超声对腹腔镜胆囊切除的价值

Hypersound role in laparoscopic cholecystectomy

目的评估腹部超声对腹腔镜胆囊切除术(LC)的价值。方法对1200例LC难度和术前腹部超声进行前瞻性研究,术前超声检查包括胆囊壁的厚度、胆囊周围有无积液、胆囊大小。LC难易程度根据镜下解剖胆囊三角和剥离胆囊床最短时间为标准来划分。结果术前超声对胆囊结石诊断正确率为95.8%。30例(2.5%)中转开腹(OC)前解剖胆囊三角和/或剥离胆囊床的最短时间为30分钟,超声检查胆囊壁厚度>3mm350例中340例(97.1%)行LC困难。而胆囊壁<3mm的850例中85例(10.0%)行LC困难,两者有显著性差异(P<0.05);所有胆囊周围积液均行LC困难,其中约75%中转开腹;60例胆囊积液中54例(90%)行LC困难,50例萎缩性胆囊炎中有47例(95%)行LC困难。结论术前超声检查中胆囊壁增厚是预测LC困难与否的较精确的指标,而胆囊周围积液、胆囊积液、胆囊萎缩对预测LC难易程度有较高的特异性。

Objective To access the value of abdominal sonography in the patients undergoing laparoscopic cholecystectomy （LC）. Methods 1200 patients were included in this prospective c linical study. Gallbladder wall, pericholecystic fluid,size. The minimal time required to dissect laparoscopically gallbladder triangle and bed of patients was judged as criteria of technical difficulty of LC. Results The accuracy of preoperative sonography for cholecystolithiasis was 95.8%.30 patients（2.5%） were converted to OC.The minimal time required for laparoscopic dissection of calot triangle and gallbladder bed before OC was 30 min which was judged as demonstrating technical difficulty of LC.350 of 340 patients （97.1%） with thick gallbladder wall （〉3 mm） and 85 of 850 patients （10.0%） without thick gallbladder wall （〈3 mm） had technical difficulties in LC procedures respectively （P〈0.05）.All of patients with pericholecystic fluid had technical difficuhies of LC including 75% of them converting to OC.Also,54 of 60 （90%） empyema gallbladders and 47 of 50 （95%） shrunken gallbladders were performed in LC with difficulty. Conclusions Gallbladder wall thickening detected by preoperative sonography, is the accurate indicator of technical difficulties during LC. Pericholecystic fluid and shrunken or emptema gallbladders are very meaningful in specificity of predicting technical difficulties in LC.