Röthlin M, Schlumpf R, Klotz H P, Largiadèr F
Department Chirurgie, Universitätsspital, Zürich.
Chirurg. 1993 May;64(5):387-91.
The aim of this prospective study was the comparison of laparoscopic sonography with intraoperative cholangiography (IOC) during laparoscopic cholecystectomy. A 360 degree-sector scanner with a frequency of 5.5 MHz was used. The examination was successful in all 69 patients entered into the study. In the beginning 19 patients were examined sonographically without subsequent IOC. None of these patients had bile duct stones and their postoperative history was uneventful. In the 50 patients operated on subsequently both laparoscopic sonography and IOC were tried. IOC was not performed due to technical failure in 4 patients and due to allergic reactions to contrast media in one patient. Thirty-one patients demonstrated normal bile ducts without stones in both examinations. Ten patients had dilated ducts without stones. In three cases a stone was seen on IOC and intraoperative sonography. In one case a duodenal diverticulum containing debris, demonstrated by IOC, was the reason for a false positive sonographic finding. Sensitivity and specificity of laparoscopic sonography concerning the visualisation of bile duct stones were 100 and 98%, respectively. The time necessary for the examination was significantly shorter in laparoscopic sonography than in intraoperative cholangiography (p = 0.0001). If these results can be reproduced in a larger population of patients, laparoscopic sonography can be considered a safe, fast and non-invasive alternative to intraoperative cholangiography.
这项前瞻性研究的目的是比较腹腔镜胆囊切除术期间腹腔镜超声检查与术中胆管造影（IOC）。使用了一台频率为5.5MHz的360度扇形扫描仪。纳入研究的69例患者的检查均获成功。开始时，对19例患者进行了超声检查，之后未进行术中胆管造影。这些患者均无胆管结石，术后病程顺利。随后对50例患者同时进行了腹腔镜超声检查和术中胆管造影。4例患者因技术故障、1例患者因对造影剂过敏而未进行术中胆管造影。31例患者在两项检查中均显示胆管正常且无结石。10例患者胆管扩张但无结石。3例患者在术中胆管造影和腹腔镜超声检查中均发现结石。1例患者术中胆管造影显示十二指肠憩室有碎片，这是超声检查假阳性的原因。腹腔镜超声检查对胆管结石可视化的敏感性和特异性分别为100%和98%。腹腔镜超声检查所需时间明显短于术中胆管造影（p = 0.0001）。如果这些结果能在更多患者中得到验证，那么腹腔镜超声检查可被视为术中胆管造影的一种安全、快速且无创的替代方法。
