术中B超检测肝内结石的作用

评估术中超声在肝内结石手术中的应用。方法:200例肝内结石病人行术中B超检查(IOUS),以确定结石部位、分布,显示狭窄与扩张的部位,决定手术方式。待认为结石取净后,再行IOUS,如发现残石,再行B超引导下取石,直到结石取净或小残石无法取出。结果:本组行不同方式的肝叶切除99例,胆肠吻合82例,单纯“T”管引流98例,术毕残石率为20％,术后胆镜取净结石12例,自行排出6例,出院时残石率11％。结论:IOUS显示肝内结石清晰,定位准确,无损伤,术中可反复使用,可显示隐蔽结石、异位肝管内结石和易被忽视的尾叶结石。

Removal of Intrahepatic Stones under the Guiding of Intraoperative Ultrasonography

To assess the value of Intraoperative ultrasonography(IOUS) during operations for in-trahepatic stones. Methods: IOUS was performed in 200 patients with intrahepatic stones and/or bile duct strictures. After the assumed complete removal of stones, IOUS was repeated to verify the com-pleteness. Should residual stones be present, further attempts to remove the stones were made under the guidance of IOUS. Minute stones fixed in fine bile ducts remained unavoidably. Results: In this se-ries, different forms of hepatic lobectomy were performed in 99 cases and choledochoenterostomy in 82 cases, and bile duct drainage in 98 cases. The incidence of residual stones was 20%. Postoperatively complete stone removal was achieved in 12 patients by fibroscopy and spontaneous evacuation of sto-nes in 6 cases, giving an incidence of 11% of retained stones on discharge from the hospital. Conclusions: IOUS gives distinct imaging of intrahepatic calculi difficult to be found by fibrocholangioscopy; It is atraumatic and could be used repeatedly.