Gui G P, Borgstein R L, Beaugie J M
Department of Surgery, North Middlesex Hospital, London, UK.
J R Coll Surg Edinb. 1995 Feb;40(1):16-9.
Sixty-seven consecutive patients undergoing cholecystectomy for symptomatic gallstones were investigated by both ultrasonography (US) and intravenous cholangiography (IVC). This provided the opportunity to compare these methods for assessing the common bile duct (CBD) preoperatively for stones. The results were correlated with a subsequent definitive procedure that formed the diagnostic standard in each case. The CBD diameters of 8 (12%) patients with stones was significantly greater than those without stones (t = 10.96, P < 0.001). Sensitivities of US and IVC were 87.5% and 100% respectively, but there were three unsuccessful IVC investigations that had to be excluded from the calculations. Specificities and overall accuracy of both methods were greater than 95%. The positive and negative predictive value of each test was similar and no difference using McNemar's test was found between US and IVC for providing information relating to CBD stones. Performing both procedures as routine assessment of the CBD is thus unnecessary as US, in conjunction with clinical history and liver biochemistry profile, provide an adequate preoperative screen of the CBD.
对67例因有症状胆结石而接受胆囊切除术的连续患者，采用超声检查（US）和静脉胆管造影（IVC）进行了研究。这提供了比较这些术前评估胆总管（CBD）结石方法的机会。结果与随后的确定性手术相关，该手术构成了每个病例的诊断标准。8例（12%）有结石患者的胆总管直径明显大于无结石患者（t = 10.96，P < 0.001）。US和IVC的敏感性分别为87.5%和100%，但有3例IVC检查未成功，必须从计算中排除。两种方法的特异性和总体准确性均大于95%。每项检查的阳性和阴性预测值相似，使用McNemar检验未发现US和IVC在提供与CBD结石相关信息方面存在差异。因此，作为对CBD的常规评估，同时进行这两种检查是不必要的，因为US结合临床病史和肝脏生化指标，可提供足够的术前CBD筛查。
