腹腔镜胆囊切除术术前彩色超声定位肝中静脉的临床意义

The clinical significance of localization of venae hepaticae intermediae with chromatic color ultrasound before laparoscopic cholecystectomy

目的：探讨腹腔镜胆囊切除术（1aparoscopic cholecystectomy，LC）术前彩色多普勒超声波检查在避免术中损伤胆囊床肝中静脉致大出血的临床意义。方法：2003年1月～2005年1月行LC的1100例患者术前均经彩色多普勒超声波检查，常规对胆囊床肝中静脉及属枝的解剖关系进行分析。结果：对于术前经彩色多普勒超声波检查明确的肝中静脉直接和胆囊床相贴的非萎缩性胆囊炎胆囊结石的102例患者，采用紧靠胆囊壁的浆肌层直接进行剥离；而慢性萎缩性胆囊炎胆囊结石的24例患者，采用胆囊粘膜切除，或者直接开腹手术切除，未发生因损伤胆囊床肝中静脉而大出血。结论：术前常规彩色多普勒超声波检查，明确胆囊床肝中静脉及属枝位置关系，对于肝中静脉与胆囊床相贴的病例，采用紧靠胆囊壁的浆肌层剥离，或采用胆囊粘膜切除，或直接开腹手术切除，可以避免因损伤胆囊床肝中静脉而导致大出血。

Objective：To investigate the role of localization of venae hepaticae intermediae with preoperative chromatic color ultrasound in laparoscopic cholecystectomy（LC）. Methods： All 1 300 cases from January 2003 to January 2006 treated with LC were detected by the chromatic color ultrasound preoperatively. The anatomic relationship of venae hepaticae intermediae and its branches on gallbladder bed were analyzed ,which could be the reference during LC. Results：For 102 patients suffering from inatrophic cholecystitis and cholecystolithiasis, gallbladders were decoherence directly from ectoptygma-muscular coat close to the gallbladder wall. Gallbladder endoscopic mucosal resection（EMR） or open cholecystectomy were applied in 24 cases with chronic atrophic cholecystitis and cholecys- tolithiasis. No hemorrhea resulted from injury of venae hepaticae intermediae on gallbladder bed occured in all cases. Condusions： Preoperative chromatic color ultrasound localization of venae hepaticae intermediae routinely can be helpful to choose operative methods.