| Laparoscopic cholecystectomy (LC) has been accepted as a new "gold standard" of the treatment for benign lesions of the gallbladder. Some drawbacks inherent to the procedure, however, lead to problems not solved yet: â‘ more unpredicted common bile duct (CBD) residual calculi after LC; â‘¡ higher morbidity of bile duct injury (BDI); â‘¢ more than half of BDI had not been recognized at original LC. Laparoscopic intraoperative cholangiography (LIOC) has been proposed as an effective means for insurance and qualitye of LC. Nevertheless, for the time being, a number of flaws coupling with LIOC have not been solved.Laparoscopic ultrasonography(LUS)provides an alternative solution for problems carried by LC and LIOC. Nevertheless, in a limited space under laparoscope, some sonic windows on some aspects cannot be utilized. LUS may not be simply regarded as a "laparoscopic edition" of traditional intraoperative ultrasonography. Problems in recent researches on LUS for LC were noted, including troublesome performance, unsatisfactory visualization rate of the low segment of the CBD, unfeasible or unreliable sonic anatomic landmarks for judgment of the end segment of the CBD, and unconfirmed capacity of diagnosis for BDI. In three part, the present study aim to investigate the role of LUS in LC and try to modify the existing techniques for LUS in LC.Part I. Imaging the low segment of the common bile duct in full-length by laparoscopic ultrasonography through the optimized single sonic window.LUS was applied in 420 cases of LC to scanning the extrahepatic bile duct. The aim of this part of study is to evaluate the capacity of visualizing the extrahepatic bile duct, low segment of the CBD in especial, through single optimized sonic window and with simple manoeuvre. As well, the more feasible and anatomically-based sonic anatomic landmarks for judging the end segment of the CBD were sifted out.Patients and materials:420 cases of gallstones were included. No common bile duct calculi was recognized by preoperative ultrasonography. Occult CBD calculi was suspected in 13 patients, of which 5 hadundergone ERCP and 2 received EST. CBD calculi was estimated to have been completely removed in these 5 patients.B&K Medical 8555 flexible tip laparoscopic ultrasound probe was applied. The probe was introduced into the abdominal cavity through the subxiphoid port to scan the extraheptic biliary system . Results: 1.Through the optimized single sonic window and with modified simple techniques, LUS could provide a satisfactory visualization of the low segment of the CBD in full-length, which is most difficult to be imaged.The overall full-length visualization rate of the low segment of the CBD amounted to 96.9%, which is significantly higher than that obtained by some authors.2.CBD calculi in 9 cases was detected by LUS, including ones unpredicted preoperatively in 7 patients.3.The varied combination of the following 4 sonic landmarks were proposed by author as the indicators for judgment of the end segment of the CBD: â‘ The tapering down, mouse tail-shaped low segment of the CBD; â‘¡ the interior wall of the second segment of the duodenum; â‘¢ lateral-inferior part of the right border of the pancreas; â‘£ lateral-inferior part of the hypoechonic circle between the duodenum and pancreas. Conclusions:1.Through the optmized single sonic window and with modified simple technique, LUS can provide a satisfactory visualization of the extrahepatic bile duct, especially the end segment of the CBD, in ful-length. 2.The new indicators for judgment of the end segment of the CBD sifted out by author are more feasible and anatomically-based. 3.LUS can effectively detect occult calculi in the low segment of the CBD unrecognized by preoperative ultrasonography. 4.False positive and false negative results are associated with inexperience. Additionally, in some individuals, the low segment of the CBD is difficult to be visualized by LUS. For these cases, LIOC still has special value. Part...
|
PDF Full Text Request