腹腔镜胆囊切除术中腹腔镜超声与数字荧光胆管造影术检测胆总管结石的比较。

A comparison of laparoscopic ultrasound with digital fluorocholangiography for detecting choledocholithiasis during laparoscopic cholecystectomy.

作者信息

Thompson D M, Arregui M E, Tetik C, Madden M T, Wegener M

机构信息

Saint Vincent Hospital and Health Care Center, 2001 West 86th Street, Indianapolis, IN 46260, USA.

出版信息

Surg Endosc. 1998 Jul;12(7):929-32. doi: 10.1007/s004649900749.

DOI:10.1007/s004649900749

PMID:9632863

Abstract

BACKGROUND

Laparoscopic ultrasound is an alternative to operative cholangiogram for evaluation of the common bile duct (CBD) during laparoscopic cholecystectomy. It is a safe, fast, and reliable method for detecting choledocholithiasis.

METHODS

We prospectively evaluated the sensitivity and specificity of laparoscopic ultrasound (LUS) and digital fluorocholangiogram (DFCG) in a three-phase study of 360 consecutive patients.

RESULTS

In phase I, 140 patients undergoing laparoscopic cholecystectomy had LUS performed first, followed by DFCG. Thirteen patients had CBD calculi identified on LUS. Four patients with confirmed (two cases) or presumed (two cases) CBD calculi on DFCG were not identified on LUS. Thus, the specificity of LUS was 100%, whereas the sensitivity was 76.5%. DFCG had four false positives, for a sensitivity of 100% with a specificity of 96.7%. LUS was performed, on average, in 6.6 min, whereas DFCG required 10.9 min to perform. In phase II, the infusion of saline through a cystic duct catheter was performed in instances where the distal CBD could not be well seen. This maneuver distended the intrapancreatic portion of the CBD, allowing better visualization. Nine stones were identified on LUS in 78 patients, increasing the sensitivity to 100%. One false positive DCFG was encountered, resulting in a sensitivity of 100% and a specificity of 98.6%. In phase III, we performed routine LUS and used DFCG only in select cases. The sensitivity and specificity for LUS were 95.7% and 100%, respectively, whereas DFCG had a sensitivity of 95.2% and a specificity of 100%. One patient in phase III has returned 11 months post-op with a CBD stone. This was initially missed on LUS, DFCG, and postoperative ERCP. The sensitivity and specificity in all 360 patients were 90% and 100% for LUS and 98.1% and 98.1% for DFCG, respectively. A total of five CBD stones were missed by LUS, four early in the study (phase I). One missed on LUS in phase III was also missed by DFCG and ERCP.

CONCLUSIONS

LUS is a reliable alternative to DFCG during laparoscopic cholecystectomy (LC). With experience, it is as sensitive as DFCG and more specific. It is more rapidly performed than cholangiography.

摘要

背景

在腹腔镜胆囊切除术期间，腹腔镜超声是用于评估胆总管（CBD）的手术胆管造影的替代方法。它是一种检测胆总管结石安全、快速且可靠的方法。

方法

我们在一项针对360例连续患者的三阶段研究中前瞻性评估了腹腔镜超声（LUS）和数字荧光胆管造影（DFCG）的敏感性和特异性。

结果

在第一阶段，140例行腹腔镜胆囊切除术的患者先接受LUS检查，随后进行DFCG检查。LUS检查发现13例患者存在胆总管结石。DFCG检查确诊（2例）或疑似（2例）胆总管结石的4例患者未被LUS检查发现。因此，LUS的特异性为100%，而敏感性为76.5%。DFCG有4例假阳性，敏感性为100%，特异性为96.7%。LUS平均检查时间为6.6分钟，而DFCG检查需要10.9分钟。在第二阶段，对于胆总管远端观察不清的情况，通过胆囊管导管注入生理盐水。该操作使胆总管胰内段扩张，便于更好地观察。78例患者经LUS检查发现9枚结石，敏感性提高至100%。DFCG出现1例假阳性，敏感性为100%，特异性为98.6%。在第三阶段，我们进行常规LUS检查，仅在特定病例中使用DFCG检查。LUS的敏感性和特异性分别为95.7%和100%，而DFCG的敏感性为95.2%，特异性为100%。第三阶段有1例患者术后11个月出现胆总管结石。最初LUS、DFCG及术后内镜逆行胰胆管造影（ERCP）均未发现。所有360例患者中，LUS的敏感性和特异性分别为90%和100%，DFCG的敏感性和特异性分别为98.1%和98.1%。LUS总共漏诊了5枚胆总管结石，其中4枚在研究早期（第一阶段）漏诊。第三阶段1例LUS漏诊的病例DFCG和ERCP也未发现。