超声造影在腹腔镜胆囊切除术中的临床价值

目的：评价术前超声造影在腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）中的临床价值,为LC的术前评估提供有效的方法参照。方法：选择2006年9月至2013年8月417例胆囊疾病患者于LC术前行超声造影检查,将超声造影结果、LC术中探查情况及术后病理结果进行对比分析,评价LC术前超声造影检查的临床价值。结果：术前超声造影对影响手术的良性病变及解剖异常的总体诊断符合率为93.2%（136/146）,其中对LC术中胆囊穿孔、周围粘连、解剖异常的诊断符合率分别为94.1%（32/34）、93.7%（59/63）、91.8%（45/49）。超声造影结合病灶增强达峰时间、增强形态及胆囊壁结构破坏等表现诊断胆囊癌;与术后病理结果相比,超声造影对胆囊癌诊断准确率为93.9%（31/33）,诊断符合率较高。结论：LC术前的超声造影检查可准确判断胆囊穿孔、周围粘连及解剖异常,并有效筛查胆囊恶性肿瘤,明显提高LC的手术安全性,降低中转率,具有较高的临床价值。

The significance of contrast-enhanced ultrasound in diagnosis of various lesions in gallbladder treated by laparoscopic cholecystectomy

Objective： To investigate the significance of contrast-enhanced ultrasound（ CEUS） in diagnosis of various lesions in gallbladder treated by laparoscopic cholecystectomy（ LC）,and to provide an effective method for the preoperative evaluation before LC as well. Methods： From Sep. 2006 to Aug. 2013,a total of 417 patients with various lesions in gallbladder all underwent the examination of CEUS before LC. Results from CEUS,intraoperative exploration consequence and pathologic diagnosis of patients were retrospectively analyzed in the present study in order to evaluate the clinical value of CEUS before LC. Results： The overall diagnostic accuracy of CEUS in benign lesions and anatomic abnormalities was 93. 2%（ 136 /146）. And the diagnostic accuracy of CEUS was 94. 1%（ 32/34） in gallbladder perforation,93.7%（ 59/63） in surrounding adhesions,91.8%（ 45/49） in anatomic abnormalities,respectively. The time to peak enhancement,the shape of enhancement and the destruction of the integrity of gallbladder wall in CEUS were integrated to diagnose gallbladder carcinoma. The diagnostic accuracy of CEUS in malignant lesion of gallbladder was 93. 9%（ 31 /33） in comparison with pathological diagnosis. Conclusions： Preoperative evaluation of CEUS before LC can effectively differentiate gallbladder perforation,surrounding adhesions and anatomic abnormalities,and accurately screen potential gallbladder cancer. In view of its high clinical significance,CEUS should be routinely performed before LC in order to improve the operation safety and reduce the transfer rate.