B-ultrasound.
It is a B-type ultrasound examination, which is non-invasive, with clear examination images and high resolution, and is a safe, fast, easy, economic and accurate examination method, and is the preferred method for diagnosing liver and biliary tract diseases.
Ultrasound examination of gallbladder stones shows strong echogenic light mass with acoustic shadow, and moves in the gallbladder with the change of body position, and can detect stones of 2mm or more in diameter, with a diagnostic accuracy of over 95%.
Extrahepatic bile duct stones are characterized by strong echogenic light masses with acoustic shadowing in the lumen of the bile ducts, which are more constant and have a three-dimensional feeling, and the probe is not deformed under pressure.
Intrahepatic bile duct stones are characterized by strong light masses with acoustic shadowing in the bile duct branches along the portal vein, which vary in shape and size, and can be round, striped or speckled. Based on the presence or absence of bile duct dilatation, the site and degree of dilatation, ultrasound can localize and qualitatively diagnose the cause of jaundice, with an accuracy rate of 93% to 96%.
Ultrasound can also diagnose cholecystitis, gallbladder and bile duct tumors, biliary ascariasis, congenital biliary malformations, etc. It can also perform percutaneous hepatic cholangiopancreatography, drainage and stone extraction under ultrasound guidance. Intraoperative ultrasound can improve the diagnosis rate of hepatobiliary diseases by using a special probe, because it is not disturbed by other organ tissues and gastrointestinal gas; it can detect residual stones in time to guide surgical stone extraction and reduce the residual rate of stones after surgery.
CT, MRI or magnetic resonance cholangiopancreatography (MRCP).
CT is computerized X-ray tomography, CT is a fully functional condition detection instrument, which is short for electronic computerized X-ray tomography. MRI is magnetic resonance imaging, which is a new examination technique based on the principle that the nucleus with magnetic distance can produce inter-level leap under the action of magnetic field. The imaging process is similar to that of image reconstruction and CT, except that MRI does not rely on either external co-radiation, absorption and reflection, or gamma co-radiation of radioactive materials in the body, but uses the interaction of external magnetic fields and objects to image, and the high-energy magnetic field is harmless to the human body. Therefore, MRI examination is safe. Both have the characteristics of imaging without overlap and high contrast resolution. CT and MRI examinations are non-invasive, safe and accurate, but costly, and are mainly used for patients whose diagnosis is not clear from ultrasound examination and are suspected to be tumors.
The main advantages of MRI compared with CT are.
1. MRI has no damage to the human body.
2. it can directly make cross-sectional, sagittal, coronal and various oblique body images
3, shows the pathological process of the disease more extensively than CT, and the structure is clearer. It can find isodense lesions that CT shows completely normal.
Its disadvantages.
1. like CT, MRI is also an imaging diagnosis, and many lesions are still difficult to be diagnosed by MRI alone, unlike endoscopy which can obtain both imaging and pathological diagnosis.
2. examination of the liver, pancreas, adrenal glands and prostate is no less superior than CT, but much more costly
3. inferior to endoscopy for lesions of the gastrointestinal tract
4. MRI is not recommended for those who have metal objects left in their bodies.
ERCP.
For endoscopic retrograde cholangiopancreatography (ERCP), a catheter is inserted into the bile duct and/or pancreatic duct through the duodenal papilla under direct visualization of the fiberoptic duodenoscope for imaging.
This method
① can directly observe the situation and lesions in the duodenum and papilla, and the suspicious lesions can be directly taken for biopsy.
(ii) Duodenal fluid, bile and pancreatic fluid can be collected for physicochemical and cytological examination.
(③) The anatomy and lesions of the biliary system and pancreatic ducts can be shown by imaging. ERCP can induce acute pancreatitis and cholangitis, and should be closely observed after the procedure.ERCP can also be used for treatment, such as nasobiliary drainage for biliary tract infection, sphincter of Oddi dissection for sphincter of Oddi stenosis, and stone extraction for lower bile duct stones and biliary ascariasis.
PTC.
Percutaneous hepatic perforation cholangiography (PTC) is a direct cholangiography method that uses a special puncture needle to penetrate the intrahepatic bile ducts percutaneously under X-ray television or ultrasound surveillance, and then injects the contrast agent directly into the bile ducts to rapidly visualize the bile ducts inside and outside the liver.
Its advantages: it can clearly show the situation of the intra- and extrahepatic bile ducts, the site, scope, degree and nature of lesions, etc., which can help in the diagnosis and differential diagnosis of biliary tract diseases, especially jaundice. This method is easy to operate, has a high success rate, and is more likely to be successful in those with bile duct dilatation. The results are not affected by liver function and blood bilirubin concentration, and there are few complications, so it is an important diagnostic technique in current biliary surgery and has been widely used in clinical practice.
Disadvantages: It is an invasive test, and complications such as bile leakage, bleeding and biliary tract infection may occur. Coagulation function should be checked and vitamin K should be injected for 2-3 days before surgery; antibiotics should be applied if necessary, especially for those with symptoms of infection. And various preparations before dissection should be done for timely management of biliary peritonitis, bleeding and other emergency complications.
PTCD: It is based on PTC, and bile duct drainage (PTCD) through a contrast tube is used as treatment.
Cholangioscopy.
(1) Intraoperative choledochoscopy: It can be performed at the common bile duct incision via fiberoptic choledochoscope or rigid choledochoscope. It is suitable for
(i) suspected residual stones in the bile duct.
②suspected intra-biliary tumor.
③Suspected narrowing of the lower end of the common bile duct and the main branches of the intrahepatic bile duct. The stones can be removed intraoperatively by choledochoscopy using mesh blue, flushing, etc. Biopsy is also feasible.
(2) Postoperative choledochoscopy: fiberoptic choledochoscopy can be inserted through the T-tube fistula or subcutaneous jejunal blind collaterals for bile duct examination, stone extraction, worm extraction, flushing, infusion of antibiotics and litholytic drugs.
Cholangiography.
During biliary surgery, cholangiogram can be performed via cystic duct cannulation, common bile duct puncture or placement of a tube to understand the presence of bile duct stricture, stone residue and patency of the lower end of the common bile duct, which can help determine whether common bile duct exploration and surgical approach are needed. For those who have T-tube drainage of common bile duct or other bile duct placement drainage, cholangiography should be routinely performed via T-tube or placement duct before extraction.