摘要
目的研究腹腔镜胆囊切除术术前超声评估胆囊周围粘连的方法及临床价值。方法选择近期于本院接受腹腔镜胆囊切除术患者204例。采用手术与超声结果的双盲对照研究法对所有手术病理术前行多普勒超声检查,评定胆周粘连情况,并与术中结果进行对比分析。同时探讨胆囊壁增厚与胆周粘连的关系。结果根据胆囊与周围脏器的滑动状态,综合判断胆囊周围粘连发生率为73.5%(150/204)。其中7例(4.7%)经手术证实属误诊。另2例(3.7%)超声判定为无粘连的术中均见Calot’s三角区粘连,但超声图像表明胆囊与周围组织及结构有错位滑动存在。超声确定胆囊周围粘连敏感性为95.3%,特异性为96.3%。以胆囊壁增厚为标准判断胆周粘连敏感性、特异性分别为69.7%、64.4%。结论提前超声观察胆囊与周围脏器及组织间是否存在错位滑动有利于判断胆周粘连情况,为手术医师术前评估手术难度、制定合理的手术方案提供指导。
Objective To study the clinical value of ultrasonic in treatment of pericholecyst adhesion before laparo- scopic cholecystectomy. Methods A total of 204 cases of patients receiving laparoscopic cholecystectomy in our hospi- tal were selected. Taking surgery and ultrasonic double-blind comparison method for the results analysis. All the pa- tients receiving surgical pathology accepted preoperative doppler ultrasound examination to evaluate pericholecyst ad- hesion status and compared with the results of surgical results. Results According to the sliding state of gallbladder and the status with the surrounding organs, the pericholecyst adhesion rate was 73.5%（150/204）, of which 7 cases （4.7%） were misdiagnosis confirmed by surgery. The other 2 cases （3.7%）, ultrasonic determination saw no adhesion in Calot＇s triangle adhesion, but in ultrasound images showed the dislocation slip between gallbladder and the surrounding tissue. The sensitivity of ultrasonic determining in the pericholecyst adhesion was 95.3%, and specificity 96.3%. Based on the gallbladder wall incrassation, adhesion sensitivity and specificity were 69.7%, 64.4% respectively. Conclusion Gall- bladder ultrasound check in advance and determining whether there is a dislocation and sliding between adjacent or- gans and tissue slide is helpful to evaluate pericholecyst adhesion, which is also helpful for evaluating the surgery diffi- culty and doctors ＇preoperative assessment. It is also helpful for providing guidance for design reasonable operation schedule.
出处
《中国现代医生》
2014年第8期80-82,共3页
China Modern Doctor
基金
吴阶平医学基金会临床科研专项资助基金(320.6750.11008)
关键词
腹腔镜胆囊切除术
超声
胆囊周围粘连
Laparoscopic cholecystectomy
Ultrasound
Pericholecystic adhesion
