Fahlke J, Ridwelski K, Manger T, Grote R, Lippert H
Department of Surgery, Otto-von-Guericke University, Leipziger Str. 44, D-39120 Magdeburg, Germany.
Hepatogastroenterology. 2001 Jan-Feb;48(37):59-65.
BACKGROUND/AIMS: A prerequisite for successful laparoscopic cholecystectomy is the exclusion of potential risks such as cholangiolithiasis, anatomical malformations or diseases of the stomach. As there is no general agreement regarding the appropriate preoperative diagnostic workup, we compared different diagnostic methods as to their value in detecting unknown accompanying diseases and complications.
Between 9/90 and 8/93, we performed 850 laparoscopic cholecystectomies. The first 700 were included in this study. A prospective comparison was carried out of the diagnostic accuracy of history, physical examination, laboratory tests, upper gastrointestinal endoscopy or barium meal, i.v. cholangiography and abdominal ultrasound.
Measurement of the diameter of the common bile duct was found to be a good noninvasive method for diagnosing common bile duct stones (sensitivity 80%, specificity 99%). In combination with the history and the laboratory tests the sensitivity could be improved to 99%. The sensitivity of i.v. cholangiography in detecting common bile duct stones was 80%, the specificity 99.3%. 646/700 patients underwent preoperative endoscopy/barium meal. In 53 (8.2%) patients pathological findings were found, but only in 4 cases (0.6%) they influenced the indication for laparoscopic cholecystectomy. In 1 patient an advanced gastric cancer was diagnosed 6 months after laparoscopic cholecystectomy, the preoperative barium meal did not show any pathological findings.
The results show that routine ultrasonography in combination with history and laboratory tests prior to laparoscopic cholecystectomy can be recommended for detecting common bile duct stones. In patients with 1 or more pathologic finding endoscopic retrograde cholangiopancreatography should be performed preoperatively. A gastroscopy should be done in patients with nonspecific upper abdominal pain, history of peptic ulcer disease and persisting pain after laparoscopic cholecystectomy.
背景/目的：成功实施腹腔镜胆囊切除术的一个前提是排除潜在风险，如胆管结石、解剖畸形或胃部疾病。由于对于合适的术前诊断检查尚无普遍共识，我们比较了不同诊断方法在检测未知伴随疾病和并发症方面的价值。
在1990年9月至1993年8月期间，我们实施了850例腹腔镜胆囊切除术。本研究纳入了前700例。对病史、体格检查、实验室检查、上消化道内镜检查或钡餐检查、静脉胆管造影和腹部超声检查的诊断准确性进行了前瞻性比较。
发现测量胆总管直径是诊断胆总管结石的一种良好的非侵入性方法（敏感性80%，特异性99%）。结合病史和实验室检查，敏感性可提高至99%。静脉胆管造影检测胆总管结石的敏感性为80%，特异性为99.3%。646/700例患者接受了术前内镜检查/钡餐检查。在53例（8.2%）患者中发现了病理结果，但仅4例（0.6%）影响了腹腔镜胆囊切除术的手术指征。1例患者在腹腔镜胆囊切除术后6个月被诊断为进展期胃癌，术前钡餐检查未显示任何病理结果。
结果表明，腹腔镜胆囊切除术前行常规超声检查并结合病史和实验室检查可用于检测胆总管结石。对于有1项或多项病理结果的患者，术前应行内镜逆行胰胆管造影。对于有非特异性上腹部疼痛、消化性溃疡病史且腹腔镜胆囊切除术后仍有疼痛的患者，应进行胃镜检查。
