术中超声在肝胆胰外科的应用价值

目的探讨术中超声在肝胆胰外科的应用价值.方法对77例需手术治疗的肝胆胰患者,采用7.5～12 MHz术中专用探头,应用术中超声引导辅助手术切除或术中治疗,并发现隐匿性病变.结果术中确认33例活体肝移植供体肝中静脉全程走行,7例受体血管重建后发现5例血流异常;31例肝胆胰肿瘤患者术中超声与术前超声定性诊断率分别为74.19%（23/31）和70.96%（22/31）,对直径≤1 cm的肿瘤检出率分别为93.33%（14/15）和66.67%（10/15）;对5例结石患者及1例肝脏异物（缝衣针）进行精确定位并引导取出;动态引导穿刺活检、引流和射频消融6例.结论术中超声能提高细小结构的显示率,对指导手术方案的制定与术中病灶的定位有很高的临床应用价值.

Application Value of Intraoperative Ultrasonography in Hepatobiliary Pancreatic Surgery

Objective To appraise the value of the intraoperative ultasonography（IOUS）in the hepatohiliary pancreatic surgery.Methods The prober（7.5～12 MHz）was used in 77 patients with hepatobiliary pancreatic diseases.IOUS showed occult lesions also can guide or assist variors surgical procedures in real time.Results The line of middle hepatic vein and its tributaries were marked by the IOUS in 33 donors with living donor liver transplantation.The blood flow showed anomaly in 5 recipients of the reanastomosed blood vessels.The quality accurately rate traoperative of the chloelithiasis were 74.19%（23/31）and 70.96%（22/31）and the diagnostic rate for tumors with diameter≤1 cm of the cholelithiasis were 93.33%（14/15）and 66.67%（10/15）of the intraoperative and preoperative ultrasonography in the 31 patients with hepatobiliary and pancreatic tumors.IOUS located the focus accurately in the 5 patients with lithiasis and 1 patient with liver foreign body.The 6 patients with tumors were needle biopsy of tap,and radiofrequency ablation under the guidance of IOUS.Conclusion As the inraoperative ultrasonography can raise the detectable rate of the attenuate structure,it has a very high clinical application value in making the operation scheme and locating the focus in the operation.