术前超声评估胆囊粘连与腹腔镜胆囊切除术难度关系研究

目的评价超声在腹腔镜胆囊切除术(LaparoscopicChoecystectomy,LC)前预测胆囊周围粘连的准确性,探讨超声预测胆囊周围粘连与LC手术难度的关系及其临床应用价值。方法连续选择30例似接受LC患者,采用自身对照试验方案,术前应用B超检测胆囊底及胆囊颈部周围脏器滑动情况评估胆囊周围有无粘连,并经LC术中判断证实;收集30例患者LC手术时间、出血量及并发症发生率。结果30例观察对象术前B超评估胆囊周围粘连8例,经LC术中探查证实7例,χ2比较术前B超对胆囊周围有无粘连的评估与术中相应的判断结果,差异无统计学意义(P>0.05);术前B超评估胆囊周围有粘连组手术时间、出血量及并发症发生率均显著大于无粘连组(P<0.05),以手术时间和出血量差异非常有统计学意义(P<0.01)。结论术前B超可以预测胆囊周围有无粘连及LC难度,对术者能安全顺利完成LC及患者选择合适的住院方式均具有临床指导意义。

Ultrasonic evaluation of abdominal adhesion preoperatively for predicting difficulty in laparoscopic cholecystectomy

Objective: To investigate the effectiveness of ultrasonic in evaluating adhesion to gallbladder and prediction about the difficulty in laparoscopic cholecystectomy (LC) preoperatively, also the applications of ultrasonic in evaluating adhesion to gallbladder for the patients undergoing LC were discussed. Methods: With self-controlled trial, the detectable duodenum slide next to the fundus of gallbladder and the neck of gallbladder were examined on ultrasound scan for evaluation of any adhesions to the gallbladder in thirty patients undergoing LC preoperatively, which were confirmed during the LC. The time of operation, blood loss and the rates of the operative complication were collected from these 30 cases. Results: 30 cases in studying objects, eight cases of the adhesions to gallbladder were suspected preoperatively by ultrasonic with seven cases confirmed by LC, Chi-square was applied to the results of adhesions and there was no significant discrepancy (P>0.05). The operative time and blood loss in the patients suspected of adhesions to gallbladder surpassed significantly those without suspection of adhesions (P<0.01), the rates of the operative complication of the patients suspected of adhesions also were higher than those suspected of no adhesions (P<0.05). Conclusions: Ultrasonics evaluation could be applied preoperatively to predict the adhesions gallbladder in patients undergoing LC, which facilitates the surgeon to estimate the difficulty of LC and the patients to make a choice of the mode hospitalization preferred.