Wigmore S J, Wood K, Rainey J B, Macleod D A
Department of Surgery, St. John's Hospital at Howden, West Lothian, Scotland, UK.
Surg Laparosc Endosc. 1994 Aug;4(4):254-7.
This study examines the role of intravenous cholangiography in the preoperative assessment of the first 100 patients considered for laparoscopic cholecystectomy at this institution. Intravenous cholangiography detected common bile duct (CBD) stones in 10 patients, of whom only five had a dilated CBD (> 8 mm). There were no cases of inadequate visualization of the CBD using IVC and no allergic reactions to the contrast medium. All CBD stones were confirmed by either endoscopic retrograde cholangiopancreatography (ERCP) or exploration of the CBD. There have been no cases of missed CBD stones during a follow-up period of 8 to 18 months. In contrast, ultrasound scanning was only able to detect one CBD stone, and there was a 14% incidence of inadequate visualisation of the CBD. Intravenous cholangiography is a safe, inexpensive, and highly accurate technique for assessing the CBD in patients undergoing laparoscopic cholecystectomy, with false-positive and false-negative rates of 0 in this study. The timing of the investigation permits preoperative clearance of the duct by ERCP and, should this fail, the option of a single procedure of open exploration of the CBD.
本研究探讨了静脉胆管造影在本机构前100例拟行腹腔镜胆囊切除术患者术前评估中的作用。静脉胆管造影在10例患者中检测到胆总管（CBD）结石，其中只有5例胆总管扩张（>8mm）。使用静脉胆管造影未出现胆总管显影不充分的情况，也没有对造影剂的过敏反应。所有胆总管结石均通过内镜逆行胰胆管造影（ERCP）或胆总管探查得以证实。在8至18个月的随访期内，没有出现胆总管结石漏诊的情况。相比之下，超声扫描仅能检测到1例胆总管结石，胆总管显影不充分的发生率为14%。静脉胆管造影是一种安全、廉价且高度准确的技术，用于评估行腹腔镜胆囊切除术患者的胆总管，在本研究中假阳性和假阴性率均为0。该检查的时机允许通过ERCP在术前清理胆管，如果失败，还可选择单一的胆总管开放探查手术。
