Li Jian-Wen, Feng Bo, Wu Liang, Wang Ming-Liang, Lu Ai-Guo, Zang Lu, Mao Zhi-Hai, Dong Feng, Zheng Min-Hua
Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China.
Med Sci Monit. 2009 Sep;15(9):MT126-30.
There is still a debate about the utility of intraoperative cholangiography (IOC) or laparoscopic ultrasonography (LUS) for detection of occult choledocholithiasis during laparoscopic cholecystectomy (LC). The aim of this study was to assess the value of IOC combined with LUS for detection of occult common bile duct (CBD) stones at LC.
MATERIAL/METHODS: From Dec 2002 to Aug 2006, 103 patients with moderate risk of CBD stones underwent IOC and LUS simultaneously during LC. The physician teams for the two different procedures were blinded by each other. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were calculated by several contingency tables that cross-tabulated the results of each technique with those of the gold standard.
The success rate of IOC and LUS were 91.3% and 100% respectively and the time required for LUS was significantly shorter (P<0.01). The visualization of intrapancreatic part of CBD by IOC (97.3%) was significantly higher than LUS (73.8%). The sensitivities, specificities, accuracies, positive and negative predictive values, positive and negative likelihood rations identifying occult CBD stones were 75.0%, 98.7%, 92.2%, 95.5%, 91.4%, 57.7 and 0.253 by IOC, and 82.1%, 98.7%, 94.2%, 95.8%, 93.7%, 63.2 and 0.181 by IUS respectively. The McNemar test showed no significant difference between two methods. The sensitivity of IOC combined with LUS was 92.9%, which was greater than that of IOC and LUS taken separately.
LUS is usually performed in case where IOC has failed or is contraindicated. The combination of both methods maximizes intraoperative detection of occult CBD stones and should at least be recommended as two complementary methods.
关于术中胆管造影（IOC）或腹腔镜超声检查（LUS）在腹腔镜胆囊切除术（LC）中检测隐匿性胆总管结石的效用仍存在争议。本研究的目的是评估IOC联合LUS在LC中检测隐匿性胆总管（CBD）结石的价值。
材料/方法：2002年12月至2006年8月，103例有中度CBD结石风险的患者在LC期间同时接受了IOC和LUS检查。两种不同检查的医生团队相互不知情。通过几个列联表计算敏感性、特异性、准确性、阳性预测值、阴性预测值、阳性似然比和阴性似然比，这些列联表将每种技术的结果与金标准的结果交叉制表。
IOC和LUS的成功率分别为91.3%和100%，LUS所需时间明显更短（P<0.01）。IOC对CBD胰腺内部分的可视化率（97.3%）明显高于LUS（73.8%）。IOC识别隐匿性CBD结石的敏感性、特异性、准确性、阳性和阴性预测值、阳性和阴性似然比分别为75.0%、98.7%、92.2%、95.5%、91.4%、57.7和0.253，LUS分别为82.1%、98.7%、94.2%、95.8%、93.7%、63.2和0.181。McNemar检验显示两种方法之间无显著差异。IOC联合LUS的敏感性为92.9%，高于单独使用IOC和LUS的敏感性。
通常在IOC失败或禁忌的情况下进行LUS。两种方法的联合可最大限度地在术中检测隐匿性CBD结石，至少应作为两种互补方法推荐使用。
