超声在腹腔镜胆囊切除术前诊断腹腔粘连的价值

目的探讨超声在腹腔镜胆囊切除术前诊断腹腔粘连的可能性及应用价值.方法连续选择100例接受腹腔镜胆囊切除术患者,采用自身手术前后对照方法,术前应用超声检测脐孔、胆囊底及胆囊颈腹腔脏器滑动情况诊断有无粘连,并与术中脐孔、胆囊底及胆囊颈粘连诊断结果比较,分别计算超声诊断脐孔、胆囊底及胆囊颈粘连的敏感性、特异性、准确性、阳性预测值、阴性预测值.结果比较100例拟行腹腔镜胆囊切除术患者术前超声与术中诊断脐孔、胆囊底及胆囊颈粘连发生率,两者间差异均无显著性意义（P＞0.05）,即术前超声与术中诊断粘连结果基本一致.超声对诊断脐孔、胆囊底和胆囊颈粘连的敏感性分别为100%、66.6%和84.0%,特异性98.9%、91.7%和89.3%,准确性99.0%、85.0%和88.0%,阳性预测值：50.0%、75.0%和72.4%,阴性预测值100%、88.1%和94.7%.结论术前超声可以预测脐孔及胆囊周围有无粘连,对术者估计手术难度及选取第一穿刺点具有帮助作用.

Ultrasonic diagnosis of abdominal adhesion before laparoscopic cholecystectomy

Objective To evaluate ultrasonic diagnosis of abdominal adhesion before laparoscopic cholecystectomy(LC).Methods With self-controlled trial,100 patients undergoing LC were preoperatively examined by ultrasound scan for diagnosis of any adhesions to the umbilicus or fundus and the neck of gallbladder in terms of detectable visceral slide,then the adhesions were confirmed during LC.The sensitivity,specificity ,accuracy,positive predictive value and negative predictive value were calculated.Results The rates of adhesions between two procedures showed no significant difference(P>0.05).Comparison with the intraoperative results,the sensitivity of ultrasonic diagnosis of adhesions in umbilicus,fundus and neck of gallbladder were 100%,66.6% and 84.0% respectively, the specificity were 98.9%,91.7% and 89.3%,the accuracy were 99.0%,85.0% and 88.0%,the positive predictive value were 50.0%,75.0% and 72.4%,and the negative predictive value were 100%,88.1% and 94.3%.Conclusions Ultrasonics could be applied preoperatively to diagnose the adhesions to umbilicus and gallbladder in patients undergoing LC,it is useful for surgeons to estimate the difficulty of LC and to select an adhesion-free site for the first trocar insertion.