Intraoperative ultrasonography vs.cholangiography during laparoscopic cholecystectomy : a prospective comparative study

背景。虽然腹腔镜胆囊切除术（LC）已被认为是良性胆囊疾病的首选治疗方法，但与开放式胆囊切除术相比，腹腔镜胆囊切除术更容易导致胆管（或其他器官）损伤或胆总管结石残留。方法：1994年6月至1996年6月，连续100例胆石症患者行胆石造影。每个患者在胆囊切除术前都进行了欠条和术中胆道造影（IOC）。比较iou与IOC对肝门解剖结构的检测、伴发总管结石的检测及检查时间。本研究使用的超声设备为Aloka SSD 650，线性扫描探头（Aloka LC探头，7.5Mhz）。结果：在所有病例中，ious和IOC的可行性分别为100%和75%。白条对每种结构的描述如下：94%的病例为胆囊管汇合处，97%为上胆管或中胆管汇合处，97%为下胆管汇合处，51%为水腹，98%为肝固有动脉，97%为肝右动脉，46%为胆囊动脉，100%为门静脉汇合处。IOC描述如下：上胆管或中胆管占89%，下胆管占100%，壶腹占94%。4例合并胆管结石患者，iou和IOC均检出胆管结石。iou组检查时间（9.7min）明显短于IOC组（24.4min） （P<0.0001）。IOUS在描绘门静脉结构方面优于IOC，在描绘胆管结石方面与IOC相当。欠条比IOC更省时。因此，在LC期间，白条似乎对防止损伤或保留导管结石有用。

BACKGROUND.Although laparoscopic cholecystectomy (LC) has been considered the treatment of choice for benign gallbladder diseases, it may result in injury of the bile duct (or other organs) or retained common bile duct stones more frequently than open cholecystectomy. This study was intended to evaluate the effectiveness of intraoperative ultrasonography (IOUS) for preventing these complications associated with LC.METHODS.From June 1994 to June 1996,100 consecutive patients underwent LC for cholelithiasis, who were included in this study. Both IOUS and intraoperative cholangiography (IOC) were done prior to cholecystectomy in each patient. Detection of anatomical structures in the porta hepatis, detection of concomitant common duct stones, and duration of examination were compared between IOUS and IOC.The ultrasonographic apparatus used in this study was Aloka SSD 650 with linear scan probe (Aloka LC probe, 7.5Mhz). Student's t-test was used for data comparison.RESULTS.IOUS and IOC were feasible in 100% and 75% of all cases, respectively. IOUS depicted each structure as follows : the confluence of the cystic duct in 94% of all cases, upper or middle bile duct in 97%, lower bile duct in 97%, ampulla of Vater in 51%, proper hepatic artery in 98%, right hepatic artery in 97%, cystic artery in 46%, and portal vein in 100%. IOC depicted each as follows : upper or middle bile duct in 89%, lower bile duct in 100%, and ampulla of Vater in 94%. Both IOUS and IOC detected duct stones in all of 4 patients with concomitant choledocholithiasis. The duration of examination was significantly shorter (P<0.0001) in IOUS (9.7min.) than in IOC (24.4min.).CONCLUSIONS.IOUS is superior to IOC in depicting portal structures and is comparable to IOC in depicting bile duct stones. IOUS is less time-consuming than IOC.Thus, IOUS appears to be useful for preventing injuries or retained duct stones during LC.