超声和CT术前预测困难型腹腔镜胆囊切除术的价值

摘要

Objective To explore the value of ultrasonography and CT in preoperatively predicting difficult laparoscopic cholecystectomy.Methods Imaging data of 154 patients who underwent laparoscopic cholecystectomy from January 2009 to February 2013,including 78 cases undergoing ultrasonography (US group) and 76 cases taking CT examination (CT group) before operation,were retrospectively analyzed.The ability of US and CT in preoperatively predicting difficult laparoscopic cholecystectomy was compared and the causes of difficult laparoscopic cholecystectomy were analyzed.Results The sensitivity,specificity and accuracy of US and CT in predicting difficult laparoscopic cholecystectomy were 94.9％ (56/59),100.0％ (19/19),96.2％ (75/78),and 82.0％ (50/61),100.0％ (15/15),85.5％ (65/76);the sensitivity and accuracy of US were significantly higher than those of CT group (P ＜ 0.05).The main cause of difficult laparoscopic cholecystectomy was cholecystolithiasis incarceration in gallbladder neck complicated with acute cholecystitis [46.4％ (26/56)] in US group,the main causes of difficult laparoscopic cholecysteting in CT group was turgid type of cholecystolithiasis [48.0％ (24/50)].Conclusion The sensitivity and accuracy of US are higher than those of CT in preoperatively predicting difficult laparoscopic cholecystectomy.%目的 探讨超声和CT检查术前预测困难型腹腔镜胆囊切除术的价值.方法 回顾性分析2009年1月至2013年2月四川省南江县中医医院154例住院择期行腹腔镜胆囊切除术患者的影像学资料,其中78例于术前行超声检查(超声组),76例术前行CT检查(CT组);比较2种方法术前预测困难型腹腔镜胆囊切除术的效能,分析困难型腹腔镜胆囊切除术的病因.结果 超声术前预测困难型腹腔镜胆囊切除术的敏感度、特异度、准确率分别为94.9％(56/59)、100.0％(19/19)和96.2％(75/78),CT分别为82.0％(50/61)、100.0％(15/15)和85.5％(65/76),超声组敏感度和准确率明显高于CT组,差异有统计学意义(P＜0.05).超声组病因主要为胆囊颈部结石嵌顿合并急性胆囊炎[46.4％ (26/56)],CT组病因主要为充满型胆囊结石[48.0％(24/50)].结论 超声检查术前预测困难型腹腔镜胆囊切除术的敏感度及准确率高于CT检查.