MRCP和腹部CT检查术前评估胆囊结石合并胆囊炎患者手术难度价值分析*

doi:10.3969/j.issn.1672-5069.2025.04.037

摘要/Abstract

摘要： 目的探讨磁共振胰胆管成像(MRCP)和腹部CT检测术前评估胆囊结石合并胆囊炎患者手术难度的价值。方法 2022年1月～2024年6月我院收治的胆囊结石合并胆囊炎患者102例,所有患者均接受腹腔镜胆囊切除术(LC)治疗,术前行MRCP和腹部CT检查。参考LC手术难度评分与分级标准评估手术难度,根据影像学检查胆囊动脉和胆囊管走形和显示清晰度进行评分。结果在102例胆囊结石合并胆囊炎患者中,胆囊动脉走形为Ⅰa型81例,Ⅰb型9例,Ⅱa型5例和Ⅱb型7例。胆囊动脉走形正常81例(79.4%),走形变异21例(20.6%);胆囊管走形正常85例(83.3%),走形变异17例(16.7%);24例术前评估手术困难组胆囊动脉显示评分和胆囊管显示评分分别为(1.3±0.3)分和(1.4±0.3)分,均显著低于78例手术简单组【分别为(1.6±0.3)分和(1.7±0.3)分,P＜0.05】,而胆囊壁厚度、胆囊容积和结石直径分别为(10.1±2.3)mm、(53.2±8.3)mm³和(18.2±3.3)mm,均显著大于简单组【分别为(7.5±2.1)mm、(46.4±7.1)mm³和(14.4±5.1)mm,P＜0.05】。结论使用MRCP和腹部CT检查可以清晰地显示胆囊结石合并胆囊炎患者胆囊动脉和胆囊管走形及其与周围组织的解剖结构关系,对帮助评估手术难度具有较高的应用价值。

关键词: 胆囊结石, 胆囊炎, 磁共振胰胆管成像, 腹部CT, 术前评估

Abstract: Objective The aim of this study was to investigate magnetic resonance cholangiopancreatography (MRCP) and abdominal CT scan in preoperative evaluation of surgical difficulty in patients with gallstones and cholecystitis. Methods A total of consecutive 102 patients with gallstones and cholecystitis were encountered in our hospital between January 2022 and June 2024, and all underwent laparoscopic cholecystectomy (LC). Prior to operation, all patients received MRCP and abdominal CT scan. Operation difficulty was evaluated according to literature report, and readability of cystic arteries and cystic ducts were assessed based on imaging. Results Of the 102 patients with gallstones and cholecystitis, the imaging showed types of cystic arteries weretypeⅠa in 81 cases, type Ⅰb in 9 cases, type Ⅱa in 5 cases and type Ⅱb in 7 cases, with normal shape in 81 cases (79.4%), and abnormal in 21 cases (20.6%); the imaging also showed normal cystic duct shape in 85 cases (83.3%) and abnormal in 17 cases (16.7%);the scores of gallbladder artery display and gallbladder duct display in24 patients with surgical difficulty as assessed pre-operationally were (1.3±0.3) points and (1.4±0.3)points, both significantly lower than [(1.6±0.3) points and (1.7±0.3)points, respectively, P＜0.05] in 78 patients with operation easily, while the gallbladder wall thickness, gallbladder volume and stone diameter were (10.1±2.3)mm, (53.2±8.3)mm³ and (18.2±3.3)mm, all significantly greater than [(7.5±2.1)mm, (46.4±7.1)mm³ and (14.4±5.1)mm, respectively, P＜0.05] in easy operation group. Conclusion MRCP and abdominal CT scan could clearly display anatomic structure around gallbladder artery and cystic duct, which might help evaluate pre-operationally LCdifficulty in patients with gallstones and cholecystitis.

Key words: Gallstone, Cholecystitis, Magnetic resonance cholangiopancreatography, Abdominal CT scan, Preoperative evaluation

景超, 张宏娟, 张力. MRCP和腹部CT检查术前评估胆囊结石合并胆囊炎患者手术难度价值分析^*[J]. 实用肝脏病杂志, 2025, 28(4): 625-628.

Jing Chao, Zhang Hongjuan, Zhang Li. Magnetic resonance cholangiopancreatography and abdominal CT scan in preoperative evaluation of surgical difficulty in patients with gallstones and cholecystitis[J]. Journal of Practical Hepatology, 2025, 28(4): 625-628.

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MRCP和腹部CT检查术前评估胆囊结石合并胆囊炎患者手术难度价值分析^*

Magnetic resonance cholangiopancreatography and abdominal CT scan in preoperative evaluation of surgical difficulty in patients with gallstones and cholecystitis

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