腹腔镜超声检查在腹腔镜胆囊切除术中的应用价值

摘要

Objective To investigate the application value of laparoscopic ultrasonography (LUS) in laparoscopic cholecystectomy(LC).Methods The 103 patients who underwent the LC from January 2009 to December 2011 in our hospital with the indication of intraoperative cholangiography (IOC) underwent LUS and IOC.Student t test was used to compare the difference of examination duration between LUS and IOC . Chi-square test was used to compare the difference of the demonstration and the detection of the bile duct stones between LUS and IOC.Results The examination duration of LUS was significantly shorter than that of IOC [(9.6 ±1.8)min vs (24.1 ±4.2)min,t=3.821,P<0.01].The difference of display rate of common hepatic duct between LUS and IOC was no statistically significant [98.0%(101/103) vs 100%(103/103),χ2 =2.020,P>0.05].The demonstration of the cystic duct ,common hepatic duct and intrahepatic bile duct in LUS were significantly superior to those in IOC [96.1%(99/103) vs 86.4%(89/103),χ2 =6.087, P<0.05;100%(103/103) vs 86.4%(89/103),χ2 =15.021,P<0.01;98.0%(101/103) vs 89.3%(92/103),χ2 =6.650,P<0.05].There was a significant difference in the display of the Ampulla Vater in LUS and IOC[62.1%(64/103) vs 94.2%(97/103),χ2 =30.964,P <0.01].The detection rate of common bile duct stones in LUS and IOC was 75.0%(6/8) and 100%(8/8), respectively, with no significant difference(χ2 =0.307,P>0.05).In addition,the detection rate of intrahepatic bile duct stones in LUS and IOC was 100%(5/5) and 60.0%(3/5) respectively, and there was no significant difference (χ2 =0.520,P>0.05).Additionally,LUS also found one case of sand-like stones in common bile without found in IOC.Conclusion LUS has excellent application value in the LC .%　　目的探讨腹腔镜超声检查(LUS)在腹腔镜胆囊切除术中的应用价值.方法对2009年1月至2011年12月在南京大学医学院附属鼓楼医院行腹腔镜胆囊切除术、具有术中胆道造影(IOC)指征的103例患者行术中LUS及IOC检查.采用t检验比较LUS和IOC检查耗时；采用χ2检验比较LUS、IOC对肝胆解剖结构显像情况差异以及胆管结石检出情况差异.结果 LUS检查平均耗时(9.6±1.8) min,少于IOC检查平均耗时(24.1±4.2) min,且差异有统计学意义(t=3.821, P<0.01). LUS对肝总管的显示率与 IOC 比较差异无统计学意义[98.0%(101/103) vs 100%(103/103),χ2=2.020,P>0.05]；LUS对胆囊管及汇合部、肝总管、肝内胆管及汇合部的显示率均优于IOC[96.1%(99/103) vs 86.4%(89/103),100%(103/103) vs 86.4%(89/103),98.0%(101/103) vs 89.3%(92/103)],且差异均有统计学意义(χ2=6.087,P<0.05；χ2=15.021,P<0.01；χ2=6.650, P<0.05)；LUS对Vater壶腹部的显示率较IOC差[62.1%(64/103) vs 94.2%(97/103)],且差异也有统计学意义(χ2=30.964,P<0.01). LUS胆总管结石检出率为75.0%(6/8),IOC检出率为100%(8/8),差异无统计学意义(χ2=0.307,P>0.05)；LUS肝内胆管结石检出率为100%(5/5),IOC检出率为60.0%(3/5),且差异也无统计学意义(χ2=0.520,P>0.05). LUS还发现1例IOC未发现的胆总管泥沙样结石.结论 LUS在腹腔镜胆囊切除术中具有良好的应用价值.