Gross B H, Harter L P, Gore R M, Callen P W, Filly R A, Shapiro H A, Goldberg H I
Radiology. 1983 Feb;146(2):471-4. doi: 10.1148/radiology.146.2.6849097.
Ultrasound is the modality of choice for the diagnosis of cholelithiasis and for the evaluation of the intra- and extrahepatic biliary tree in the patient with jaundice, but its role in the diagnosis of choledocholithiasis is less certain. We prospectively examined 90 patients who were to undergo endoscopic retrograde cholangiopancreatography (ERCP) by performing right upper quadrant sonography immediately prior to ERCP. We assessed the size of the intra- and extrahepatic ducts and the presence or absence of calculi. ERCP, which was successfully performed in 77 of 94 attempted examinations, percutaneous transhepatic cholangiography, or surgical follow-up composed the diagnostic standard for comparison. Ultrasound was not accurate in the diagnosis (sensitivity, 25%) or exclusion (value of a negative study, 73%) of choledocholithiasis. Furthermore, in the postcholecystectomy patient population, ultrasound assessment of biliary duct size is not a useful predictor of biliary disease. For symptomatic postcholecystectomy patients, we recommend ERCP as the initial diagnostic modality.
超声是诊断胆石症以及评估黄疸患者肝内和肝外胆管树的首选检查方法，但其在胆总管结石诊断中的作用尚不确定。我们对90例拟行内镜逆行胰胆管造影（ERCP）的患者进行了前瞻性研究，在ERCP前即刻对其右上腹进行超声检查。我们评估了肝内和肝外胆管的大小以及结石的有无。在94例尝试检查中，77例成功进行了ERCP，经皮肝穿刺胆管造影或手术随访构成了用于比较的诊断标准。超声在胆总管结石的诊断（敏感性为25%）或排除（阴性检查的价值为73%）方面并不准确。此外，在胆囊切除术后患者群体中，超声对胆管大小的评估并非胆管疾病的有用预测指标。对于有症状的胆囊切除术后患者，我们建议将ERCP作为初始诊断方法。
