Bosseckert H
Dtsch Z Verdau Stoffwechselkr. 1985;45(6):274-82.
Aim of a rational diagnostic approach is keeping the risks and challenges of the patient at a minimum, shortening the time interval till the diagnosis is established and putting the charges to a low level. Anamnesia, clinical examination and laboratory results allow the experienced clinician in about 90% a correct diagnosis if an extrahepatic cholestasis is the case in question. On the other hand the result is only 75-80% if there is an intrahepatic cholestasis. Non dilated bile ducts do not exclude an extrahepatic cholestasis and additional diagnostic measures like ERCP or/and PTC are recommended in case the suspicion of a extra hepatic pattern exists. The diagnostic approach may be shorten at all if anamnesia and clinical statement are suspect of an extrahepatic cholestasis. Then after getting the laboratory results the ERCP or PTC may add.
合理诊断方法的目的是将患者的风险和挑战降至最低，缩短确诊所需的时间间隔，并降低费用。如果所讨论的病例是肝外胆汁淤积，通过问诊、临床检查和实验室检查结果，经验丰富的临床医生大约有90%的概率能做出正确诊断。另一方面，如果是肝内胆汁淤积，诊断正确率仅为75% - 80%。胆管未扩张并不能排除肝外胆汁淤积，如果怀疑是肝外胆汁淤积模式，建议采取额外的诊断措施，如内镜逆行胰胆管造影（ERCP）或/和经皮肝穿刺胆管造影（PTC）。如果问诊和临床表现怀疑是肝外胆汁淤积，诊断过程可能会整体缩短。在获得实验室检查结果后，可接着进行ERCP或PTC检查。
