超声诊断在腹腔镜胆囊切除术中的应用及价值

Application and value of ultrasonic diagnosis in laparoscopic cholecystectomy

目的:观察术前超声检查对施行腹腔镜胆囊切除术(LC)患者的临床应用价值。方法:将121例LC患者依据手术难易程度分为手术困难与手术容易两组,并均于术前行超声诊断检查,观察并记录两组胆囊形态与大小,胆囊壁厚度以及胆囊结石息肉情况,胆囊颈管是否存在结石嵌顿、胆囊周边是否粘连以及胆囊窝是否存在积液等。结果:所有患者中超声诊断与手术符合率为99.17%(120/121),超声提示存在胆囊粘连的4例患者中有2例术中其胆囊三角处胆总管、胆囊管、肝总管存在难分离的粘连,解剖结构难以分辨而中转开腹,中转率为1.65%(2/121)。手术困难组与容易组的胆壁厚度分别为(3.3±0.62)cm与(3.3±0.62)cm,组间差异有统计学意义(t=12.097,P<0.05);所有患者术后均未见严重并发症,且均痊愈后才出院。结论:术前给予LC患者行腹部超声诊断检查,可对其急慢性胆囊炎、胆囊结石与胆囊息肉样病变等予以确诊,并且还可准确评估手术的难易程度,该法对LC具有重要的临床指导价值。

Objective To observe the clinical application value of preoperative uhrasonography in laparoscopic cholecystectomy （LC） in patients. Method 121 cases of LC patients according to the degree of difficulty of operation were divided into surgery difficult group and surgical easy group,and were on ultrasonic diagnosis in operation, observe and record the two groups of gallbladder morphology and size, the thickness of gallbladder wall and gallstones polyps, the neck of gallbladder calculus incarcerated, whether there is whether adhesion around the gallbladder and gallbladder fossa the existence of effusion. Results The ultrasomld diagnosis and surgery all patients coincidence rate was 99. 17% （120/121） ,4 cases of gallbladder ultrasound suggested the presence of sticky even in patients who have adhesion in 2 cases of gall- bladder triangle at the common bile duct, cystic duct, common hepatic duct is difficult to separate, anatomical structure is difficult to distin- gnish and converted to laparotomy,the conversion rate was 1.65% （2/121）. The gallbladder wall thickness and easy operation difficult group group were （3. 3 ±0. 62） cm and （3.3 ±0. 62） cm group （t = 12. 097,P 〈0. 05） ;all the patients had no serious complications,and recovered after discharged from hospital. Conclusion Preoperative administration of LC patients undergoing abdominal ultrasonic diagnosis, the acute and chronic cholecystitis and cholecystolithiasis and gallbladder polypoid lesions be diagnosed, the degree of difficulty and can accurately assess the operation,this method has important clinical value for LC.