Bilal O Al-Jiffry, Owaid AlMalki, Fares Rayza, Mohammed Hatem, Department of Surgery, College of Medicine and Medical Sciences, Taif University, Taif 21947, Saudi Arabia.
World J Gastroenterol. 2013 Sep 21;19(35):5877-82. doi: 10.3748/wjg.v19.i35.5877.
To find a non-invasive strategy for detecting choledocholithiasis before cholecystectomy, with an acceptable negative rate of endoscopic retrograde cholangiopancreatography.
All patients with symptomatic gallstones were included in the study. Patients with abnormal liver functions and common bile duct abnormalities on ultrasound were referred for endoscopic retrograde cholangiopancreatography. Patients with normal ultrasound were referred to magnetic resonance cholangiopancreatography. All those who had a negative magnetic resonance or endoscopic retrograde cholangiopancreatography underwent laparoscopic cholecystectomy with intraoperative cholangiography.
Seventy-eight point five percent of patients had laparoscopic cholecystectomy directly with no further investigations. Twenty-one point five percent had abnormal liver function tests, of which 52.8% had normal ultrasound results. This strategy avoided unnecessary magnetic resonance cholangiopancreatography in 47.2% of patients with abnormal liver function tests with a negative endoscopic retrograde cholangiopancreatography rate of 10%. It also avoided un-necessary endoscopic retrograde cholangiopancreatography in 35.2% of patients with abnormal liver function.
This strategy reduces the cost of the routine use of magnetic resonance cholangiopancreatography, in the diagnosis and treatment of common bile duct stones before laparoscopic cholecystectomy.
寻找一种在胆囊切除术前检测胆总管结石的非侵入性策略，其内镜逆行胰胆管造影术的阴性率可接受。
所有有症状的胆囊结石患者均纳入本研究。肝功能异常和超声显示胆总管异常的患者转至内镜逆行胰胆管造影术。超声正常的患者转至磁共振胰胆管造影术。所有磁共振或内镜逆行胰胆管造影术阴性的患者均行腹腔镜胆囊切除术并术中行胆管造影。
78.5%的患者直接行腹腔镜胆囊切除术，无需进一步检查。21.5%的患者肝功能检查异常，其中 52.8%的超声结果正常。该策略避免了 47.2%肝功能异常患者中不必要的磁共振胰胆管造影术，且阴性内镜逆行胰胆管造影术率为 10%。该策略还避免了 35.2%肝功能异常患者中不必要的内镜逆行胰胆管造影术。
该策略减少了常规使用磁共振胰胆管造影术在腹腔镜胆囊切除术前诊断和治疗胆总管结石的成本。
