Cardone G, Di Girolamo M, Lomanto D, Pavone P, Carlei F, Nardovino M, Paganini A, Messina A, Lezoche E, Speranza V
Reparto di Radiologia, Ospedali Riuniti di Livorno.
Radiol Med. 1994 Sep;88(3):233-7.
On the basis of recent technological improvements, the laparoscopic approach has become the method of choice during cholecystectomy. This surgical procedure, however, needs that cholangiography be performed simultaneously to better define the anatomy of the biliary ducts and the possible presence of choledochus stones. The use of intraoperative US during cholecystectomy is nowadays advocated for the unquestionable advantages offered by this technique--i.e., its non-invasiveness, high spatial resolution and no need of contrast agent administration. In this study, we examined 30 patients with cholelithiasis who underwent laparoscopic cholecystectomy and were submitted to endolaparoscopic US besides routine intraoperative cholangiography. In all cases, both techniques allowed optimal visualization of the biliary tree, clearly demonstrating choledochus stones in 2 cases. Intraoperative US proved to be more accurate in two cases. In one case which was positive at intraoperative cholangiography, the method allowed the biliary duct filling defect to be referred to an artifact caused by the presence of an air bubble. In another case, the lack of opacification of the hepatic ducts at cholangiography was referred, after US, to extrinsic gallbladder compression. US also allowed the adjacent parenchymal organs, such as the liver and the head of pancreas, to be studied. A limitation of this technique was represented by the difficult assessment of the choledochus in the patients with anatomical abnormalities or adhesions of the intestinal loops of the upper abdomen. In conclusion, endolaparoscopic US proved to be a reliable technique in the intraoperative study of the biliary ducts and can be considered as a procedure complementary to intraoperative cholangiography.
基于近期的技术改进，腹腔镜手术已成为胆囊切除术的首选方法。然而，该手术需要同时进行胆管造影，以更好地明确胆管的解剖结构以及胆总管结石的可能存在情况。如今，在胆囊切除术中提倡使用术中超声，因为该技术具有诸多明显优势，即无创性、高空间分辨率且无需注射造影剂。在本研究中，我们检查了30例接受腹腔镜胆囊切除术的胆石症患者，除了常规术中胆管造影外，还对其进行了腹腔镜内超声检查。在所有病例中，两种技术均能实现胆管树的最佳可视化，其中2例清晰显示出胆总管结石。术中超声在2例中显示更为准确。在1例术中胆管造影呈阳性的病例中，该方法能够将胆管充盈缺损归因于气泡存在所致的假象。在另一例中，胆管造影时肝管不显影，经超声检查后发现是胆囊外部压迫所致。超声还能够对相邻的实质器官，如肝脏和胰头进行检查。该技术的一个局限性在于，对于存在解剖结构异常或上腹部肠袢粘连的患者，胆总管的评估较为困难。总之，腹腔镜内超声在术中胆管研究中被证明是一种可靠的技术，可被视为术中胆管造影的补充检查方法。
