腹部超声术前预测急性胆囊炎术式的临床价值

Clinical value of abdominal ultrasound in predicting operative approaches of cholecystectomy to acute cholecystitis

目的探讨腹部超声术前预测急性胆囊炎术式选择的临床价值。方法复阅2005年1月—2010年12月在我院肝胆外科实施腹腔镜胆囊切除的354例急性胆囊炎患者的术前超声特征,统计分析腹腔镜中转开腹胆囊切除和成功实施腹腔镜胆囊切除患者的超声特征分布。结果本组急性胆囊炎患者的腹腔镜胆囊切除中转率为24%(85/354)。腹腔镜中转开腹胆囊切除患者中最常见的超声特征包括胆周明显渗出占32.9%,胆囊三角结构辨认困难占40%,胆囊壁厚超过5 mm占31.8%,严重的胆囊失形占21.2%。另外急性发作持续时间超过3d的急性胆囊炎患者中超过50%需要中转,中转率是持续时间较短患者的5倍多。腹腔镜中转开腹和成功实施腹腔镜胆囊切除术的急性胆囊炎患者的超声特征分布和症状发作持续时间,具有统计学差异(P<0.05)。结论腹部超声有助于术前急性胆囊炎术式选择。当胆囊壁厚度超过5mm、胆周明显渗出或脓肿、严重的胆囊失形、胆囊三角结构辨认困难、尤其急性发作持续时间超过3d的急性胆囊炎患者腹腔镜胆囊切除的中转率高,应首选开腹胆囊切除术。

Objective To research the clinical value of abdominal ultrasound in predicting the approaches of cholecystectomy to acute cholecystitis. Methods The records of abdominal ultrasound signs of acute cholecystifis in 354 patients who underwent laparoscopic cholecystectomy between January 2005 and December 2010 in our department were reviewed. We analyzed the abdominal ultrasound presentations of acute cholecystitis in the patients who required conversion to open cholecystectomy and compared them with the ultrasound signs of acute cholecystitis in the patients who had a completed laparoseopic eholecystectomy. Results Conver- sion to open cholecystectomy in the patients with acute choleeystitis was necessary in 24% （85/354） of the patients who started with laparoscopic cholecystectomy. The most frequent ultrasound findings in the patients requiring conversion were a pericholeeystic exudate in 32.9% , a difficult identification of anatomical structures due to local severe inflammation in 40%, gallbladder wall thickening more than 5 mm in 31.8% , and intense gallbladder wall deformation in 21.2%. Additionally, when the duration of symptoms exceeded 3 days, more than half of the patients required conversion to open eholecystectomy and the conversion rate was five times higher than that of those with a shorter duration of acute cholecystitis. There was a statistical difference in above ultrasound presentations and symptomatic duration of acute cholecystitis between the patients who required conversion and the others who had completed laparoseopic eholecysteetomy （ P 〈 0.05 ）. Conclusion Abdominal uhrasound helps to predict the approaches of eholecysteetomy to acute cholecystitis. Open cholecystectomy should be done because of the high risk of conversion in the patients with the ultrasound findings of acute cholecystitis such as gallbladder wall thickening 〉 5 mm, pericholecystie exudates or abscess adjacent to the gallbladder, intense gallbladder wall deformation and difficulty in identifying anatomical structures within Calot＇s triangle, especially in those with a duration of symptoms over three days.