术前超声在预测困难的腹腔镜胆囊切除术中的价值

doi:10.3969/j.issn.1000-8535.2022.03.022

摘要/Abstract

摘要： 目的探讨术前超声有关指标在预测腹腔镜胆囊切除术(LC)难易度中的价值,以预判LC手术的风险,减少手术的盲目性。方法 257例术前获得的超声参数包括:胆囊大小、胆囊壁厚度、胆囊黏膜面情况、胆囊内胆汁透声情况、胆囊结石最大直径、胆囊颈部结石嵌顿情况。术后资料包括手术时间、术中出血量、是否放置引流管、是否中转进腹手术、术后并发症。计算257例手术的平均时间并将其称为标准手术时间,将超过标准手术时间的、术中出血≥100 mL、术后放置引流管、中转开腹的手术定义为有难度手术。以此标准将257例手术患者分为容易组和困难组,应用χ²检验进行单因素分析,LC手术困难的危险因素;再对这些指标进行Logistic多元回归分析,确定预测LC难易的独立危险因素。结果单因素分析,术前超声指标:胆囊大小>50 cm²、胆囊壁厚度>4 mm、胆囊结石最大直径>2 cm、胆囊颈部结石嵌顿、胆囊内胆汁透声差,是LC难度的危险因素。Logistic多元回归分析证实,胆囊大小、胆囊壁厚度、胆囊内胆汁透声差、胆囊颈部结石嵌顿等4项超声检测指标是困难LC的独立危险因素。结论手术前胆囊超声检查可以客观评估LC难度,对指导术者选择LC病例具有一定的预测价值。

关键词: 腹腔镜胆囊切除术, 难度, 超声检查指标, 预测

Abstract: Objective To explore the value of preoperative ultrasound indicators in predicting the difficulty of laparoscopic cholecystectomy (LC), in order to predict the risk of LC surgery and reduce the blindness of surgery. Methods The preoperative ultrasonographic parameters of 257 cases included gallbladder size, gallbladder wall thickness, gallbladder mucosal surface, bile sound transmission in gallbladder, maximum diameter of gallstone, and gallstone incarceration in gallbladder neck. Postoperative data included operation time, intraoperative blood loss, whether drainage tube was placed, whether transfer to abdominal surgery, and postoperative complications. The average operation time of the 257 cases was calculated and called the standard operation time, and the operation that exceeded the standard operation time, intraoperative bleeding ≥100 mL, postoperative drainage tube placing, and conversion of abdominal operation were defined as difficult operation. According to this standard, 257 patients were divided into the easy group and the difficult group. The χ² test was used for univariate analysis to identify the risk factors of difficult LC operation. Logistic multiple regression analysis was performed to determine the independent risk factors for predicting LC difficulty. Results According to unifactor analysis, preoperative ultrasound indicators: gallbladder size >50 cm², gallbladder wall thickness >4 mm, maximum diameter of gallstone >2 cm, gallbladder neck stone incarceration, and poor bile ultrasound transmission in gallbladder were risk factors for LC difficulty. Logistic multiple regression analysis confirmed that gallbladder size, gallbladder wall thickness, poor bile ultrasound transmission in gallbladder and stone incarceration in gallbladder neck were independent risk factors for difficult LC. Conclusions Ultrasound examination of gallbladder before operation could objectively evaluate the difficulty of LC, and had certain predictive value for guiding the surgeon to select LC cases.

Key words: laparoscopic cholecystectomy, difficulty, ultrasound examination index, predicting

叶学忠, 程小菊, 邾磊, 周觅. 术前超声在预测困难的腹腔镜胆囊切除术中的价值[J]. 广州医药, 2022, 53(3): 95-99.

YE Xuezhong, CHENG Xiaoju, ZHU Lei, ZHOU Mi. The value of preoperative ultrasound in predicting difficult laparoscopic cholecystectomy[J]. Guangzhou Medical Journal, 2022, 53(3): 95-99.

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