腹腔镜胆囊切除术前彩色多普勒探测肝中静脉的实用价值  

Practical Values of Color Doppler Ultrasonography in Detecting the Middle Hepatic Vein before Laparoscopic Cholecystectomy

作　　者：陈曼[1] 龚新环[1] 曹瑛[1] 沈柏用[2] 

机构地区：[1]上海第二医科大学附属瑞金医院超声诊断科,200025 [2]上海第二医科大学附属瑞金医院外科,200025

出　　处：《中国超声医学杂志》2002年第3期217-219,共3页Chinese Journal of Ultrasound in Medicine

摘　　要：目的 :腹腔镜胆囊切除术因胆囊床受损引起的出血与术中损伤肝中静脉的分支有关 ,彩色多普勒检查术前了解肝中静脉与胆囊床的关系 ,以减免术中因损伤肝中静脉而大量出血以致中转的后果。方法 :136例拟行腹腔镜胆囊切除术患者术前用彩色多普勒寻找其与胆囊床的最密切的分支 ,测量至胆囊床的距离及该处内径。结果 :136例患者肝中静脉分支 C点至胆囊床的距离各异 ,有 16例为 0 (占 11.8%)。该处的内径个体差异也很大 ,以 2～ 3mm者最多 ,占 36 %(4 9/136 )。结论 :由于肝中静脉分支与胆囊床关系密切 ,彩色多普勒技术在腹腔镜胆囊切除术前可及时、准确地报告肝中静脉的分支与胆囊床的关系 ,其分支若很粗或与胆囊床紧贴 ,特别是 C点至胆囊床的距离≤1cm的患者 ,只要在术中仔细操作 ,即可避免术中因损伤肝中静脉的分支而出血的发生。Objective:Hemorrhage from the gallbladder bed during laparoscopic cholecystectomy is caused by the injury to the branch of the middle hepatic vein.Detecting the relationship of the middle hepatic vein and the gallbladder bed before operation by Color Doppler ultrasonography can diminish the occur of extensive venous hemorrhage.Methods:Color Doppler ultrasound was used to examine the diameter of the vein at the C point and the distance between the gallbladder bed and the C point,which was defined as the point on the branch of the middle hepatic vein closest to the gallbladder bed in 136 cases.Results:Distance between the gallbladder bed and the C point was varied,16 cases were 0(11.8%),and diameter in 2-3mm were common(49/136,36%).Conclusions:Anatomically,the middle hepatic vein is known to extend close to the gallbladder bed,if the branch of the middle hepatic vein is rather large and adherent,especially the distance between the gallbladder bed and the C point were less than 1cm,detected by Color Doppler ultrasound before laparoscopic cholecystectomy,extreme care should be taken during operation in order to decease the likelihood of the injury to the branch of the middle hepatic vein.

关 键 词：腹腔镜胆囊切除术 彩色多普勒 肝中静脉 诊断 

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