Pereira-Limâ J C, Jakobs R, Busnello J V, Benz C, Blaya C, Riemann J F
Department of Medicine C (Gastroenterology), Klinikum der Stadt Ludwigshafen gGmbH Academic Teaching Hospital, University of Mainz, Germany.
Hepatogastroenterology. 2000 Nov-Dec;47(36):1522-5.
BACKGROUND/AIMS: The introduction of laparoscopic cholecystectomy has increased the need for preoperative diagnosis of common bile duct stones. The purpose of this study is to verify the sensitivity of the liver function tests in the detection of duct stones.
We evaluated 438 patients (223 retrospectively and 215 prospectively) who underwent endoscopic papillotomy for bile duct stones in two different services. In every case, blood samples for liver function tests levels were collected prior to endoscopic retrograde cholangiopancreatography.
The most sensitive test was gamma-glutamyl transpeptidase, that was abnormal in 92.2% of the cases. Alkaline phosphatase was elevated in 74.7% of the patients with choledocholithiasis. The least sensitive parameter was AST, altered in only 50.8% of times. The sensitivity of all liver tests for the diagnosis of choledochal stones taken together was 94.3%.
Liver function tests are very sensitive in the detection of common bile duct stones, however these blood tests are in the normal range of about 5% of endoscopically treated patients.
背景/目的：腹腔镜胆囊切除术的引入增加了术前诊断胆总管结石的需求。本研究的目的是验证肝功能检查在检测胆管结石方面的敏感性。
我们评估了438例患者（回顾性研究223例，前瞻性研究215例），这些患者在两个不同科室接受了内镜乳头切开术治疗胆管结石。在每例患者中，在内镜逆行胰胆管造影术前采集肝功能检查水平的血样。
最敏感的检查是γ-谷氨酰转肽酶，92.2%的病例该指标异常。碱性磷酸酶在74.7%的胆总管结石患者中升高。最不敏感的参数是谷草转氨酶，仅50.8%的病例出现变化。所有肝功能检查对胆总管结石诊断的综合敏感性为94.3%。
肝功能检查在检测胆总管结石方面非常敏感，然而约5%接受内镜治疗的患者这些血液检查结果在正常范围内。
