术中超声与造影在腹腔镜胆囊切除术中诊断隐匿性胆总管结石的临床价值

Laparoscopic ultrasonography and intraoperative cholangiography for detection of occult choledocholithiasis

目的探讨腹腔镜胆囊切除术 (LC)术中胆道造影 (IOC)和腹腔镜超声 (LUS)诊断隐匿性胆总管结石的临床价值。方法 2 0 0 0年 6月至 2 0 0 1年 9月对 98例行LC术患者进行LUS和IOC的前瞻性研究。结果LUS和IOC成功率分别为 10 0 %和 95 % ,操作时间分别为 ( 7 7± 2 1)min和( 11 4± 3 5 )min(P <0 0 1)。敏感度和特异度LUS分别为 85 %和 96 % ,IOC分别为 83%和 98% ,两种方法联合应用的敏感度为 98%。两种方法诊断率差异无显著性意义 ( 0 2 5 <P <0 5 ) ,KAPPA值为0 6 79。LUS对肝内胆管、肝总管和胆总管胰外段显像率分别为 93%、99%和 10 0 % ,IOC分别为 89%、10 0 %和 10 0 % (P >0 0 5 ) ;LUS和IOC对胆总管胰内段显像率分别为 6 2 %和 97% (P <0 0 1)。结论LUS操作方便 ,无创伤 ,诊断效果及胆道显像率 (胰外段 )与IOC差异无显著性意义。

ObjectiveTo evaluate intraoperative cholangiography (IOC) and laparoscopic ultrasonography (LUS) for detection of occult common bile duct stones (CBDS) during laparoscopic cholecystectomy (LC). Methods From Jun. 2000 to Sep. 2001, 98 patients undergoing LUS and IOC during LC were analyzed prospectively.Results[The successful rate of LUS and IOC were 100% and 95% respectively, the time for LUS (7 7±2 1) min was significantly shorter than IOC (11 4±3 5) min ( P <0 01). The sensitivity of LUS and IOC were 85% vs 83% and their specificity were 96% vs 98%, the two examinations combined had a sensitivity of 98%. The diagnosis concordance of two methods had no significant difference (0 25< P <0 5) with a KAPPA coefficient of 0 679. The visualization of intrahepatic duct, common hepatic duct and extrapancreatic portion of common bile duct (CBD) by LUS were 93%, 99% and 100% vs 89%, 100% and 100% respectively by IOC ( P >0 05). The visualization of intrapancreatic portion of CBD by LUS was 62% vs 97% by IOC ( P <0 01). Conclusions LUS is a safe, quick and non invasive technique, its effectiveness in diagnosis of CBDS and visualizations of bile duct (extrapancreatic portion) are similar to IOC. The combination of both methods maximizes the intraoperative detection of CBDS.