Predicting Difficulties on Delayed Laparoscopic Cholecystectomy in Symptomatic Cholelithiasis with Preoperative Sonographic Evaluation = 지연된 복강경 담낭 절제술에서 수술적 어려움을 예측할 수 있는 수술 전 초음파의 진단적 가치에 대한 연구

다국어 초록 (Multilingual Abstract)

Purpose : The aim of this study was to evaluate the role of preoperative sonography in predicting potential technical difficulties that can be encountered in delayed laparoscopic cholecystectomy in patients with symptomatic cholelithiasis.
Material and Methods : We retrospectively reviewed the records of 239 patients who underwent laparoscopic cholecystectomy between January 2014 and May 2014 in a single hospital of university. Total of 181 patients meeting the inclusion criteria were finally consisted as the final study group. Preoperative abdominal sonography was performed by an abdominal radiologist with 19 years of experience and the patient group was devided as emergency sonography group and elective sonography group, according to the time when the sonographic evaluation was done. The following eight sonographic parameters were assessed : the thickness of the GB wall, The number of the gallstones, the maximum diameter of the gallstones, presence of the sludge in the GB, presence of the fluid at the GB fossa, the maximum diameter of extrahepatic duct (EHD), presence of CBD stone, presence of GB polyp and maximum size. The following ten parameters in surgical fields were assessed : the duration of operation, the grade of GB inflammation, the grade of adhesion to peritoneal cavity, the thickness of GB wall, The number of the gallstones, the maximum diameter of the gallstones, presence of the fluid at the GB fossa, the maximum diameter of extrahepatic duct (EHD), presence of GB polyp and maximum size, and the presence of conversion to open cholecystectomy. The timing of the operation and difficulty score were also noted.
Results : emergency group (n=141) shows higher age distribution as 58.55 compared with elective group (n=40) as 51.4. GB wall thickness, EHD dilatation, presence of EHD stone, and the presence of pericholecystic fluid show significantly high in the emergency sonography group. (p<0.05) GB stone number shows significantly high in the elective sonography group. (p<0.05) The operation time and the operation difficulty score are significantly higher in the emergency sonography group. In the statistical analysis does not distinguish between groups, the clinical and sonographic parameter that shows the significant difference of the operation time is the age. The clinical and sonographic parameters that show the significant difference of the operation difficulty score are sex, previous operation history, GB wall thickness, and EHD dilatation. In the statistical analysis of the elective sonography group of 141 patients, there is no parameter which shows statistically significant difference of the operation time. The operation difficulty score show difference in the parameters of sex, previous operation history, GB wall thickness, and the number of GB stones. In the statistical analysis of the emergency sonography group of 40 patients, the parameters which show statistically significant difference of the operation time are the maximum size of GB stone and pericholecystic fluid. The operation difficulty score is significantly higher in the patients over sixty years of age group. (mean 6.65, p<0.05)
Conclusion : GB wall thickness 3mm or more, dilatation of the EHD to 7mm or more on preoperative sonography, presence of previous operation history, male gender have been identified as predictive factors for the determination of potential intraoperative technical difficulties especially when the elective sonography was done. If the emergency sonography was done and interval cholecystectomy is in scheduled, maximum GB stone size and pericholecystic fluid collection should be considered to predict operative difficulties.

목차 (Table of Contents)

• ABSTRACT = i
• TABLE OF CONTENTS = v
• LIST OF TABLES = vi
• LIST OF FIGURES = vii
• I. INTRODUCTION = 1
• II. MATERIALS AND METHODS = 3
• A. Patient selection = 3
• B. Ultrasonographic procedures and parameters = 4
• C. Surgical procedures and parameters = 5
• D. statistical analysis = 7
• III. RESULTS = 7
• IV. DISCUSSION = 16
• V. CONCLUSION = 21
• REFERENCE = 22
• LEGENDS OF FIGURES = 25
• FIGURES = 27
• 국문요지 = 30