择期LC术前可疑胆总管结石诊断分析  

Diagnostic analysis of suspected choledocolithiasis before selective laparoscopic cholecystectomy

作　　者：王宏[1] 罗建管 梁鹏[1] 易旭华[1] 李虎山[1] 肖怀忠[1] 杨明[1] 

机构地区：[1]浏阳市人民医院外科,湖南长沙410300

出　　处：《岭南现代临床外科》2011年第1期27-29,40,共4页Lingnan Modern Clinics in Surgery

摘　　要：目的探讨择期腹腔镜胆囊切除术术前可疑诊断胆总管结石的诊断,并对术中胆道造影及术前MRCP诊断可疑胆总管结石进行评价。方法对2005年5月至2010年5月择期行腹腔镜胆囊切除术的1758例患者进行回顾性分析。将其中239例患者列为可疑胆总管结石,根据其肝功能、B超、既往病史等异常情况分为B、C、D、E四组。其余1519例列为A组。相互比较5组之间术后胆总管结石的发生率。在可疑胆总管结石各4组中,比较术前MRCP与术中胆道造影确诊胆总管结石准确率。结果 B、C、D、E四组胆总管结石发生率明显大于A组(P<0.0001),B、C、D、E四组比较,却无区别(P>0.1)。在可疑胆总管结石4组中,术前MRCP与术中胆道造影确诊胆总管结石准确率没有差别(P>0.1)。结论胆总管结石的发生率明显增高多见于下列情况:B超示胆总管扩张,伴肝功能异常,既往有胆原性胰腺炎史及B超检查有胆总管结石;术前MRCP与术中胆道造影在诊断可疑胆总管结石时,两者均有较高的确诊率。Objective To investigate the diagnosis of suspected choledocolithiasis before selective laparoscopic cholecystectomy.At the same time,to evaluate the diagnosis of suspected choledocholithiasis with preoperative MRCP and intraoperative cholangiography.Methods From May 2005 to May 2010,1758 cases of selective laparoscopic cholecystectomy were analyzed retrospectively,and 239 cases were suspected chdodcholithiasis,which was divided into 4 groups,including group B,C,D and E,according to abnormality of liver function,abdominal sonography and past history of illness.And the rest 1519 cases were in group A.The incidcnce of choledocholithiasis was compared among 5 groups.Accuracy of intraoperative cholangiography and preoperative MRCP diagnosing choledolithiasis were compared in each group of suspected choledocholithiasis.Results The incidence of choledocholithiasis in each group of B,C,D and E were more than that group A（P 0.0001）.But between 4 groups of B,C,D and E,there were no statistically differences（P0.1）.In the 4 groups with suspected choledocholithiasis,the diagnostic accuracy rate was not significantly different（P0.1）between preoprative MRCP and intraoperative cholangiography.Conclusion Arelatively high incidence of choledocholithiasis occurs as follows：the ultrasound showing dilatation of common bile duct,accompany by abnormal liver function,having a past history of biliary pancreatitis and choledocholithiasis by ultrasound examination.Preoperative MRCP and intraoperative chloangiography both have a higher diagnostic accuracy rate in the diagnosis of suspected choledocholithiasis.

关 键 词：择期腹腔镜胆囊切除术 可疑胆总管结石 

分 类 号：R657.4[医药卫生—外科学]