腹腔镜胆囊切除术术前难度预测的研究

Preoperative Prediction of the Difficulty Of The Laparoscopic Cholecystectomy

目的探讨术前评估腹腔镜胆囊切除术(LC)难度的预测方法及意义。方法收集500例行LC住院患者的术前临床资料,进行预测LC手术难度的回顾性研究[11]。确定判别行LC术难易程度的标准,根据判别标准将500例患者术前分为容易组、困难组,并与术中的实际情况进行对比分析,最后对所获得的数据进行统计学分析和处理。结果术前超声检查诊断胆囊结石的准确率为98.61%。500例患者中成功完成LC465例;中转开腹35例,中转率为7%。.术前预测的准确度为92.4%,灵敏度为96.41%,特异度为78.19%。结论①B超检查对胆囊疾病的诊断具有较高的准确度,对于预测LC术的难易程度具有一定的应用价值。②胆囊三角以及胆囊与周围脏器严重粘连、胆囊颈部结石嵌顿伴急性胆囊炎、胆囊结石充满型、萎缩性胆囊炎、上腹部手术史对术前预测腹腔镜胆囊切除术的难易程度具有重要参考意义。

Objective To evaluate the significance and method of preoperative prediction of the difficulty of laparoscopic cholecystectomy.Method The preoperative clinical data was collected from 500 cases underwent LC.According to the standard of operative difficulty or ease,the 500 cases with gall bladder diseases were divided into two groups,namely difficult group and easy group.All the preoperative and operative data were compared between the two groups.Results The accuracy rate of preoperative diagnosis with sonography for cholecystolitiasis were 98.61%.465 cases were performed with LC,35 cases are required to convert into open cholecystectomy.The conversion rate was 7%.The total prediction accuracy of sonography was 92.4% and the sensitivity was 96.41% ;specificity was 78.19%.Conclusions ① The diagnosis with B-type ultrasound shows high accuracy rate for the diagnosis of the disease of gallbladder,and it has a definite value for the prediction of the difficulty of LC.② Severe adhesions presented in Calot＇s triangle or gallbladder,incarceration with stone at gallbladder＇s neck associated with acute cholecystitis,the repletion type of cholecystolithiasis,atrophic cholecystitis and previous surgery at the upper abdomen have an important value for the evaluation of the difficultiy of the LC.