腹腔镜超声辅助下复杂类型的腹腔镜胆囊切除术

Laparoscopic ultrasonography assisted complicated laparoscopic cholecystectomy

目的 评估腹腔镜超声在复杂的腹腔镜胆囊切除 (LC)术中避免胆道损伤及胆总管结石残留的作用。 方法 10 4例LC因肝外胆系解剖变异、胆囊管真实性不确定、疑有胆总管结石或胆道损伤、三角区粘连或炎症、急性或萎缩性胆囊炎等被界定为复杂的LC患者。借助腹腔镜术中超声检查 (LUS)显示的胆总管下端 ,肝外胆管与胆囊壶腹、胆囊管之间的解剖关系施行LC。 结果 在LUS辅助下顺利完成复杂的LC 85例。 19例因LUS提示的潜在胆道损伤危险 ,胆总管下段结石 ,及疑有胆道损伤而中转开腹手术。 结论 通过LUS显示的肝外胆管 ,并在术野中胆囊管、胆囊壶腹的参照下 ,可了解肝外胆系诸结构之间的解剖关系 ,由此避免胆道损伤。LUS还可发现隐匿的胆总管结石。

Objective To evaluate the role of laparoscopic ultrasonography(LUS) in prevention of bile duct injury(BDI) and residual common bile duct(CBD) calculi during complicated laparoscopic cholecystectomy (LC). Methods One hundred and four cases of LC were defined complicated because of anatomic aberrance of the extrahepatic biliary system, unconfirmed exposed cystic duct, suspected CBD calculi or BDI, adhesion or inflammation in the Calot′s triangle, acute cholecystitis, and atrophic gallbladder. LUS was performed to scan the extrahepatic bile duct. LC was carried out with assistance of the LUS. Results Assisted with the LUS demonstrated anatomic relationship between the extrahepatic bile duct and cystic infundibulum or cystic duct, 85 cases of LC were accomplished successfully. 19 were converted to open cholecystectomy because of LUS indicated potential risk of BDI, CBD calculi, and suspected BDI. Conclusions With the extrahepatic bile duct visualized by LUS and contrast of the cystic infundibulum and cystic duct, operators can precisely identify the anatomic relationships between the cystic infundibulum, cystic duct and extrahepatic bile duct. Preoperatively unpredicted choledocholithiasis may be recognized.