腹腔镜肝胆手术中超声技术的应用

目的：探讨腹腔镜肝胆手术中超声技术的应用价值。方法：对68例患者(23例肝脏疾病、45例术前估计处理困难的胆囊病变)进行腹腔镜超声检查，并在术中超声指导下进行治疗性操作。结果：术中超声检查发现2例胆总管小结石和1例Mirrizi综合征，后者及1例多发性肝囊肿中转开腹。余66例均在术中超声引导下顺利完成腹腔镜手术：对肝囊肿实施囊肿开窗术，对肝脓肿实施脓肿切开置管引流术，对肝脏不明原因的占位病变实施肝肿块切除活检术、肝穿刺活检术，对孤立性肝脏占位性病变实施肝脏肿瘤切除术，对不能切除的肝癌实施毁损(微波和注射无水酒精)和门静脉插管化疗，对急性胆囊炎、慢性胆囊炎伴胆囊结石、胆囊粗蒂息肉行胆囊切除术。结论：腹腔镜术中超声具有快速、可重复、准确性高等特点，在肝胆疾病的腹腔镜诊断和治疗中具有重要的临床应用价值。

Evaluation on the significance of intraoperative laparoscopic ultrasonography in hepatobiliary surgery

Objective To evaluate the significance of intraoperative laparoscopic ultrasonography (IOUS) during hepatobiliary surgery. Methods Sixty-eight cases of hepatobiliary lithiasis (liver disease 23 and cholecystopathy with difficulty in management by preoperative estimation, 45 ) were examined by intraoperative laparoscopic ultrasonography. Results Two CBD stones and one Mirrizi syndrome were found in IOUS. The laparoscopic procedures were successful fulfilled in 68 cases under the guidance of sonography including fenestration on liver cyst, incision and drainage on liver abscess, resection and biopsy on space occupied liver lesion with unknown cause, resection of solitary space occupied mass in liver, destruction of unre-sectable liver cancer by microwave and injection of absolute alcohol and chemotherapy through portal vein catheterization, cholecystectomy in acute cholecystitis, chronic cholecystitis with chiledolithiasis, and broad pedicle polyps in gallbladder etc. Conclusion IOUS has the advantages of non-invasive, fast, repeatable, high accuracy and has important clinical significance in laparoscopic diagnosis and treatment.