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超声内镜学习笔记之基于大体解剖的方向判断

  • 2026-02-22 10:57:14
超声内镜学习笔记之基于大体解剖的方向判断
进修结束回科，科里、家里感觉时间好像不是自己的了，看书的时间比之前少了很多，但想想还是应该坚持。
最近自己独立做了几个超声，发现自己从一个目标到另一个目标扫查的时候还是不那么顺畅，比如在门脉汇和部如果想往门脉或是往胰头方向扫查时还是得停下想想应该怎么操作内镜，偶尔还会走错重来。回想起进修时曾问都海明老师类似的一个问题，如何根据超声所见移动内镜去扫查目标脏器，都老师的回答就是记住大体解剖，按照大体解剖的方向去移动内镜探头。虽然道理也明白，但却没有很深的体会，最近又翻了一下书，结合自己的扫查，还是有点感悟，分享一下，希望对正在学习EUS的朋友能有所帮助。
为了能够找到要扫查的目标，我们需要时刻清楚以下的3个问题：
1.脏器之间的相对位置；
2.探头的方向：
 a.探头的头端是朝向：头侧还是足侧（实际上在第一站和第三站的时候都是朝向足侧的，只有在第二站时才需要判断朝向）；
b.超声探测的方向：腹侧/背侧/左侧/右侧
3.探头旋转及进退内镜时扫查方向如何移动。
比如在第一站扫查的时候，肝左叶是在贲门/胃底的前方，超声内镜扫查到肝左叶时，探头的头端朝向足侧，超声探测的方向是朝向腹侧，顺时针旋转时探头探测方向从腹侧先转向右侧再转向背侧，所以我们在超声上看到的结构一次是肝左外叶--门静脉脐部（左内叶）--门脉左支主干--右肝（门脉右支/门脉主干/尾状叶）--下腔静脉--腹主动脉
第一站当我们扫查的门脉汇合部的时候（探头还是朝向足侧，探测方向是朝向背侧的）：1. 如果想扫查胰腺体尾部（相对于门脉汇合部在胃的后方和上方），需要让探头向右上移动（理论上是要顺时针旋镜同时拉镜，实际操作中我自己的感觉是先旋后拉再加上压大扭）；2.如果想扫查门静脉入肝方向（相对于汇合部在右上方），需要逆时针旋镜同时向上拉镜；3.如果想扫查胰头（相对于汇合部在右下方），需要顺时针同时进镜。
第二站扫查相对复杂，探头朝向可以是头侧，也可以是足侧，但大体上扫查肝脏/胆囊时探头是斜向足侧的，而扫查胰头时则是斜向头侧的（朝向头侧时其探测旋转方向与操作者的内镜旋转方向是相反的）。
第三站扫查的时候探头的朝向跟第一站是一样的，也是朝向足侧，但从降部扫查时探测方向是与第一站相反的，随着缓慢的拉镜及旋镜慢慢探测方向变得与第一站扫查时相似，所以有时候会得到与第一站扫查相似的图像。第三站扫查到右肾时说明扫查方向朝向背侧偏右侧，如果想扫查壶腹部（相对于右肾在左侧）就需要顺时针（右旋）内镜；如果扫查到腹主动脉长轴（相对于壶腹部在左侧），需要逆时针（左旋）寻找壶腹部。
在超声扫查中大扭的调节是一个非常重要的操作，压得紧可以与目标器官靠的更近，远场能看到更清楚一些，有几个地方扫查的时候需要大扭压得很紧，比如胃底扫查脾门的时候和胃内扫查胆管下段向乳头移行的时候；有些地方不适合压得太紧，比如十二指肠球部扫查胆管时，压得太紧反而会把胆管压扁，另外大扭的调节可以改变超声扫查的方向。
另外感觉每一次翻书好像都有一点不一样的收获，后边计划从头再把《胆胰EUS》这本书从头翻一遍，然后再把学习的过程也记录一下。
另外不当之处也希望有同道留言指正，共同进步！
本文来自网友投稿或网络内容，如有侵犯您的权益请联系我们删除，联系邮箱：wyl860211@qq.com 。

不小心删掉2年多的学习资料后,我发现“重要”没那么重要

【优质课学习笔记】2025湖北好课堂课例人教版新教材七下Unit 5 Here and Now. Project 3a-3c

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  1. CONNECT:[ UseTime:0.000724s ] mysql:host=127.0.0.1;port=3306;dbname=no_67808;charset=utf8mb4
  2. SHOW FULL COLUMNS FROM `fenlei` [ RunTime:0.000972s ]
  3. SELECT * FROM `fenlei` WHERE `fid` = 0 [ RunTime:0.000344s ]
  4. SELECT * FROM `fenlei` WHERE `fid` = 63 [ RunTime:0.000296s ]
  5. SHOW FULL COLUMNS FROM `set` [ RunTime:0.000700s ]
  6. SELECT * FROM `set` [ RunTime:0.000195s ]
  7. SHOW FULL COLUMNS FROM `article` [ RunTime:0.000537s ]
  8. SELECT * FROM `article` WHERE `id` = 469434 LIMIT 1 [ RunTime:0.000381s ]
  9. UPDATE `article` SET `lasttime` = 1771751768 WHERE `id` = 469434 [ RunTime:0.001572s ]
  10. SELECT * FROM `fenlei` WHERE `id` = 65 LIMIT 1 [ RunTime:0.000252s ]
  11. SELECT * FROM `article` WHERE `id` < 469434 ORDER BY `id` DESC LIMIT 1 [ RunTime:0.000409s ]
  12. SELECT * FROM `article` WHERE `id` > 469434 ORDER BY `id` ASC LIMIT 1 [ RunTime:0.000499s ]
  13. SELECT * FROM `article` WHERE `id` < 469434 ORDER BY `id` DESC LIMIT 10 [ RunTime:0.001552s ]
  14. SELECT * FROM `article` WHERE `id` < 469434 ORDER BY `id` DESC LIMIT 10,10 [ RunTime:0.000683s ]
  15. SELECT * FROM `article` WHERE `id` < 469434 ORDER BY `id` DESC LIMIT 20,10 [ RunTime:0.001189s ]
0.075783s