Ohtani T, Kawai C, Shirai Y, Kawakami K, Yoshida K, Hatakeyama K
Department of Surgery, Niigata University School of Medicine, Japan.
J Am Coll Surg. 1997 Sep;185(3):274-82. doi: 10.1016/s1072-7515(97)00030-6.
The purpose of this study was to compare the functional utility of intraoperative ultrasonography (IOUS) and cholangiography (IOC) during a laparoscopic cholecystectomy for the treatment of gallstone disease.
A prospective study comparing IOUS and IOC was carried out in 65 patients. Intraoperative ultrasonography was conducted first using a 7.5-MHz linear array probe. After IOUS, IOC was then conducted in all patients. The respective usefulness of IOUS and IOC in the identification of gallstones, detection of hepatobiliary structures, and demonstration of congenital anomalies was then compared.
Intraoperative ultrasonography was successful in all 65 patients, and IOC was successful only in 54. The time required for IOUS was significantly shorter (p < 0.0001) than for IOC. Intraoperative ultrasonography imaged the hepatic ducts and their confluence, the common hepatic duct, the common bile duct, and the ampulla of Vater in 97, 100, 97, and 51% of cases, respectively. Intraoperative cholangiography, on the other hand, depicted these structures in 85, 89, 100, and 94% of cases, respectively. Intraoperative ultrasonography demonstrated the cystic duct and its confluence in 94% of cases. Biliary anomalies were identified by IOUS in 12 patients and by IOC in 13. Intraoperative ultrasonography could detect the hilar vascular structures in most patients and visualized anomalies of the hepatic arteries in 5 patients. In this series, 5 patients had choledocholithiasis. The sensitivities, specificities, positive and negative predictive values, and accuracies in identifying these bile duct stones were 80, 98, 80, 98, and 97% by IOUS, and 80, 97, 67, 98, and 95% by IOC, respectively.
Intraoperative ultrasonography is superior to cholangiography with respect to its safety, shorter examination period, and ease of administration in all patients. In addition, IOUS is also better for identifying subtle anatomic detail. Intraoperative ultrasonography compares favorably with IOC in terms of utility in exploring bile ducts for stones. Intraoperative ultrasonography is an effective procedure for biliary exploration during a laparoscopic cholecystectomy.
本研究的目的是比较术中超声检查（IOUS）和术中胆管造影（IOC）在腹腔镜胆囊切除术治疗胆结石疾病中的功能效用。
对65例患者进行了一项比较IOUS和IOC的前瞻性研究。首先使用7.5MHz线性阵列探头进行术中超声检查。在IOUS检查后，对所有患者进行IOC检查。然后比较IOUS和IOC在识别胆结石、检测肝胆结构以及显示先天性异常方面各自的效用。
65例患者术中超声检查均成功，而IOC仅在54例患者中成功。IOUS所需时间明显短于IOC（p<0.0001）。术中超声检查分别在97%、100%、97%和51%的病例中显示了肝管及其汇合处、肝总管、胆总管和十二指肠乳头。另一方面，术中胆管造影分别在85%、89%和100%、94%的病例中显示了这些结构。术中超声检查在94%的病例中显示了胆囊管及其汇合处。IOUS在12例患者中发现了胆道异常，IOC在13例患者中发现了胆道异常。术中超声检查能在大多数患者中检测到肝门血管结构，5例患者中显示了肝动脉异常。在本系列中，5例患者患有胆总管结石。IOUS识别这些胆管结石的敏感性、特异性、阳性和阴性预测值以及准确性分别为80%、98%、80%、98%和97%，IOC分别为80%、97%、67%、98%和95%。
术中超声检查在安全性、检查时间短和对所有患者易于实施方面优于胆管造影。此外，IOUS在识别细微解剖细节方面也更好。术中超声检查在探查胆管结石的效用方面与IOC相当。术中超声检查是腹腔镜胆囊切除术中胆道探查的有效方法。
