超声检查在腹腔镜胆囊切除术前难度判断及术中指导作用

PREDICTION OF INTRAOPERATIVE TECHNICAL DIFFICULTIES AND GUIDANCE OF OPERATIVE STEPS WITH ULTRASOUNDDURING LAPAROSCOPIC CHOLECYSTECTOMY

目的：评价Ｂ型超声（Ｂ超）探测在预测腹腔镜胆囊切除术（ＬＣ）中难度和指导操作方面的作用，以减少ＬＣ并发症和中转开腹率。方法：综合分析１４２例ＬＣ患者的Ｂ超记录及术中难度。Ｂ超记录包括４个方面：①胆囊壁厚、长径、轮廓；②结石大小、数量、位置；③胆囊颈部回声情况；④胆囊管和胆总管长度、宽度以及两者之间的解剖关系。将难度分为Ⅰ、Ⅱ、Ⅲ级，分别代表术中容易、困难和非常困难，并确定了它们的术中判定标准。结果：本组１４２例Ｂ超判断与术中符合率为８１％。１９例中转开腹发生于Ⅰ级１例、Ⅱ级５例，Ⅲ级１３例。３例并发症Ⅱ级１例，Ⅲ级２例。结论：Ｂ超探测对ＬＣ术前难度判断有较高的准确性，并对术中操作有重要指导作用，帮助术者选择病例。

Objective:To evaluate the significance of ultrasound(US) findings as a predictor of potential operative difficulties to decrease the complications and rate of conversion to open cholecystectomy during laparoscopic cholecystectomy(LC).Methods:US records and operative difficulties in 142 LC patients were analyzed.Four parameters in US record were assessed:①the wall thickness,length and outline of gallbladder(GB);②the maximum size,number and position of GB stone;③the echoinformation of GB neck;④the width,length and the anatomic relationship of GB duct and common bile duct.The predictive judgment of technical difficulties was divided into easy(A),difficult(B),and very difficult(C) classes,which were confirmed in the operation.Results:The accuracy of the US classes was 81% in accordance with the operators intraoperative judgment in 142 cases.Nineteen cases converted to open,one occurred in class A,five in class B,13 in class C.Complications occnrred in three cases including one in class B,and two in class C.Conclusion:The preoperative US has a higher accuracy to predict the technical difficulties of LC with its significant guidance to intraoperative steps,and can help to choose those suitable cases for their technical difficulties to improve the effects and successful rate of LC.