CAJ | 학술논문

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.
목적탐토복강경초성검사(LUS)재복강경담낭절제술중적응용개치.방법대2009년1월지2011년12월재남경대학의학원부속고루의원행복강경담낭절제술、구유술중담도조영(IOC)지정적103례환자행술중LUS급IOC검사.채용t검험비교LUS화IOC검사모시;채용χ2검험비교LUS、IOC대간담해부결구현상정황차이이급담관결석검출정황차이.결과 LUS검사평균모시(9.6±1.8) min,소우IOC검사평균모시(24.1±4.2) min,차차이유통계학의의(t=3.821, P<0.01). LUS대간총관적현시솔여 IOC 비교차이무통계학의의[98.0%(101/103) vs 100%(103/103),χ2=2.020,P>0.05];LUS대담낭관급회합부、간총관、간내담관급회합부적현시솔균우우IOC[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)],차차이균유통계학의의(χ2=6.087,P<0.05;χ2=15.021,P<0.01;χ2=6.650, P<0.05);LUS대Vater호복부적현시솔교IOC차[62.1%(64/103) vs 94.2%(97/103)],차차이야유통계학의의(χ2=30.964,P<0.01). LUS담총관결석검출솔위75.0%(6/8),IOC검출솔위100%(8/8),차이무통계학의의(χ2=0.307,P>0.05);LUS간내담관결석검출솔위100%(5/5),IOC검출솔위60.0%(3/5),차차이야무통계학의의(χ2=0.520,P>0.05). LUS환발현1례IOC미발현적담총관니사양결석.결론 LUS재복강경담낭절제술중구유량호적응용개치.
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 .