急性胆囊炎术前超声征象与腹腔镜胆囊切除术转开腹的关系

Relationship between ultrasonic features of acute cholecystitis and conversion from laparoscopic to open cholecystectomy

目的探讨急性胆囊炎术前腹部超声检查征象与腹腔镜胆囊切除术(laparoscopic cholecys-tectomy,LC)中转开腹的关系。方法对2 2 6例急性胆囊炎LC患者术前行腹部超声检查,记录胆囊容积,胆囊壁厚度,胆囊窝有无积液,胆囊颈管是否有结石嵌顿,胆囊与周围粘连,胆囊三角粘连情况。分析超声显像与LC转开腹的关系。结果 208例成功完成LC,18例中转开腹。单因素分析显示超声检查胆囊容积增大,胆囊壁增厚,胆囊颈管结石嵌顿,胆囊颈粘连是中转开腹的危险因素(P<0.05)。多因素回归分析显示胆囊壁增厚和胆囊颈粘连是影响腹腔镜中转开腹率的独立危险因素。结论术前超声检查预测急性胆囊炎LC转开腹简便易行,对急性胆囊炎行腹腔镜手术适应证的选择有重要指导意义。

Objective To explore the relationship between preopertive abdominal ultrasonic features of acute cholecystitis and conversion from laparoscopic to open cholecystectomy.Methods A total of 226 patients with acute cholecystitis received ultrasonic examination before LC.The parameters measured pre-operatively included the gallbladder volume,cholecystic wall thickness,gallbladder fossa fluid,stone impaction in gallbladder neck,adhesions of gallbladder to arourd tissue or adhensions of Calot′s triangle.The relationship between the imaging results and conversion to laparotomy in LC were analyzed.Results LC was successfully performed in 208 patients,but 18 were converted to open surgery.Univariate analysis showed that enlarged gallbladder,cholecystic wall thickness,stone impaction in gallbladder neck and adhesions of Calot′s triangle were significantly correlated with the conversion to open cholecystectomy（P0.05）.Multivariate analysis showed that cholecystic wall thickness and adhesion of Calot′s triangle were independent risk factors for conversion from laparoscopic cholecystectomy to open surgery.Conclusions Preoperative ultrasonography for predicting conversion from laparoscopic to open cholecystectomy in acute cholecystitis is simple,and has important significance for selection of laparoscopic operation in acute cholecystitis.