目的 研究多层螺旋CT在胆囊结 石合并胆囊炎患者腹腔镜胆囊切除术(LC) 术前的评估价值。方法 随机收集2015年1 月-2016年9月我院48例经CT或B超等各种 影像学诊断确诊为胆囊结石合并胆囊炎患 者作为研究组，并选取同期48例经过上腹 增强扫描诊断为非胆囊疾病患者纳入对照 组，比较2组胆囊动脉与胆囊管具体显示 率、显示评分，并观察患者解剖结构与临 床变异情况。结果 对照组胆囊管均可以 显示，研究组有3例无法显示，且都是胆 囊结石合并急性胆囊炎患者，2组胆囊管 显示率、平均显示评分、胆囊管走行变异 率、胆囊动脉走行变异率比较无显著差异 (P＞0.05)；2组胆囊动脉均可以显示，研 究组胆囊动脉平均显示评分明显高于对照 组(P＜0.05)；96例患者中，93例可以显 示胆囊管，正常走行81例(87.10％)，走 行变异12例(12.90％)，包括高位胆囊管 7例，右迷走胆管形成与旋前于肝总管右 壁位置汇入各2例，低位胆囊管1例；93例 可将胆囊动脉走行准确显示出来，其中77 例(82.80％)胆囊动脉走行显示正常(Ia 型)，走行变异16例(17.20％)，包括5例 Ib型，4例IIa型，7例IIb型。结论 在胆 囊结石合并胆囊炎患者LC术前行多层螺旋 CT检查，可有效显示胆囊管与胆囊动脉及 周围解剖关系，且能发现其行走变异情 况，从而为LC术前评估提供重要指导。

Objective To study the evaluation value of multi-slice spiral CT in patients with cholecystolithiasis and cholecystitis before laparoscopic cholecystectomy (LC). Methods A total of 48 patients with cholecystolithiasis and cholecystitis which diagnosed by CT or type B ultrasound from January 2015 to September 2016 were selected as the study group. Another 48 patients without gallbladder diseases which diagnosed by enhanced abdominal CT scan were selected the control group at the same time. The specific display rates and display scores of cystic artery and cystic duct were compared between the two groups. The anatomic structure and clinical variation were observed. Results Cystic ducts of all patients in the control group could be displayed, while there were 3 cases not displayed in the study group, and they all had acute cholecystolithiasis and cholecystitis. There were no significant differences between the two groups in the display rate and display score of cystic duct, the average display score, the variation rate of cystic duct route and the variation rate of cystic artery (P>0.05). Cystic arteries of two groups could be displayed, and the average display score of cystic artery in the study group was significantly higher than that in the control group (P＜0.05). Of the 96 patients, cystic ducts of 93 patients could be displayed, and the route was normal in 81 cases (87.10%) and variant in 12 (12.90%), including 7 cases of high cystic duct, 2 cases of right vagus bile duct formation, 2 cases of pronation in the right wall of the common hepatic duct and 1 case of low cystic duct. The cystic artery routes of 93 cases could be accurately displayed, among which 77 cases (82.80%) of cystic arteries were normal (type I a) and 16 cases (17.20%) were variant, including 5 cases of type Ib, 4 cases of type IIa and 7 cases of II b. Conclusion Carrying out multi-slice spiral CT examination in patients with cholecystolithiasis and cholecystitis before LC can effectively display the cystic duct and cystic artery, and find their route and variance, so as to provide important guidance for evaluation before LC.