Shim C S, Joo J H, Park C W, Kim Y S, Lee J S, Lee M S, Hwang S G
Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea.
Endoscopy. 1995 Aug;27(6):428-32. doi: 10.1055/s-2007-1005735.
To reduce the rate of conversion to open cholecystectomy, and to avoid retained bile duct stones, it is essential to detect choledocholithiasis prior to laparoscopic cholecystectomy. The aim of the present study was to evaluate the usefulness and safety of performing endoscopic ultrasonography (EUS) for the diagnosis of choledocholithiasis prior to laparoscopic cholecystectomy.
One hundred thirty-two patients with symptomatic cholelithiasis were evaluated prospectively using standard abdominal ultrasonography (US), US plus EUS, and US plus endoscopic retrograde cholangiography (ERC) for the detection of choledocholithiasis prior to laparoscopic cholecystectomy.
Twenty-eight patients (21.2%) had choledocholithiasis, and six patients with common bile duct stones had normal-sized ducts on US. The common bile duct was successfully examined in all patients using EUS, but only in 65.9% of patients when US was used and 94.7% of patients when ERC was used. US plus EUS detected choledocholithiasis in 25 of 28 patients (89.3%), US in 19 of 28 patients (67.9%), and US plus ERC in 26 of 28 patients (92.9%). While no complications as a result of EUS were encountered, complications resulting from ERC occurred in seven patients (5.3%), including cholecystitis in two patients, cholangitis in three patients, and pancreatitis in two patients. In view of the complication and failure rates, EUS appears to offer significant advantages over ERC. These results suggest that EUS is more sensitive than standard abdominal ultrasonography, and as sensitive as ERC.
EUS appears to be as sensitive as, and safer than, ERC in the detection of choledocholithiasis prior to laparoscopic cholecystectomy.
为降低转为开腹胆囊切除术的比例并避免残留胆管结石，在腹腔镜胆囊切除术之前检测胆总管结石至关重要。本研究的目的是评估在腹腔镜胆囊切除术之前进行内镜超声检查（EUS）诊断胆总管结石的有效性和安全性。
前瞻性地评估了132例有症状胆结石患者，在腹腔镜胆囊切除术之前使用标准腹部超声（US）、US联合EUS以及US联合内镜逆行胆管造影（ERC）来检测胆总管结石。
28例患者（21.2%）患有胆总管结石，6例胆总管结石患者的胆管在US检查时大小正常。所有患者使用EUS均成功检查了胆总管，但使用US时仅65.9%的患者成功检查，使用ERC时为94.7%的患者成功检查。US联合EUS在28例患者中的25例（89.3%）检测到胆总管结石，US在28例患者中的19例（67.9%）检测到，US联合ERC在28例患者中的26例（92.9%）检测到。虽然未遇到因EUS导致的并发症，但7例患者（5.3%）出现了ERC相关并发症，包括2例胆囊炎、3例胆管炎和2例胰腺炎。鉴于并发症和失败率，EUS似乎比ERC具有显著优势。这些结果表明EUS比标准腹部超声更敏感，且与ERC一样敏感。
在腹腔镜胆囊切除术之前检测胆总管结石时，EUS似乎与ERC一样敏感且更安全。
