超声检测在胆囊功能分级评估中的临床应用研究

Study on the Clinical Application of Classification of Gallbladder Function in Ultrasonic Examination

目的通过脂餐试验,对胆囊结石患者利用超声检测进行胆囊排空功能的评价,并探讨胆囊收缩功能与胆囊切除术后胆道动力障碍(post-cholecystectomy blocked dynamia,PCBD)之间的关系。方法选取30例正常体检者为对照组,对60例经B超、CT诊断为胆囊结石的患者行常规脂餐试验,动态观察胆囊收缩情况,检测胆囊储存、收缩和释放胆汁的功能,并计算出排空率;同时根据患者病史、体格检查、肝功检查、术中及术后病理证实为慢性胆囊炎、胆囊结石后将胆囊功能进行评分和分级,按胆囊收缩功能不同将其分为I^IV级。对照组30例正常体检者综合评定胆囊收缩功能良好后将其定为0级。结果60例胆结石患者,脂餐60min后胆囊排空率平均值为(28.3±4.7)%,明显低于正常人脂餐试验的平均值(64.4±5.1)%,I和II级胆囊功能大于III和IV级,低于50%应视为胆囊收缩功能异常。结论脂餐后50～60min,胆囊排空率≥50%～60%为正常指标,为0级;胆囊收缩功能I级、II级者PCBD发生率较高,适宜采用非手术治疗,推迟手术时间动态观察胆囊功能变化;III级、IV级适宜行胆囊切除术。因此,合理选择手术时机是预防的重要方法。

Objective To study the relationship of the gallbladder shrinking function and post-chotecystectomy blocked dynamia（PCBD） in patients with cholelithiasis and choleeystitis.It provided theory, basis for optimization of surgical time. Methods Thirty healthy subjects were chosen as the normal control group .The clinical data of 60 cases of cholecystectomy of chronic cholecystolithiasis which were h-fat meal. and detected their storge, concertration and shrinking function, and worked out erupting rate .The results of ease history, clinical signs, liver function, cooperation specimens and postoperative pathology those showed that were chronic cholecystolithiasis and chloecystecroy. And according to the result above gallbladder function could be classified into Ⅰ,Ⅱ,Ⅲ.Ⅳfour grades. And the gallbladder function of normal group was zero grade. Results The mean incidence of 60 cases of gallbladder emptying was （28.3 ± 4.7）%,significantly lower than that of normal group, （64.4±5.1）%. Ⅰ and Ⅱ gallbladder function were higher than those in group of grade Ⅲ and Ⅳ.The gallbladder function maybe abnormal when the gallbladder emptying rate was lower than 50%. Conclusion After h-fat meal 50-60 minutes,the incidence of PCBD in group of grade Ⅰ and Ⅱgallbladder function were higher, suitable for undergoing the conservative operations. Cholecystectomy was the treatment of choice in group of grade Ⅲ and Ⅳ. So the reasonable surgery time was a major measure that prevented PCBD.