术前多层螺旋CT检查胆囊结石合并胆囊炎患者对术式选择的指导意义分析*

doi:10.3969/j.issn.1672-5069.2024.03.037

摘要/Abstract

摘要： 目的探讨术前多层螺旋CT(MSCT)检查对指导胆囊结石合并胆囊炎(GCS)患者术式选择的价值。方法 2021年4月～2023年4月我院收治的GCS患者104例,术前所有患者均接受MSCT检查,根据胆囊动脉和胆囊管显示情况选择开腹胆囊切除术或腹腔镜胆囊切除术(LC)。结果 104例GCS患者胆囊管显示率和显示评分分别为90.4%和(1.5±0.2)分,其中11例走行变异,包括2例低位胆囊管、3例右迷走胆管形成和6例高位胆囊管,胆囊动脉显示率和显示评分分别为94.2%和(1.8±0.2)分,其中13例走行变异,包括4例Ⅰb型、2例Ⅱa型和7例Ⅱb型;16例无法明确胆囊三角区患者接受开腹胆囊切除术,对其余88例患者均行LC术,结果LC组术中出血量、手术时间和住院日分别为(36.4±7.8)mL、(46.7±8.3)min和(6.3±1.1)d,显著少于或短于开腹胆囊切除术组【分别为(50.6±8.4)mL、(73.5±9.6)min和(8.9±1.5)d,P＜0.05】;LC组术后切口感染、胆道出血和胆漏等并发症发生率为8.0%,显著低于开腹胆囊切除术组的25.0%(P＜0.05)。结论术前MSCT检查能显示GCS患者胆囊三角情况,指导术式选择,能更精准地采用适当的手术方式。

关键词: 胆囊结石, 胆囊炎, 多层螺旋CT, 胆囊切除术, 诊断

Abstract: Objective This study was conducted to explore application of preoperative multi-slice spiral CT (MSCT) scan for selection of surgical Methods in patients with gallstones and cholecystitis (GCS). Methods A total of 104 patients with GCS were enrolled in our hospital between April 2021 and April 2023, and all patients underwent MSCT examination to observe display of gallbladder artery and gallbladder ducts. Base on the imaging manifestations, open or laparoscopic cholecystectomy (LC) were performed. Results Of the 104 patients with GCS, display rate and display score of gallbladder ducts were 90.4% and (1.5±0.2) points, with duct course variation in 11 cases, including low-level gallbladder ducts in 2 cases, right vagus duct formation in 3 cases and high-level gallbladder ducts in 6 cases, and the display rate and display score of gallbladder artery were 94.2% and (1.8±0.2) points, with vessel course variation in 13 cases, including type Ib in 4 cases, type IIa in 2 cases and type IIb in 7 cases; open cholecystectomy was conducted in 16 patients because of gallbladder trigonum undefined pre-operationally, and LC was performed in left 88 patients; intraoperative blood loss, operation time and hospital stay in LC-treated patients were (36.4±7.8)mL, (46.7±8.3)min and (6.3±1.1)d, all much less or shorter than [(50.6±8.4)mL, (73.5±9.6)min and (8.9±1.5)d, respectively, P＜0.05] in open operation-treated patients; incidence of post-operational complications, such as infection, bleeding and bile leakage in LC group was 8.0%, significantly lower than 25.0% (P＜0.05) in open surgery group. Conclusion The preoperative MSCT scan could clearly display gallbladder ducts and gallbladder artery in patients with GCS, which might help precisely select operation mode and get a best outcomes.

Key words: Gallstone, Cholecystitis, Multi-slice spiral CT scan, Cholecystectomy, Diagnosis

陈爱娥, 彭向前, 陈利娜. 术前多层螺旋CT检查胆囊结石合并胆囊炎患者对术式选择的指导意义分析^*[J]. 实用肝脏病杂志, 2024, 27(3): 466-469.

Chen Ai’e, Peng Xiangqian, Chen Lina. Choice of open orlaparoscopic cholecystectomy under guidance of preoperative multi-slice spiral CT scan in patients with gallstones and cholecystitis[J]. Journal of Practical Hepatology, 2024, 27(3): 466-469.

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术前多层螺旋CT检查胆囊结石合并胆囊炎患者对术式选择的指导意义分析^*

Choice of open orlaparoscopic cholecystectomy under guidance of preoperative multi-slice spiral CT scan in patients with gallstones and cholecystitis

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