摘要
目的探讨择期腹腔镜胆囊切除(LC)术前可疑胆总管结石的诊断,并对术中胆道造影及术前MRCP诊断可疑胆总管结石进行评价。方法对2005年5月—2010年5月择期行LC的1758例患者的临床资料进行回顾性分析。其中1519例患者临床未疑胆总管结石(A组);余239例患者疑存胆总管结石,根据其不同临床病理特征分为4组(B,C,D,E组)。比较各组术后胆总管结石的发生率。并分析胆总管结石发生的独立危险因素。在可疑胆总管结石的4组中,比较术前MRCP与术中胆道造影确诊胆总管结石准确率。结果 4组可疑患者胆总管结石发生率均明显大于A组(均P<0.01),但4组可疑患者间无统计学差异(P>0.05)。多因素非条件Logistic回归分析结果显示:胆总管直径≥8mm、既往有胆源性胰腺炎、既往有胆总管结石是发生胆总管结石的独立危险因素(P<0.05)。在4组可疑患者中,术前MRCP与术中胆道造影确诊胆总管结石准确率无统计学差异(P>0.05)。结论肝功能异常、B超示胆总管有扩张、既往有胆源性胰腺炎或既往B超示胆总管有结石情况下,胆总管结石发生率显著性增加;胆总管直径≥8mm、既往有胆源性胰腺炎、既往有胆总管结石是发生胆总管结石的独立危险因素;术前MRCP与术中胆道造影在诊断胆总管结石中无差异。
Objective To investigate the diagnosis of suspected choledocholithiasis before elective laparoscopic cholecystectomy（LC）,and the value of intraoperative cholangiography and preoperative magnetic resonance cholangiopancreatography（MRCP） for diagnosis of suspected choledocholithiasis. Methods The clinical data of 1758 patients undergoing elective LC from May 2005 to May 2010 were retrospectively analyzed.Of the patiens,1519 cases were not suspected of having choledocholithiasis（group A） and the remaining 239 cases were suspected of having choledocholithiasis,and the latter were divided into 4 groups（group B,C,D and E） according to their clinicopathological characteristics.The incidence of postoperative choledocholithiasis was compared among the groups.Meanwhile,the independent risk factors for the development of choledocholithiasis were analyzed.The coincidence rate between intraoperative cholangiography and preoperative MRCP for diagnosis of choledocholithiasis in each group with suspected choledocholithiasis was compared. Results The incidence of postoperative choledocholithiasis of all groups with suspected choledocholithiasis was significantly higher than that of group A（all P〈0.01）,but no significant difference was noted among the four groups with suspected choledocholithiasis（P〈0.05）.Multivariate unconditional Logistic regression analysis revealed that common bile duct greater than or equal to 8 mm in diameter,previous history of biliary pancreatitis and previous history of choledocholithiasis were independent risk factors for choledocholithiasis（P〈0.05）.There was no significant difference in the coincidence rate between intraoperative cholangiography and preoperative MRCP for diagnosis of choledocholithiasis in each group with suspected choledocholithiasis（P〈0.05）. Conclusions The incidence of choledocholithiasis greatly increases under the conditions of common bile duct dilation,abnormal liver function,and past history of biliary pancreatitis or of common bile duct stones detected by B ultrasounic examination.Common bile duct dilation（≥8 mm）,past history of biliary pancreatitis and past history of common bile duct stones are independent risk factors for choledocholithiasis.There is no difference between intraoperative cholangiography and preoperative MRCP for diagnosis of choledocholithiasis.
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2011年第8期803-807,共5页
China Journal of General Surgery
