial echographies by injection of carbon dioxide used in our series showed advantages such as improving the sensitivity in detecting tumor foci,increasing the accuracy of catheterization,and investigating the tumor blood supply.We used OUS for guiding hepatectonies and systematic subsegmentectomies in which curative resections and reservation of more functioning hepatic parenchyma were obtained.For cholelithiasis,extraction of stones and hepatectomy under OUS guidance could reduce residual stones as much as passible.