腹腔镜超声对于胆囊切除术中同期治疗胆道结石决策的价值

Value of laparoscopic ultrasound for simultaneous treatment decision of cholecystectomy for bile duct calculi

目的观察腹腔镜超声(LUS)用于制定胆囊切除术中同期治疗肝内胆管结石及胆总管结石(CBDS)决策的价值。方法回顾性分析53例明确诊断胆囊结石(GS)并接受择期腹腔镜下胆囊切除术患者,术中根据LUS所见判断有无肝内胆管结石及CBDS,进而决定是否同期行病变部分肝脏切除术和(或)腹腔镜胆总管探查术(LCBDE)。结果53例均成功切除胆囊,术中LUS检查胆囊结果与术中及术后所见相同,LUS诊断准确率100%(53/53)。24例术前诊断为单纯GS,其中19例术中LUS诊断与术前相符、5例术中LUS诊断为GS合并CBDS而同期行LCBDE;25例术前诊断为GS合并CBDS,其中23例术中LUS诊断与术前相符而同期行LCBDE,2例术中LUS未发现CBDS、术后影像学复查亦未见CBDS;4例术前诊断GS合并肝内胆管结石,其中3例术中LUS所见与术前相符而行部分肝脏切除,1例术中LUS发现CBDS而行部分肝脏切除术+LCBDE。结论LUS有助于胆囊切除术中同期治疗肝内胆管结石及CBDS制定决策,可及时完善诊断、调整术式并辅助实施手术。

Objective To observe the value of laparoscopic ultrasonography(LUS)for simultaneous treatment decision of cholecystectomy for intrahepatic bile duct stone and common bile duct stone(CBDS).Methods Data of 53 patients with gallbladder stone(GS)who underwent elective laparoscopic operation for biliary calculi were retrospectively analyzed.Intraoperative determination of intrahepatic bile duct stones and/or CBDS were made according to LUS findings,and then simultaneous partial hepatectomy and/or laparoscopic common bile duct exploration(LCBDE)were performed.Results The gallbladder was removed successfully in all 53 cases,and the intraoperative LUS examination results were completely consistent with that of intraoperative and postoperative findings,and the diagnostic accuracy was 100%(53/53).Among 24 cases who were diagnosed as pure GS before operation,after LUS examination,19 patients were diagnosed as pure GS unchangeably,and 5 were diagnosed as GS complicated with CBDS and underwent LCBDE.Among 25 patients who were diagnosed as GS complicated with CBDS before operation,23 cases were verified with LUS,and LCBDE was performed simultaneously,while no CBDS was found in 2 cases with intraoperative LUS,and the original CBDS disappeared in postoperative imaging reexamination.GS complicated with intrahepatic bile duct stones before operation was diagnosed in 4 cases,among them LUS findings were consistent with preoperative LUS diagnosis and partial liver resection was performed in 3 cases,and the rest 1 case diagnosed as GS complicated with CBDS by LUS and underwent partial liver resection plus LCBDE.Conclusion LUS was helpful for the decision-making of simultaneous treatment of intrahepatic bile duct stone and CBDS in cholecystectomy,hence timely improving diagnosis,adjusting the method and assisting the implementation of surgical operation of bile duct calculi.