بررسي يافته‌هاي سونوگرافي پيش از عمل در پيش‌بيني طول عمل جراحي كوله‌سيستكتومي لاپاراسكوپيك

Examination of preoperative ultrasound findings in predicting the operative time of laparoscopic cholecystectomy

زمينه و هدف: شناخت عوامل خطر تبديل كوله‌سيستكتومي لاپاراسكوپيك به جراحي باز لازم و ضروري مي‌باشد. هدف از اين مطالعه بررسي يافته‌هاي سونوگرافي پيش از عمل در پيش‌بيني طول جراحي كوله‌سيستكتومي لاپاراسكوپيك مي‌باشد. روش بررسي: مطالعه حاضر به‌صورت مقطعي بر روي 122 بيمار كه از شهريور 1397 تا شهريور 1398 در بيمارستان شهيد بهشتي قم تحت جراحي كوله‌سيسيتكتومي لاپاراسكوپيك قرار گرفتند انجام شد. پيش از جراحي اطلاعات بيماران شامل سن، جنس، يافته‌هاي سونوگرافي در چك‌ليست ثبت شد. در نهايت مدت زمان عمل كوله‌سيستكتومي با توجه به متغيرهاي مذكور به دو درجه عمل آسان (زير 60 دقيقه و بدون عارضه) عمل دشوار (بالاي 60 دقيقه به همراه عوارض) تقسيم شد. اطلاعات توسط SPSS software, version 22 (IBM SPSS, Armonk, NY, USA) مورد تجزيه و تحليل قرار گرفت. در اين مطالعه سطح معناداري كمتر از 0/05 در نظر گرفته شد. يافته‌ها: 28 (22/4%) مرد و 97 (77/6%) زن با ميانگين سني 13/85±44/66 سال بررسي شدند. عمل‌هاي دشوار 35 مورد (28%) و عمل‌هاي آسان 90 مورد (72%) بود. تبديل به جراحي باز در سه مورد اتفاق افتاد. در بين يافته‌هاي سونوگرافي، بين افزايش ضخامت جدار كيسه صفرا و Impacted stone با مدت زمان عمل ارتباط معناداري وجود داشت (0/05≤P). اما بين يافته Presence of pericholecystic fluid با مدت زمان عمل ارتباط معناداري يافت نشد (0/05>P). نتيجه‌گيري: نتيجه نشان داد كه سونوگرافي پيش از عمل قادر به ارايه داده‌هاي ارزشمند در پيش‌بيني مدت زمان عمل كوله‌سيستكتومي لاپاراسكوپي مي‌باشد.

Background: Identifying risk factors for conversion to open surgery laparoscopic cholecystectomy and factors are difficult to predict cholecystectomy surgery is required. The aim of this study was to evaluate the findings of preoperative ultrasound in predicting the length of laparoscopic cholecystectomy surgery. Methods: The present study was performed cross-sectional on 122 patients who underwent laparoscopic cholecystectomy in Shahid Beheshti, Forghani and Nekoei’s Hospital in Qom from September 2016 to September 2017. Inclusion criteria: All cases of acute cholecystitis, chronic cholecystitis, symptomatic gallstones and biliary pancreatitis underwent laparoscopic cholecystectomy. The exclusion criteria included patients undergoing laparoscopic cholecystectomy at the same time were other procedures. Before surgery patients' information such as age, sex, ultrasound findings including gallbladder wall thickness, compressed stone and the presence of fluid around the gallbladder were recorded in the checklist. Finally, the duration of cholecystectomy was divided into two degrees of easy operation (less than 60 minutes and without complications) and difficult operation (above 60 minutes with complications) according to the mentioned variables. Data were analyzed by SPSS software, version 22 (IBM SPSS, Armonk, NY, USA). In this study, a significance level of less than 0.05 was considered. Results: 28 (22.4 percent) males and 97 (77.6 percent) females with a mean age of 44.66 13 13.85 years were studied. There were 35 difficult cases (28 percent) and 90 easy cases (72 percent). Conversion to open surgery occurred in three cases. Among the sonographic findings, there was a significant relationship between the increase in gallbladder wall thickness and Impacted stone with the duration of operation (P≤0.05). But no significant relationship was found between the findings of Presence of pericholecystic fluid and the duration of operation (P>0.05). Conclusion: Overall, the findings of this study showed that preoperative ultrasound is able to provide valuable data in predicting the duration of laparoscopic cholecystectomy.