Qiu Yan, Yang Zhengpeng, Li Zhituo, Zhang Weihui, Xue Dongbo
Department of General Surgery, the First Affiliated Hospital of Harbin Medical University, 23 Youzheng St., Nangang Dist., 150001, Harbin, China.
BMC Gastroenterol. 2015 Nov 14;15:158. doi: 10.1186/s12876-015-0392-1.
The diagnosis of associated choledocholithiasis prior to cholecystectomy for patients with gallstones is important for the surgical decision and treatment efficacy. However, whether ultrasound is sufficient for preoperative diagnosis of choledocholithiasis remains controversial, with different opinions on whether routine magnetic resonance cholangiopancreatography (MRCP) is needed to detect the possible presence of common bile duct (CBD) stones.
In this study, a total of 413 patients with gallstones who were admitted to the Department of General Surgery of the First Affiliated Hospital of Harbin Medical University in China for a period of 3 years and underwent both ultrasound and MRCP examinations were retrospectively analysed. After reviewing and screening these cases according to the literature, 11 indicators including gender, age, alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, indirect bilirubin, alkaline phosphatase, γ-aminotransferase, CBD diameter, and concurrent acute cholecystitis were selected and comparatively analysed.
Among the 413 patients, a total of 109 cases showed concurrent gallstones and choledocholithiasis, accounting for 26.39 % of all cases. Among them, 60 cases of choledocholithiasis were revealed by ultrasound examination, accounting for 55.05 %, while 49 cases of choledocholithiasis were not detected by ultrasound examination but were confirmed by MRCP instead (the missed diagnosis rate of ultrasound was 44.95 %). The results of statistical analysis suggested that alanine aminotransferase, acute cholecystitis, and CBD diameter were the three most relevant factors for missed diagnosis by ultrasound.
The accuracy of preoperative ultrasonography for the diagnosis of associated CBD stones for patients with gallstones is not high. However, elevated alanine aminotransferase, concurrent acute cholecystitis, and CBD diameter were identified as key factors that may affect the accuracy of the diagnosis. Thus, routine preoperative MRCP examination is suggested for patients with gallstones to rule out possible concomitant CBD stones.
对于胆结石患者，在胆囊切除术之前诊断合并胆总管结石对于手术决策和治疗效果至关重要。然而，超声检查对于胆总管结石的术前诊断是否足够仍存在争议，对于是否需要常规磁共振胰胆管造影（MRCP）来检测胆总管（CBD）结石的可能存在存在不同意见。
本研究回顾性分析了中国哈尔滨医科大学附属第一医院普通外科收治的413例胆结石患者，这些患者在3年期间接受了超声和MRCP检查。根据文献对这些病例进行回顾和筛选后，选择了包括性别、年龄、丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、直接胆红素、间接胆红素、碱性磷酸酶、γ-转氨酶、CBD直径和并发急性胆囊炎在内的11项指标进行比较分析。
在413例患者中，共有109例显示合并胆结石和胆总管结石，占所有病例的26.39%。其中，超声检查发现胆总管结石60例，占55.05%，而超声检查未发现但经MRCP证实的胆总管结石有49例（超声漏诊率为44.95%）。统计分析结果表明，丙氨酸转氨酶、急性胆囊炎和CBD直径是超声漏诊的三个最相关因素。
术前超声检查对胆结石患者合并CBD结石的诊断准确性不高。然而，丙氨酸转氨酶升高、并发急性胆囊炎和CBD直径被确定为可能影响诊断准确性的关键因素。因此，建议对胆结石患者进行术前常规MRCP检查，以排除可能合并的CBD结石。
