MRI及MRCP在急性胆囊炎腹腔镜胆囊切除术前评估中的应用  

Use of MRI and MRCP in preoperative evaluation of patients undergoing laparoscopic cholecystectomy for acute cholecystitis

作　　者：汪建初[1] 浦涧[1] 宋斌[2] 陆涛[1] 马日海[1] 吴贤建[1] 卓臣义[1] 路远[1] 王存川[3] 

机构地区：[1]右江民族医学院附属医院肝胆外科,广西省百色533000 [2]陕西省人民医院普外科 [3]暨南大学附属第一医院微创外科中心

出　　处：《中华普通外科杂志》2015年第3期198-200,共3页Chinese Journal of General Surgery

基　　金：广西教育厅课题基金资助项目（201106LX453）

摘　　要：目的 探讨MRI及MRCP在急性胆囊炎腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）术前评估中的作用.方法 前瞻性搜集我院收治的术前行MRI检查的159例急性胆囊炎资料,记录LC中暴露胆囊三角、胆囊三角解剖、胆囊床剥离所需时间,分析MR表现如胆囊壁厚度、胆囊大小、胆囊壁连续性、胆囊周围积液、胆囊管与肝总管角度等与手术时间关系.结果 手术时间＞ 90 min的有98例（98/159,61.64％）;胆囊壁厚度≥5 mm的患者,胆囊三角解剖及胆囊自胆囊床剥离所需时间较多（P =0.001）;胆囊≥4 cm及胆囊黏膜断裂的患者在暴露胆囊三角、胆囊三角解剖、胆囊自胆囊床剥离所需时间均较长（P=0.001）,胆囊周围有积液的患者,在暴露胆囊三角、胆囊三角解剖、胆囊床剥离阶段所需时间均较长（P =0.001）.胆囊管与肝总管角度＜60.的患者,在解剖胆囊三角方面所占时间较长（P =0.001）.在暴露胆囊三角方面,胆囊≥4 cm、胆囊黏膜断裂、胆囊周围积液等所需时间较长（P =0.001）;全组无中转开腹病例,1例胆总管误夹,无其他严重并发症.结论 MRI及MRCP检查可以预测急性胆囊炎LC手术难度,为急性胆囊炎LC提供指导.Objective To study MRI and MRCP in preoperative evaluation of laparoscopic cholecystectomy for acute cholecystitis.Methods This is a prospective study,159 acute cholecystitis cases with MRI preoperative evaluation between May 2011 and May 2014 were treated by laparoscopic cholecystectomy （LC）.Time required for exposing gallbladder triangle,dissecting gallbladder triangle,and resection of gallbladder was recorded.The relationship between MRI finding and thickness and size of gallbladder wall,gallbladder effusion,and the angle between hepatic duct and cystic duct ＜ 60° was analyzed.Results The time length for LC was more than 90 minutes in 98 out of the 159 cases; In cases with gallbladder wall thickness ≥ 5 mm the time required for dissecting gallbladder triangle and stripping gallbladder from the bed was longer （P =0.001） ; It took a longer time in the cases of gallbladder ≥4 cm,and with gallbladder mucosa discontinuity,for exposing gallbladder triangle,dissecting gallbladder triangle,and removing the gallbladder（P =0.001） ; In cases with gallbladder effusion,time was longer for exposing gallbladder triangle,dissecting gallbladder triangle （P =0.001） ; In cases of the angle of hepatic duct at cystic duct ＜ 60 °,dissecting gallbladder triangle took a longer time（P =0.001）.No case was converted to open surgery in this study.Major complication included in one case of bile duct injury.Conclusions MRI and MRCP examination helps to predict the difficulty encountered during LC for acute cholecystitis.

关 键 词：胆囊炎 急性 胆囊切除术 腹腔镜 磁共振成像 术前评估 

分 类 号：R657.4[医药卫生—外科学]