Cavdar Faruk, Yildar Murat, Tellioğlu Gürkan, Kara Melih, Tilki Metin, Titiz Mesut İzzet
Department of General Surgery, Yalova State Hospital, Yalova, Turkey.
Department of General Surgery, Balıkesir University Faculty of Medicine, Balıkesir, Turkey.
Pancreatology. 2014 Sep-Oct;14(5):411-4. doi: 10.1016/j.pan.2014.08.002. Epub 2014 Aug 23.
The majority of bile duct stones (BDS) that cause acute biliary pancreatitis (ABP) pass spontaneously into the duodenum. If not passed, they worsen the prognosis or cause recurrence. Therefore, they must be treated. The purpose of this study was to assess the number and timing of spontaneous passage of BDS using magnetic resonance cholangiopancreatography (MRCP) and to determine the effect of this approach on endoscopic retrograde cholangiopancreatography (ERCP).
Sixty patients diagnosed with ABP were evaluated prospectively. MRCP was performed between the 1st and 4th days of an acute attack in all the patients. A control MRCP was performed after 7 days in patients with MRCP-identified choledocholithiasis. Patients in whom BDS were visible on imaging or who showed no decrease in bilirubin or cholestasis enzymes underwent ERCP.
MRCP revealed choledocholithiasis in 20 (33%) of the 60 patients. In the control MRCP imaging, choledocholithiasis was detected in 16 of 20 (80% of those who had stone initially) patients. ERCP was performed in these patients and in 2 patients who did not have BDS on the control MRCP but whose bilirubin values and cholestatic enzyme levels had not decreased. ERCP verified choledocholithiasis in 16 of the 18 patients. The positive predictive value of MRCP was 93.7% (15/16).
MRCP performed in the second week in ABP patients with a nonworsening prognosis and a suspicion of choledocholithiasis will give more specific results. This will avoid unnecessary ERCP and the potential morbidity and mortality that can develop with this invasive procedure.
导致急性胆源性胰腺炎（ABP）的大多数胆管结石（BDS）会自行排入十二指肠。若未排出，则会使预后恶化或导致复发。因此，必须对其进行治疗。本研究的目的是利用磁共振胆胰管造影（MRCP）评估BDS自行排出的数量和时间，并确定该方法对内镜逆行胆胰管造影（ERCP）的影响。
对60例诊断为ABP的患者进行前瞻性评估。所有患者在急性发作的第1天至第4天进行MRCP检查。对MRCP检查发现胆总管结石的患者，在7天后进行对照MRCP检查。影像学检查可见BDS或胆红素或胆汁淤积酶无下降的患者接受ERCP检查。
60例患者中，20例（33%）经MRCP检查发现胆总管结石。在对照MRCP检查中，20例中有16例（最初有结石患者的80%）检测到胆总管结石。对这些患者以及2例对照MRCP检查未发现BDS但胆红素值和胆汁淤积酶水平未下降的患者进行了ERCP检查。ERCP证实18例患者中有16例存在胆总管结石。MRCP的阳性预测值为93.7%（15/16）。
对预后无恶化且怀疑有胆总管结石的ABP患者，在第二周进行MRCP检查将得出更具体的结果。这将避免不必要的ERCP检查以及这种侵入性操作可能引发的潜在发病率和死亡率。
