术中超声检查在硬性胆道镜保胆取石术中的应用价值  

Application of lntraoperative Ultrasonography in Removal of Gallbladder Stones with Rigid Choledochoscope

作　　者：周永刚[1] 杨一林[1] 王佳[1] 杨瑞静[1] 王青[2] 金京兰[1] 段云友[1] 

机构地区：[1]解放军第四军医大学唐都医院超声科,西安市710038 [2]解放军第四军医大学唐都医院普通外科,西安市710038

出　　处：《中国超声医学杂志》2011年第5期470-472,共3页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨术中超声实时检查胆道系统在硬性胆道镜保胆取石术中的应用价值。方法 35例胆结石患者在行硬性胆道镜保胆取石术前经超声检查进行肋缘下胆囊底部体表定位;硬性胆道镜直视下清除胆囊内结石后,术中实时进行经腹超声探查,观察胆囊、胆囊管及胆总管内是否有残余结石,必要时进行引导取石。结果 35例患者术前胆囊底部体表定位成功率为100%。硬性胆道镜清除胆囊内结石后,术中进行实时经腹超声探查。20例患者胆囊腔内未见明确结石强回声;11例患者胆囊腔内残存结石,结石直径0.3～0.9 cm,其中2例超声引导胆道镜取出结石;1例患者胆囊管残存结石,结石直径0.3 cm;1例胆囊后壁气泡误诊为小结石;2例患者经腹超声证实胆囊管结石嵌顿,继而转为腹腔镜胆囊切除术。结论术前超声检查行胆囊底部体表定位有助于手术部位的选择。术中超声检查可降低术后结石残留率,明确结石残存部位,为手术方式变更提供可靠的依据。Objective To evaluate the clinical value of intraoperative ultrasonography in removal of gallbladder stones by rigid choledochoscope. Methods Thirty-five patients with gallbladder stones had examination of ultrasonography to locate gallbladder bottom on the body surface at costal margin before choledochoscope operation. Intraoperative transabdominal ultrasound was used to look for residual stones in gallbladder, cystic duct and common bile duct, and ultrasound guided choledochoscope was used if necessary after choledochoscope operation. Results The success rate of gallbladder bottom body surface positioning was 100%preoperative. After clearing cystic stones with rigid choledochoscope, we use intraoperative transabdominal ultrasound to explore residual stones in biliary system. Twenty patients had no stone in gallbladder, eleven patients had residual stones in gallbladder, stones diameter were from 0.3 cm to 0.9 cm, two patients were removed stones with ultrasound guidance; one patient had residual stone in cystic duct, stone diameter was 0.3 cm; One patient had a small bubble misdiagnosed as small stone; Two patients were confirmed cystic duct stones by intraoperative ultrasonography, and converted to laparoscopic cholecystectomy. Conclusions The preoperative ultrasound location gallbladder bottom helps to select operative site and reduce body surface damage. It also helps reduces the rate of postoperative residual stones, identifies residual stones, provides reliable evi- dence for the alteration of operation method.

关 键 词：术中超声 胆囊结石 硬性胆道镜体表定位 

分 类 号：R657.4[医药卫生—外科学] R445.1[医药卫生—临床医学]