KOYAMA Syuntaro Niigata University School of Medicine, Department of Surgery, Medical Staff, 医学部・附属病院, 医員
OHTANI Tetsuya Niigata University School of Medicine, Department of Surgery, Medical Staff, 医学部・附属病院, 医員
TSUKADA Kazuhiro Niigata University School of Medicine, Department of Surgery, Assistant Professo, 医学部, 講師 (90171967)
|Budget Amount *help
¥2,000,000 (Direct Cost : ¥2,000,000)
Fiscal Year 1996 : ¥1,300,000 (Direct Cost : ¥1,300,000)
Fiscal Year 1995 : ¥700,000 (Direct Cost : ¥700,000)
BACKGROUND.Although laparoscopic cholecystectomy (LC) has been considered the treatment of choice for benign gallbladder diseases, it may result in injury of the bile duct (or other organs) or retained common bile duct stones more frequently than open cholecystectomy. This study was intended to evaluate the effectiveness of intraoperative ultrasonography (IOUS) for preventing these complications associated with LC.
METHODS.From June 1994 to June 1996,100 consecutive patients underwent LC for cholelithiasis, who were included in this study. Both IOUS and intraoperative cholangiography (IOC) were done prior to cholecystectomy in each patient. Detection of anatomical structures in the porta hepatis, detection of concomitant common duct stones, and duration of examination were compared between IOUS and IOC.The ultrasonographic apparatus used in this study was Aloka SSD 650 with linear scan probe (Aloka LC probe, 7.5Mhz). Student's t-test was used for data comparison.
RESULTS.IOUS and IOC were feasible in 100% and 75% of all cases, respectively. IOUS depicted each structure as follows : the confluence of the cystic duct in 94% of all cases, upper or middle bile duct in 97%, lower bile duct in 97%, ampulla of Vater in 51%, proper hepatic artery in 98%, right hepatic artery in 97%, cystic artery in 46%, and portal vein in 100%. IOC depicted each as follows : upper or middle bile duct in 89%, lower bile duct in 100%, and ampulla of Vater in 94%. Both IOUS and IOC detected duct stones in all of 4 patients with concomitant choledocholithiasis. The duration of examination was significantly shorter (P<0.0001) in IOUS (9.7min.) than in IOC (24.4min.).
CONCLUSIONS.IOUS is superior to IOC in depicting portal structures and is comparable to IOC in depicting bile duct stones. IOUS is less time-consuming than IOC.Thus, IOUS appears to be useful for preventing injuries or retained duct stones during LC.