继发性胆总管结石外科治疗中应用腹腔镜超声的优势  

Laparoscopic ultrasonography in surgical treatment of secondary choledocholithiasis

作　　者：邱枫[1] 刘佐军[1] 孙海涛[1] 韩洋[1] 张腾 牛旭[1] 冯章东 韩威[1] 刘佳 

机构地区：[1]首都医科大学附属北京潞河医院普通外科,北京101100

出　　处：《中华肝胆外科杂志》2017年第11期766-770,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：北京市科技计划生物医药与生命创新培育研究（Z151100003915102）;通州区卫生发展科研专项（TF-2017-ZD-01.10）

摘　　要：目的探讨腹腔镜超声（LUS）与CT、MRCP及经腹超声在诊断继发性胆总管结石准确率方面的差异，及与超声科医师辅助完成相比，外科医师独立完成LUS是否有助于提高检查效率。方法选取2017年1月至2017年6月首都医科大学附属北京潞河医院成功施行腹腔镜胆囊切除、经胆囊颈管胆道探查（LTCBDE）的患者共42例，均行术中LUS检查。其中26例由外科医师独立完成（外科医师组），16例由超声科医师协助完成（超声医师组）。通过术中胆道镜探查验证结果，记录两组扫查的时间及准确率，并将LUS、CT、MRCP及术前经腹超声的诊断准确率进行比较。结果 LUS胆总管结石诊断准确率为92.9%，优于CT（73.8%）及经腹超声检查（23.8%，P＜0.05）；LUS的准确率高于MRCP（89.7%），但差异无统计学意义（P＞0.05）。外科医师独立扫查时间少于超声科医师协助［（8.5±3.0） min比（13.2±4.6） min，P＜0.05］，两组准确率差异无统计学意义（92.3%比93.8%，P＞0.05）。结论LUS诊断胆总管结石具有较高的准确率。由经过规范超声培训的外科医师独立完成LUS更有助于检查效率的提高。ObjectiveTo investigate the diagnostic accuracies among laparoscopic ultrasonography （LUS）, CT, MRCP and transabdominal ultrasonography in secondary choledocholithiasis, and to compare the procedural efficacy of LUS carried out by surgeons assisted by ultrasound physicians, and by surgeons alone. MethodsForty-two patients underwent laparoscopic transcystic common bile duct exploration （LTCBDE） in Beijing Luhe Hospital, Capital Medical University. All these patients underwent LUS examination. In 26 patients, LUS was carried out by surgeons alone while in 16 patients it was assisted by ultrasound physicians. The results of intraoperative choledochoscopy were used to verify the results in the two groups in scan time, and in its accuracies when compared with CT, MRCP and preoperative abdominal ultrasound. ResultsThe accuracy of LUS was 92.9%, which was significantly better than that of CT （73.8%） and transabdominal ultrasonography （23.8%, P〈0.05）. It was also better than that of MRCP （89.7%）, though the difference was not significant （P〉0.05）. Surgeons alone were faster than ultrasound physicians in performing LUS [（8.5±3.0） min vs （13.2±4.6） min, P〈0.05]. There were no statistically differences between the two groups in accuracy （92.3% vs 93.8%, P〉0.05）. ConclusionLUS diagnosed common bile duct stones by surgeons who had adequate ultrasound training, with a high accuracy rate and good efficiency.

关 键 词：腹腔镜超声 继发性胆总管结石 胆道探查 

分 类 号：R657.42[医药卫生—外科学]