彩色多普勒超声对急性胆囊炎LC难度的预测价值

Role of color Doppler flow imaging in predicting difficulties of laparoscopic cholecystectomy

目的探讨彩色多普勒超声（color Doppler flow imaging，CDFI）检查对急性胆囊炎LC难度的预测价值。方法99例因急性胆囊炎行LC的患者，根据术前CDFI检查的指标（胆囊容积、胆囊壁厚度及血流信号、胆囊腔、胆囊床和肝内外胆管的情况）评分分为容易组和困难组；根据术中难度评分分为手术容易组和手术困难组，评估其对手术难度的预测价值。结果术前CDFI预测容易组和困难组分别为67例和32例；根据术中难度评分，手术容易组和手术困难组分别为61例和38例。术前CDFI预测困难组与容易组比较，胆囊容积增大[（39．5±13．2）cm^3 vs（32．6±10．4）cm^3]，胆囊壁增厚[（10．1±4．0）mm vs （3．8±0．9）mm]，胆囊颈结石嵌顿、胆囊壁血流信号丰富和胆囊粘连的患者多于容易组，差异有统计学意义（t=-2．820，-12．318，-3．952，Χ^2=33．548，19．461，P〈0．05）。以胆囊容积、胆囊壁厚度、胆囊颈结石嵌顿、胆囊周围粘连情况为预测指标，急性胆囊炎术前CDFI预测LC难度准确率为94％（93／99）。结论术前CDFI检查有助于掌握急性胆囊炎LC适应证，对手术难度预测具有指导价值。

Objective To evaluate the color Doppler flow imaging （CDFI）findings in predicting possible difficulties of laparoscopic cholecystectomy （ LC ）. Methods A total of 99 patients with acute cholecystitis received CDFI examination, and were divided into easy LC group （ n = 67 ） and difficult LC group （ n = 32 ） according to the indexes including the volume of gallbladder, the thickness of gallbladder wall, the condition of arterial flow in the gallbladder wall, the condition of gallbladder cavity and fossa, and of the intra- and extrahepatic bile duct. After LC, all the patients were redivided into easy LC group and difficult LC group according to a difficulty scoring system of LC. The relationship among imaging results, operation difficulties and operation findings was investigated. Results According to the final score of difficulty scoring system of LC, the number of patients in easy LC group and difficult group was 61 and 38, respectively. Compared with easy LC group, patients in difficult LC group had bigger gallbladder volume[ （ 39.5 ± 13.2 ） cm^3 vs （ 32.6 ± 10.4 ） cm^3 ], thicker gallbladder wall [ （ 10.1±4.0） mm vs （3.8 ± 0.9 ） mm] , more stone incarceration in the neck of gallbladder, abundant color blood flow signal of the gallbladder wall and more severe adhesion of gallbladder to the adjacent tissues, with statistical difference between the 2 groups （ t = -2,820, -12,318, -3,952, Χ^2 = 33. 548, 19. 461, P 〈 0.05 ）. Using gallbladder volume, the thickness of gallbladder wall, infarction of stones in the neck of gallbladder and adhesion of gallbladder to the adjacent tissues as prediction indexes, the accuracy of CDFI in predicting the possible difficulties of LC was 94% （93/99）. Conclusion Preoperative CDFI is helpful in predicting difficulties of LC for acute cholecystitis.