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

腹腔镜胆囊切除术中术中超声与胆管造影：一项前瞻性比较研究

• 批准号: 07671373
• 负责人: SHIRAI Yoshio
• 金额: $ 1.28万
• 依托单位: Niigata University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 1995
• 资助国家: 日本
• 起止时间: 1995 至 1996
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-07671373/
• 关键词: Laparoscopic cholecystectomy; Intraoperative ultrasonography; Intraoperative cholangiography; Cholelithiasis; Biliary injury; Retained common bile duct stone; 胆道損傷; 術中超音波検査; 術中胆道造影

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.

背景：尽管腹腔镜胆囊切除术（LC）被认为是良性胆囊疾病的首选治疗方法，但它可能比开腹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。本研究旨在评价术中超声检查（IOUS）的有效性，以防止这些并发症与LC.METHODS。从1994年6月至1996年6月，100例连续患者接受LC胆石症，谁被列入本研究。每例患者在胆囊切除术前均进行IOUS和术中胆管造影（IOC）。比较IOUS和IOC对肝门部解剖结构的显示、对合并胆总管结石的显示以及检查时间。结果：IOUS和IOC的可行性分别为100%和75%。IOUS显示胆囊管汇合处占94%，中、上胆管汇合处占97%，下胆管汇合处占97%，乏特壶腹占51%，肝固有动脉占98%，肝右动脉占97%，胆囊动脉占46%，门静脉占100%。IOC分别描述如下：上或中胆管89%，下胆管100%，乏特壶腹94%。4例合并胆总管结石患者IOUS和IOC均检出胆管结石。IOUS检查时间明显缩短（P<0.0001）（9.7min）。而IOC组为24.4min。结论：IOUS在显示门静脉结构方面比IOC优越上级，在显示胆管结石方面与IOC相当。IOUS比IOC耗时更少，因此IOUS对于预防LC术中损伤或胆管结石残留是有用的。

项目成果

Yoshio Shirai: "Laparoscopic cholecystectomy may disseminate gallbladder carcinoma." Hepato-Gastroenterology. (in press). (1997)

白井义夫：“腹腔镜胆囊切除术可能会播散胆囊癌。”

Yoshio Shirai: "Tumor dissemination during laparoscopic cholecystectomy for gallbladder carcinoma." Surgical Endoscopy. (in press). (1997)

Yoshio Shirai：“胆囊癌腹腔镜胆囊切除术中的肿瘤播散。”

Shirai Y: "Is laparoscopic cholecystectomy recommended for large polypoid lesions of the gallbladder ?" Surgical Laparosocopy & Endoscopy. (in press). (1997)

Shirai Y：“对于胆囊较大的息肉样病变，是否建议进行腹腔镜胆囊切除术？”

Nobuhiro Fujita: "Junction of the cystic duct with the left hepatic duct : report of a case discovered during laparoscopic cholecystectomy." Surgical Laparoscopy & Endoscopy. 6. 445-447 (1996)

Nobuhiro Fujita：“胆囊管与左肝管的交界处：腹腔镜胆囊切除术中发现的病例报告。”

Yoshio Shirai: "Is laparoscopic cholecystectomy indicated for early gallbladder cancer?" Surgery. (in press). (1997)

白井义夫：“腹腔镜胆囊切除术适合早期胆囊癌吗？”