| Nowadays the main therapy of Cholecystolithiasis is operation. Withthe improvement of laparoscopically technique, LC is already the firstmodus operandi used to treat the nonmalignant disease of gallbladder, suchas calculus, inflammation, polypus, adenoma and so on. but there are stillsome case should be treated by OC. An available preoperative evaluationbefore LC can guide doctor in choice of modus operandi, which canavoid converting to OC. And it also can help doctor convert LC to OC intime, which can avoid severe complications. In this text throughsummarizing the successful experience of LC 276 cases,we try to study theutility of imageology in Preoperative evaluation of cholecystolithiasisbefore laparoscopic cholecystectomy.We analyzed 276 cases between June 2003 to March 2006, whosedisease were diagnose as Cholecystolithiasis. All of the cases were treatedby LC. among the total, 98 cases are male, and 178 cases are female. 271 oftotal were only examined by sonography, while there were 4 casesexamined by MRCP and 1 case examined by ERCP.We examined every patient by American ACUSON Sequoia 512diasonography, and compared the results with oporation status. The maintargets we examined for is the size of gallbladder, the degree of gallbladdercontraction when ante cibos and post cibum, the thickness of the wall ofgallbladder and bile duct, the serosa and mucosa of gallbladder rough ornot, the viscidity degree of bile, the adherence between gallbladder and thetissue beside it, and common duct stones exist or not, et al.As the result, all of the 276 cases have cholecystolithiasis, and thediagnose accordance rate of the size, quantity and incarceration is 100%.265 LC were successful, while 11 cases were converted to OC, in which 4cases due to bleeding, 6 cases due to adherence, and 1 case due to commonduct stones.We divide all cases into 3 groups. Group A: 212 cases, normal size ofgallbladder, thickness of capsule wall ≤3mm, acceptable viscidity degreeof bile, no incarceration, clear circumscription, and I dia of bile commenduct≤6mm. Group B: 54 cases, thickness of capsule wall ≤6mm and haveone of following conditions:big size of gallbladder, capsule wall>3mm, badGallbladder contraction, rough serosa and mucosa of gallbladder,unacceptable ccviscidity degree of bile, incarceration, gallbladder atrophy,unclear circumscription. Group C:10 cases, the I dia of bile commen duct >6mm but ≤9mm, and no common duct stones found.Result: Group A: all of cases were successful, without anycomplication. The average time of operation is 29.31min and the averagestay were 4 days. Group B: The average time of operation is 54.28 min andthe average stay were 8 days, and 8 cases convert to OC. Between Group Aand Group B, The average time of operation, average stay, incidence ofcomplication, and conversion rate are all different. Group C: 5 patientswere examined by MRCP or ERCP, in whom we found one patient havecommon duct stones. After EST we do LC on her successfully. Other 5patients refused further examination. When we do LC on them, we foundone case of common duct stones and converted to OC. Among 10 cases,another two cases were convert to OC, one caused by bleeding, the othercaused by adhence.Conclusion: All above-mentioned tell us that imageologicalexamination especially US does a good job before LC. Following is ourconclusion:1. The doctors must train skill very frequently;2. availableevaluation is the only way to lower incidence of complication, andconversion rate. 3. grasp the 3 stage of operational indication of LC. 4.imageological examination especially US is the most useful method todiagnose cholecystolithiasis. 5. some cases need further examination,suchas MRCP, ERCP, CT, IOC, et al. 6. we must be cautious before doing LC oncases that are suggested complex by imageological examination. 7.beforeLC, we must get ready to convert in time. 8.If bile duct can not be revealclealy, IOC is needed.
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