中国普通外科杂志 ›› 2011, Vol. 20 ›› Issue (2): 143-145.

• 胆石微创治疗专题研究 • 上一篇    下一篇

急性胆囊炎术前超声征象与腹腔镜胆囊切除术转开腹的关系

于爱军1|赵洪涛1|赵鲁文2|史华宁3|张学军1|刘金龙1   

  1. (承德医学院附属医院 1.普外一科2.妇科3.超声科|河北 承德 067000)
  • 收稿日期:2010-10-08 修回日期:2011-01-09 出版日期:2011-02-15 发布日期:2011-02-15
  • 通讯作者: 于爱军 E-mail:ccw1979@126.com
  • 作者简介:于爱军|承德医学院附属医院主治医师|主要从事微创外科方面的研究。

Relationship between ultrasonic features of acute cholecystitis and conversion from laparoscopic to open cholecystectomy

YU Aijun1|ZHAO Hongtao1, ZHAO Luwen2|SHI Huaning3|ZHANG Xuejun1|LIU Jinlong1   

  1. (1.the First Department of General Surgery 2.Department of Gynaecology 3. Department of Ultrasound, the Affiliated Hospital, Chengde Medical College, Chengde, Hebei 067000, China)
  • Received:2010-10-08 Revised:2011-01-09 Online:2011-02-15 Published:2011-02-15

摘要:

目的:探讨急性胆囊炎术前腹部超声检查征象与腹腔镜胆囊切除术(laparoscopic cholecystectomy, LC)中转开腹的关系。
方法:对226例急性胆囊炎LC患者术前行腹部超声检查,记录胆囊容积,胆囊壁厚度,胆囊窝有无积液,胆囊颈管是否有结石嵌顿,胆囊与周围粘连,胆囊三角粘连情况。分析超声显像与LC转开腹的关系。
结果:208例成功完成LC,18例中转开腹。单因素分析显示超声检查胆囊容积增大,胆囊壁增厚,胆囊颈管结石嵌顿,胆囊颈粘连是中转开腹的危险因素(P<0.05)。多因素回归分析显示胆囊壁增厚和胆囊颈粘连是影响腹腔镜中转开腹率的独立危险因素。
结论:术前超声检查预测急性胆囊炎LC转开腹简便易行,对急性胆囊炎行腹腔镜手术适应证的选择有重要指导意义。

关键词: 胆囊炎, 急性; 胆囊切除术, 腹腔镜; 超声检查; 中转开腹

Abstract:

Objective:To explore the relationship between preopertive abdominal ultrasonic features of acute cholecystitis and conversion from laparoscopic to open cholecystectomy.
Methods:A total of 226 patients with acute cholecystitis received ultrasonic examination before LC. The parameters  measured pre-operatively included the gallbladder volume, cholecystic wall thickness, gallbladder fossa fluid, stone impaction in gallbladder neck, adhesions of gallbladder to arourd tissue or adhensions of Calot′s triangle. The relationship between the imaging results and conversion to laparotomy in LC were analyzed.
Results:LC was successfully performed in 208 patients, but 18 were converted to open surgery. Univariate analysis showed that enlarged gallbladder, cholecystic wall thickness, stone impaction in gallbladder neck and adhesions of Calot′s triangle were significantly correlated with the conversion to open cholecystectomy (P<0.05). Multivariate analysis showed that cholecystic wall thickness and adhesion of Calot′s triangle were independent risk factors for conversion from laparoscopic cholecystectomy to open surgery.
Conclusions:Preoperative ultrasonography for predicting conversion from laparoscopic to open cholecystectomy in acute cholecystitis is simple, and has  important significance for selection of laparoscopic operation in acute cholecystitis.

Key words: Cholecystitis, Acute, Cholecystectomy, Laparoscopic, Ultrasonography, Conversion to Laparotomy

中图分类号: 

  • R 657.4

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