B超检查在腹腔镜胆囊切除术难度预测中的应用

目的：通过术前B超检查预测LC手术难度。方法：通过B超检查与术中观察，将胆囊结石与胆囊良性病变分为Ⅵ型，并将各型Calot三角粘连率及手术时间延长发生率进行相互比较，得出结果。结果：I型为LC最佳手术适应症，而Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ型为困难的LC手术。结论：术前B超检查可以预测LC手术难度。     

B超预测急性胆囊炎行腹腔镜胆囊切除术难度的价值

目的：评价术前B超预测腹腔镜胆囊切除术（LC）的难度。方法：收集140例急性胆囊炎行腹腔镜切除术患者术前8hB超及手术的详细资料，以B超中各参数为自变量，手术难度记分为因变量，采用多元回归分析法，评估术前B超对腹腔镜胆囊切除术难度预测作用。结果：胆囊壁厚度与LC的难度呈正相关，胆囊管长度与LC的难度呈负相关。结论：术前超声检查对预测腹腔镜胆囊切除术的难度有价值。     

B超预测腹腔镜胆囊切除术的价值

通过８４例腹腔镜胆囊切除术术前Ｂ超与手术结果的对照，分析了在胆囊、胆囊壁、胆周和胆囊结石等方面Ｂ超声像图不同的病例的手术情况，阐明了Ｂ超预测腹腔镜胆囊切除术的作用，对于降低手术中转率，防止和减少手术并发症具有重要临床价值。应该指出，Ｂ超声像图显示胆囊颈部结石嵌顿伴胆囊增大或胆囊壁增厚、胆囊增大伴胆囊壁增厚的病例，腹腔镜胆囊切除术要慎重。     

B超影像对腹腔镜胆囊切除术难度评估的临床研究

目的：分析B超影像与腹腔镜胆囊切除手术难度之间的关系,建立评估模型。方法：采用Person相关分析,研究各B超影像数据与手术时间之间的关系。在此基础上采用多元线性回归法,建立评估模型。结果：相关性统计分析结果显示：手术时间与B超影像胆囊壁厚度、胆囊大小、结石数目、胆总管内径呈正相关,系数r分别为0．41、0．62、0．20、0．37（P〈0．01）;多元回归法所建立的评估模型为：Y=62．3X1＋0．31X2＋6．15X3＋28．7X4—16．3（Y代表手术时间,X1、X2、X3、X4分别代表胆囊大小、胆囊壁厚度、结石数目、胆总管内径,R^2=0．62,P〈0．01）。结论：B超影像可以应用于对手术难度的评估。     

术前B超检查对腹腔镜胆囊切除术转开腹胆囊切除术的预测价值

腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）已在临床广泛开展,与开腹胆囊切除术（open cholecystectomy,OC）比较具有创伤小、恢复快的优点,目前在我国基层医院应用广泛.随着技术的发展,LC适应证范围不断扩大,原来被认为禁忌证的急性胆囊炎现已被纳入手术适应证范围,但有较高的中转开腹率.我院除了有明确的绝对禁忌证外,对所有伴急性胆囊炎的胆囊结石患者均尽快行LC手术,这的确减少了患者的痛苦和经济负担,但同时也增加了手术难度,还可能会增大如胆管损伤等严重并发症的危险性.     

腹腔镜胆囊切除术手术难度预测分析

目的　评价B超、静脉胆道造影等作为LC手术难度预测指标的价值。方法　回顾性分析我院100例LC病例。结果　B超A图者LC难度分级均在DCⅠ-Ⅱ级,且86.5％(32/37)为Ⅰ级,B超B图者绝大多数在Ⅱ级以上,且中转开腹者均为B图,静脉胆道造影显影良好者LC难度分级均为DCⅠ-Ⅱ级,其中Ⅰ级占58.2％(32/55)无1例中转开腹,显影浅淡和不显影者均在DCⅡ级以上。结论　B超、静脉胆道造影可提高LC术前手术难度预测的准确性。     

腹腔镜胆囊切除术前的B超选择

我院自1991年12月以来，开展腹腔镜胆囊切除（LC）术前B超分类、分组选择230例，现对术前B超选择标准讨论如下。临床资料一、一般情况本组病例均为我院住院病人，男性53例，女性177例，年龄15～对岁。病史20d～15年。胆囊结石219例，胆囊息肉11例。全部病人依靠B超分类、分组选择。个别病例进行了CT和MRI检查。33例既往有腹部手术史，4例合并肝硬变。使用仪器为日本ALOKa－SSD250线阵式B超扫描仪，探头频率3．5MHz二、选择标准按B超声象图改变，将胆囊、胆囊壁、胆周、胆总管、胆结石作为5条标准（分别以1、2、3、4、5表示）提供条…     

腹腔镜胆囊切除术前预测手术难度的方法

腹腔镜胆囊切除术(LC)是新近开展的手术方法,因历史较短,病例数量有限,有丰富临床经验的医生并不多,为指导术者根据自己的实际水平,合理选择适应症,术前预测手术难度就显得十分必要,本文基于我院1991年9月～1993年1月1016例LC的实践,介绍我们LC术前预测手术难度的体会。     

静脉胆道造影结合B超预测LC手术难度的临床研究

目的 :探讨静脉胆道造影 (IVC)结合B超预测腹腔镜胆囊切除 (LC)手术难度分级标准。材料和方法 :根据患者胆囊大小、形态、胆囊壁厚薄 ,Calot三角 ,胆周有无粘连及胆道显影情况 ,将LC手术难度分为三级。结果 :Ⅰ级为适应证组 ,Ⅱ级为相对适应证组 ,Ⅲ级为禁忌证组 ,与手术对照 ,IVC结合B超分组符合率 98.4%。结论 :IVC结合B超可为手术难度及病例选择提供较为全面的依据 ,对降低LC手术中转率及并发症发生率具有重要的临床价值。     

超声诊断对结石性胆囊炎LC困难因素的预测价值

目的探讨超声诊断对腹腔镜胆囊切除术（LC）困难因素的预测价值。方法对2862例经LC手术的结石性胆囊炎患者术前超声诊断结果与术中发现进行对比,并对多种可能影响手术的因素作相关分析。结果增加手术难度的胆囊超声表现有8种,依次为胆囊轮廓不清或囊壁结构不完整、胆囊萎缩、胆汁透声差伴有点絮状强回声、胆囊肿大、胆囊颈结石嵌顿、胆囊壁增厚、胆囊腔结石充满型及肝硬化,其中胆囊轮廓不清或囊壁结构不完整、胆囊萎缩、胆囊颈结石嵌顿这3个因素导致LC中转开腹的比例为2.48%～5.13%。结论术前超声检测中,应重视对上述8种表现的观察,特别是存在胆囊轮廓不清或囊壁结构不完整、胆囊萎缩、胆囊颈结石嵌顿表现时,应提示术者术前做好中转开腹的准备。     

超声在腹腔镜胆囊手术后的观察

胆囊腹腔镜手术具有微创、损伤少、恢复快、瘢痕小、住院天数少等优点，深得医生和患者的认同，但术后仍有并发症的发生，如能及时发现并处理，可减轻患者的痛苦。本文通过对我院患者术后并发症的原因分析，旨在引起以后工作中注意，以提高技术水平，尽可能避免术后并发症的发生，减轻患者的痛苦。     

B型超声检查对74例腹部损伤的观察与分析

腹部损伤属于临床急诊 ,需要快速准确地做出诊断 ,这对治疗方案的选择有很大帮助。现将我们从 1995年 1月～ 1999年 6月对 74例腹部损伤者进行Ｂ超检查并与手术结果对照分析 ,报告如下。1　资料和方法1 1　临床资料　本组 74例 ,男性 6 1例 ,女性 13例。年龄最小 5岁 ,最大 6 8岁 ,平均 34岁。受伤后就诊最短时间0 5ｈ ,最长时间 72ｈ。致伤原因 :车祸 36例 ,坠伤 2 1例 ,打斗伤 11例 ,挤压伤 6例。闭合性腹部外伤 70例 ,开放性腹部外伤 4例 ,全部病例均有腹痛。 5 0例伴有腹膜炎。腹穿 39例抽出不凝性血液 ,10例抽出较淡的血性液体 ,5例抽…     

280例脂肪肝CT及B超诊断对比分析

我们收集了 2 80例经ＣＴ、Ｂ超检查诊为脂肪肝的患者 ,对其检查手段及诊断符合率进行了分析 ,旨在阐明ＣＴ、Ｂ超诊断脂肪肝的准确性及特异性 ,为脂肪肝的临床诊断和治疗提供可靠依据。1　资料和方法我院 1994年 1月～ 1999年 12月经ＣＴ、Ｂ超检查诊为脂肪肝的患者共 2 80例 ,其中男性 188例 ,女性 92例 ,年龄 2 1～6 9岁 ,平均 42 6岁。ＣＴ采用美国ＧＥ公司生产的Ｍａｘ 6 40全身ＣＴ ,取肝、脾同一层面 ,分别测量肝、脾ＣＴ值 ,并进行对比 ,以肝脏ＣＴ值低于脾脏ＣＴ值的多少为标准分为轻型、中型、重型及极重型 ,重型和极重型多伴有…     

超声检查在腹腔镜胆囊切除术前后的临床应用价值

电视腹腔镜胆囊切除术 (ＬａｐａｒｏｃｏｐｉｃＣｈｏｌｅｃｙｓｔｅｃｔｏｍｙ,ＬＣ)是九十年代国内外开展的一项创伤小、恢复快、简捷快速的新技术 ,也是目前治疗胆囊良性疾病最流行的方法 ,但术中转为开腹胆囊切除术 (ＯｐｅｎＣｈｏｌｅｃｙｓｔｅｃｔｏｎｙ,ＯＣ)仍时有发生 ,ＬＣ后的并发症也比常规胆囊切除术多。本研究对 1 2 50例患者进行了超声检查 ,以探讨超声检查在ＬＣ前后的应用价值。现报告如下。1　资料和方法1 1　一般资料　本组报告 1 2 50例均经手术证实的胆囊疾病患者 ,对所有病例均经病理检查认证。其中男性 3 50例 ,…     

Role of preoperative helical CT before laparoscopic cholecystectomy: evaluation of gallbladder and peritoneal adhesion

OBJECTIVE: The purpose of this study was to assess the value of preoperative helical CT for the detection of adhesion of the gallbladder or surrounding peritoneum. SUBJECTS AND METHODS: Dynamic-enhanced helical CT of the abdomen was obtained before laparoscopic cholecystectomy in 47 patients. Images were reconstructed with a 5-mm interval. Appearances on CT images were correlated with operative findings, and useful findings for predicting gallbladder or peritoneal adhesion were determined by univariate and multivariate analysis. RESULTS: Patients with gallbladder or peritoneal adhesion often have gallbladder wall thickening, gallbladder wall enhancement, and increased density of the pericholecystic fat more frequently than patients without adhesion on both precontrast and postcontrast CT. Each of these findings was significant on univariate analysis. On multivariate analysis, increased density of the pericholecystic fat and focal attenuation increase in the liver were significant factors for predicting gallbladder or peritoneal adhesion. CONCLUSION: Increased density or stranding of pericholecystic fat and transient focal hepatic attenuation increase at dynamic arterial-phase CT indicates gallbladder and peritoneal adhesion.     

A comparison of computerised tomography, laparoscopic ultrasound and endoscopic ultrasound in the preoperative staging of oesophago-gastric carcinoma.

Introduction and objective: Oesophago-gastric carcinoma is associated with a poor prognosis despite advances in diagnosis and treatment. Accurate preoperative staging of gastro-oesophageal carcinoma is, therefore, essential in order to determine patient selection for potentially curative resection. The aim of this study was to evaluate and compare the role of computerised tomography (CT), laparoscopic ultrasound (LapUS) and endoscopic ultrasound (EUS) in the staging of oesophago-gastric carcinoma. Methods and patients: Thirty-six patients with histologically proven carcinoma of the oesophagus or stomach who were considered fit for surgical resection were identified from a prospectively collected database. All patients underwent spiral CT, LapUS and EUS as part of their preoperative staging investigations. Results from the staging modalities were compared retrospectively with final histopathology where available and to intraoperative findings where the tumour was irresectable. Results: Locally advanced tumours (T3/T4) were accurately identified by CT in 15/16 (94%) and by EUS in 14/16 (88%). LapUS was unable to detect 11 tumours (of which five were T3/T4) because they were above the diaphragm, but in the locally advanced cases where the tumour could be seen the accuracy was 10/12 (83%). EUS was the best modality for assessing early tumours and locoregional nodal involvement with accuracies of 8/13 (62%) and 21/29 (72%), respectively. EUS accuracies rose to 64, 92 and 83% for T1/T2, T3/T4 and N staging with the exclusion of those patients (n=6) in whom strictures prevented full assessment. LapUS had a specificity of 100%, compared to 90% for CT and was more accurate than CT for assessing distant metastases (accuracy of 26/32 (81%) compared to 23/32 (72%) for CT). Conclusions: Although this study is small it has confirmed that CT, EUS and LapUS act in a complimentary manner to provide the most complete preoperative staging for patients with oesophago-gastric cancer.     

Dropped gallstones post laparoscopic cholecystectomy mimicking peritoneal seeding: CT and ultrasound features

PURPOSE: The purpose of this work was to investigate the ultrasound (US) and CT features of dropped gallstones mimicking peritoneal seeding in patients after laparoscopic cholecystectomy (LCC). METHOD: We describe the US and CT features of dropped gallstones mimicking peritoneal seeding in eight patients who underwent LCC. We also conducted a retrospective study of consecutive LCC patients who subsequently had CT to determine the prevalence of this condition. RESULTS AND CONCLUSION: The density of dropped gallstones on CT ranged from hypodense to partially or completely calcified nodules. Some stones did not have visible surrounding reaction, whereas others showed an enhancing halo. All stones were echogenic and demonstrated shadowing on US. The stones were located mostly on the right side of the abdomen, and the majority were around the liver. The prevalence of dropped gallstones post laparoscopic cholecystectomy was 4.2%.