Aubertin J M, Levoir D, Bouillot J L, Becheur H, Bloch F, Aouad K, Alexandre J H, Petite J P
Dept. of Gastroenterology, Broussais Hospital, Paris, France.
Endoscopy. 1996 Oct;28(8):667-73. doi: 10.1055/s-2007-1005574.
In patients who are highly likely to have common bile duct (CBD) stones, it seems necessary to image the biliary tract before laparoscopic cholecystectomy, and endoscopic ultrasonography (EUS) is one way of doing this. The aim of this study was to compare immediate preoperative EUS to intraoperative cholangiography for imaging the CBD and for the diagnosis of CBD stones, in a population with a high risk of choledocholithiasis (as assessed by clinical, biochemical, and ultrasound criteria).
From January 1993 to August 1995, EUS was carried out in the operating room in 50 patients (11 men, 39 women; mean age 57 years) before laparoscopic cholecystectomy for symptomatic choledocholithiasis. A diagnosis of CBD stones by EUS or intraoperative cholangiography was always confirmed by instrumental exploration. An absence of stones in the CBD was established by a negative EUS and intraoperative cholangiography, as well as normal findings at clinical monitoring three months after laparoscopic cholecystectomy.
EUS visualized the CBD in 100% of cases. Intraoperative cholangiography was successful in 94% of cases (n = 47 of 50), and after conversion to open laparotomy in eight patients. CBD stones were found in 12 patients (24%). The sensitivity, specificity, and positive and negative predictive values for EUS were 100%, 97%, 92%, and 100%, respectively.
Immediate preoperative EUS may make it possible to select the best form of treatment in patients with CBD stones, avoiding inappropriate laparoscopic instrumental CBD exploration.
对于极有可能患有胆总管（CBD）结石的患者，在腹腔镜胆囊切除术前行胆道成像似乎很有必要，而内镜超声检查（EUS）是实现这一目的的一种方法。本研究旨在比较术前即刻EUS与术中胆管造影在对胆总管成像及诊断胆总管结石方面的效果，研究对象为具有胆总管结石高风险的人群（通过临床、生化及超声标准评估）。
1993年1月至1995年8月，对50例因有症状胆总管结石而行腹腔镜胆囊切除术的患者（11例男性，39例女性；平均年龄57岁）在手术室进行了EUS检查。通过EUS或术中胆管造影诊断胆总管结石均通过器械探查得以证实。通过EUS及术中胆管造影结果为阴性，以及腹腔镜胆囊切除术后3个月临床监测结果正常来确定胆总管无结石。
EUS在100%的病例中显示出胆总管。术中胆管造影在94%的病例中成功（50例中的47例），8例患者中转开腹手术。12例患者（24%）发现胆总管结石。EUS的敏感性、特异性、阳性预测值和阴性预测值分别为100%、97%、92%和100%。
术前即刻EUS可能有助于为胆总管结石患者选择最佳治疗方式，避免不适当的腹腔镜器械性胆总管探查。
