急性胆囊炎腹腔镜胆囊切除术前彩色多普勒超声对其难度的预测价值

Color Doppler flow imaging in acute cholecystitis to predict technical difficulties during laparoscopiccholecystectomy

目的探讨术前彩色多普勒超声检查对急性胆囊炎腹腔镜胆囊切除术难度的预测价值。方法86例急性胆囊炎腹腔镜胆囊切除术患者，根据术中实际难度评分分为困难组（67例）和容易组（19例），比较两组术前行彩色多普勒超声检查指标，包括胆囊容积、胆囊壁厚度及血流、胆囊腔、胆囊床和肝内外胆管情况，评价术前超声检测指标与手术难度之间的关系。结果困难组与容易组超声检测胆囊容积分别为（52．6±14．6）mm3和（32．6±10．4）mm3，胆囊壁厚度分别为（9．7±4．1）mm和（3．8±0．9）mm，胆囊壁血流信号丰富的发生率分别为89．5％（17／19）和17．9％（12167），胆囊粘连的发生率分别为78．9％（15／19）和11．9％（8／67），胆囊颈部嵌顿结石的发生率分别为10．5％（2／19）和0（0，67），两组比较差异有统计学意义（P〈0．05或〈0．01）。胆囊容积≥50mm3、胆囊壁厚度≥5mm、胆囊颈部嵌顿结石、胆囊周围粘连为预测指标，86例急性胆囊炎术前彩色多普勒超声预测腹腔镜胆囊切除术难度准确率为94．2％（81/86）。结论术前彩色多普勒超声检查，有助于急性胆囊炎腹腔镜胆囊切除术适应证的掌握，对手术难度预测具有重要的临床应用和指导价值。

Objective To evaluate the value of preoperative color Doppler flow imaging findings for predicting possible difficulties encountered during laparoscopie cholecystectomy （LC）. Methods Eightysix patients with acute cholecystitis underwent color Doppler flow imaging examination were divided into operation difficult group （67 cases） and operation easy group（ 19 cases ） according to the difficulty score. The parameters were measured pre-operation including the volume of gallbladder, the thickness of the gallbladder wall, the condition of arterial flow in the gallbladder wall, the conditions of gallbladder cavity and gallbladder fossa and the intra-and extra-hepatic bile duct. The relationships among imaging results, operation difficulties and operation findings were investigated. Results Gallbladder volume, gallbladder wall thickness, the presence rates of plentiful arterial flow in the gallbladder wall, adhesion of gallbladder and stone incarceration In operation difficult group were significantly different from those in operation easy group [（52.6 ± 14.6） mm3 vs （32.6 ± 10.4）mm3, （9.7 ± 4.1）ram vs （3.8 ± 0.9） mm,89.5%（17/19） vs 17.9% （12/67）,78.9%（15/19） vs 11.9%（8/67）, 10.5%（2/19） vs 0 （0/67） ] （P 〈 0.05 or 〈 0.01 ）. The accurate rate was 94.2% （81/86 ） in predicting. Conclusion Preoperative color Doppler flow imaging is helpful in predicting difficulties of LC.