腹部彩超对困难型腹腔镜胆囊切除术的术前评估价值  

Preoperative Prediction of Abdominal Ultrasound in Difficult Laparoscopic Cholecystectomy

作　　者：葛清萌 赵顺利 胡汉华 

机构地区：[1]武汉市14医院普外科,湖北武汉430200

出　　处：《华南国防医学杂志》2013年第1期24-26,共3页Military Medical Journal of South China

摘　　要：目的探讨腹部彩超对困难型腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的术前评估价值,为临床提供参考。方法回顾性分析作者医院自2008-05/2012-05月收治的420例行腹腔镜胆囊切除的手术患者的临床资料,其中困难型腹腔镜胆囊切除手术78例为实验组,其余342例为对照组,比较术前彩超评估与术中结果。结果实验组和对照组术前预测和术中实际判断,差异无统计学意义(P>0.05)。实验组和对照组术中情况,胆囊萎缩、胆囊颈部结石嵌顿、胆囊结石充满型、单纯胆囊结石、胆囊息肉、合并肝硬化门脉高压症及有手术史等病因造成的差异有统计学意义(P<0.05)。结论胆囊萎缩、胆囊颈部结石嵌顿、合并有肝硬化门脉高压症、有上腹部手术史且胆囊与邻近脏器粘连等因素是引起困难型腹腔镜胆囊切除手术的常见原因。腹部彩超对预测LC难易程度具有一定的应用价值。Objective To study the preoperative assessment value of color Doppler ultrasound on the abdomen for difficult laparoscopic cholecystectomy and provide clinical reference.Methods The clinical materials of 420 patients undergoing laparoscopic surgery from May 2008 to May 2012 were retrospective analyzed.The experimental group contained 78 patients with difficult type of laparoscopic cholecystectomy,the remaining 342 patients were the control group.Preoperative color Doppler evaluation and intraoperative results were compared.Results The preoperative prediction and intraoperative judgment of the experimental group and control group were not significantly different（P〉0.05）.According to the intraoperative situation,the factors including gallbladder atrophy,gallbladder stone＇s neck,gallstones full of embedded type,pure cystic and calculous,gallbladder polyps,merger cirrhosis portal hypertension and have surgeries resulted in significant difference between two groups（P0.05）.Conclusion Difficult laparoscopic surgery gallbladder type common reasons are gallbladder atrophy,gallbladder neck stone＇s with liver cirrhosis,embedded portal hypertension,the abdominal surgeries and gallbladder and adjacent organs adhesion,and other factors.Abdominal ultrasonography to predict the degree of difficulty of LC surgery has a certain value.

关 键 词：困难型腹腔镜胆囊切除术 腹部彩超 术中结果 

分 类 号：R657.4[医药卫生—外科学]