目的 探讨腹腔镜下胆囊切除术前难度预测的方法及价值.方法 回顾性分析我院56例腹腔镜胆囊切除术患者的临床资料,该组患者术前均经超声检查,确定手术的难易程度的标准,按照标准分为容易组16例,困难组40例,并与实际术中情况进行比较.结果 56例患者手术成功者52例,中转开腹4例.术中确定困难组40例,占71.4％与术前的75.0％差异无统计学意义(P＞0.05).患者的年龄、体重指数、腹部手术史、发病次数≥2次及病程≥6个月与患者的手术难易程度有相关性(P＜0.05).胆囊壁增厚、胆囊颈部结石嵌顿、胆囊充满型结石是术中困难的主要构成因素.结论 超声检查对腹腔镜胆囊切除术前手术难易程度的判定具有预测价值,同时还要结合年龄、体重指数、腹部手术史、发病次数及病程长短等因素综合考虑.%Objective To explore the methods and values of preoperative prediction of degree of difficulty in laparoscopic cholecystectomy.Methods The data on 56 patients undergoing laparoscopic cholecystectomy were retrospectively analyzed.All the patients received ultrasonography preoperatively.The criteria for degree of difficulty of the procedure were determined.According to the criteria,the patients were divided into easy procedure group ( 16 patients ) and difficult procedure group ( 40 patients ).The predicted results were compared with the actual results.Results The procedure was successfully performed on 52 of the 56 patients,and the rest 4 had to undergo laparotomy.The procedure was determined as difficulty in 40 patients intraoperatively,which had no significant differences with preoperative prediction ( P ＞ 0.05 ).Age,body mass index,history of abdominal surgery,and amount of onset were related to degree of surgical difficulty ( P＜ 0.05 ).Gallbladder wall thickening,stone stuck in the gallbladder neck,and gallbladder with stones type were the major factors for the difficulty in the procedure.Conclusions Ultrasonic examination has a predictive value of degree of difficulty in laparoscopic cholecystectomy but should combine with age,body mass index,history of abdominal surgery,amount of onset,and length of disease course.
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