腹腔镜胆囊切除术联合内镜下逆行胰胆管造影和十二指肠乳头括约肌切开术治疗胆囊结石合并肝外胆管结石患者疗效研究*

目的 探讨采用腹腔镜胆囊切除术(LC)、内镜下逆行胰胆管造影(ERCP)和十二指肠乳头括约肌切开术(EST)联合治疗胆囊结石合并肝外胆管结石患者的疗效。方法 2018年1月～2020年10月我院治疗的胆囊结石合并肝外胆管结石88例,在47例观察组采用LC联合ERCP和EST手术,在41例对照组采用开腹胆囊切除和胆总管探查取石治疗。采用视觉模拟评分法(VAS)评价术后疼痛程度。结果 两组结石一次性清除率比较无显著性差异(93.6%对95.1%,P>0.05);观察组术中出血量为(28.1±6.2)ml,显著少于对照组【(43.9±7.5)ml,P<0.05】,手术时间、术后禁食时间和住院时间分别为(105.7±25.5)min、(2.2±0.4)d和(7.6±1.0)d,显著短于对照组【分别为(130.2±26.7)min、(3.0±0.6)d和(12.7±1.3)d,P<0.05】;术后48 h和72 h VAS评分分别为(3.7±0.6)分和(2.5±0.5)分,均显著低于对照组【分别为(4.0±0.7)分和(2.9±0.5)分,P<0.05】;术后7 d,观察组血清ALT和AST水平分别为(46.1±5.6)U/L和(42.5±5.2)U/L,显著低于对照组【分别为(59.8±5.4)U/L和(64.7±5.1)U/L,P<0.05】,而血脂肪酶水平为(808.2±105.7)U/L,显著高于对照组【(721.9±103.0)U/L,P<0.05】;术后观察组并发症发生率为4.3%,显著低于对照组的14.1%(P<0.05)。结论 采用LC联合ERCP和EST治疗胆囊结石合并肝外胆管结石患者可促进术后恢复,改善肝功能,减少并发症的发生。     

肝部分切除联合胆肠吻合术治疗肝内胆管结石患者临床疗效及术后结石复发危险因素分析*

目的 研究采用肝部分切除联合胆肠吻合术治疗肝内胆管结石患者的临床疗效,分析术后结石复发的相关危险因素。方法 2018年1月～2021年1月我院收治的62例肝内胆管结石患者,其中29例对照组患者接受肝部分切除术治疗,33例观察组患者接受肝部分切除联合胆肠吻合术治疗,术后随访所有患者1年。使用全自动生化分析仪检测血生化指标,应用Logistic回归分析影响术后结石复发的相关危险因素。结果 手术后,两组血清ALT和AST水平下降,低水平黄疸消退;术后两组并发症发生率比较无显著性差异(9.1% 对13.8%,P＞0.05);在术后随访1年,超声检查显示观察组结石复发率为15.2%,显著低于对照组的41.4%(P＜0.05);在62例肝内胆管结石患者中,术后结石复发17例(27.4%);单因素分析结果显示,复发与未复发患者结石残留、胆道狭窄和手术方法存在显著性差异(P＜0.05);多因素Logistic回归分析显示,结石残留[OR(95%CI)为3.5(1.3～9.6)]和胆道狭窄[OR(95%CI)为2.7(1.1～6.6)]是影响肝内胆管结石患者术后结石复发的独立危险因素,而手术方法[OR(95%CI)为0.4(0.1～0.9)]为其保护因素(P＜0.05)。结论 采用肝部分切除联合胆肠吻合术治疗肝内胆管结石患者可显著降低术后结石复发率,值得进一步研究。     

CT检查对诊断胆囊腺肌症的效能分析*

目的 总结胆囊腺肌症与胆囊癌患者多层螺旋CT(MSCT)表现特征。方法 2015年9月～2020年9月我院诊治的胆囊腺肌症患者113例和胆囊癌患者78例,均接受MSCT和超声检查,外科手术治疗后行组织病理学检查。结果 MSCT检查结果与术后组织病理学检查结果的一致性(Kappa=0.749)显著高于超声检查(Kappa=0.577);MSCT诊断胆囊腺肌症的准确度为88.0%,显著高于超声检查的79.6%(P<0.05);MSCT对局限型胆囊腺肌症的检出率为97.1%,显著高于超声检查的82.9%(P<0.05);在CT检查上,胆囊腺肌症表现为胆囊壁光滑、RAS窦和肝胆交界清楚显示率分别为36.3%、36.3%和69.0%,显著高于胆囊癌组的9.0%、6.4%和38.5%(P<0.05)。结论 MSCT检查诊断胆囊腺肌症有较高的正确率,其特征有助于与胆囊癌鉴别。     

胆源性肝损伤临床特征分析及治疗手段探讨

目的 分析总结胆源性肝损伤(BLI)患者的临床特征,探讨磁共振胰胆管造影(MRCP)阴性的BLI患者内镜下逆行胰胆管造影术(ERCP)治疗和预后。方法 2018年1月～2019年12月我院收治的BLI患者77例,其中MRCP检查为阴性组34例和MRCP阳性组43例。根据病情,给予内镜乳头括约肌切开术(EST)或狭窄处扩张术治疗。结果 在77例患者中,有黄疸者70例(92.2%),腹痛者65例(84.4%),发热者27例(35.1%);腹部超声检查提示胆囊结石48例(62.3%),胆囊切除术后14例(18.2%); ERCP术后诊断为胆总管结石者71例(92.2%),MRCP阴性组胆总管泥沙样结石占91.2%,显著高于MRCP阳性组的9.3%,两组性别、年龄以及腹痛、黄疸发生率比较无显著性差异(P＞0.05);MRCP阴性组患者发热发生率为20.6%,显著低于MRCP阳性组的46.5% (P＜0.05),MRCP阴性组患者中性粒细胞百分数为(66.6±14.4)%,显著低于MRCP阳性组【(74.6±14.8)%, P＜0.05】;两组血清谷丙转氨酶(ALT)、碱性磷酸酶(AKP)、γ-谷氨酰转肽酶(GGT)和总胆红素(TBIL)水平无显著性差异(P>0.01);MRCP阴性组与阳性组ERCP术成功率和术后并发症发生率比较无显著性差异(P＞0.05)。结论 胆总管泥沙样结石是MRCP阴性的BLI患者最常见的病因。对于MRCP阴性的BLI患者,如伴有发热或/和中性粒细胞百分数升高,应高度怀疑BLI的可能,而给予相应的处理。     

肝部分切除联合胆肠吻合术治疗肝内胆管结石患者疗效比较研究*

目的 观察肝部分切除术联合胆肠吻合术治疗肝内胆管结石患者的疗效。方法 2017年2月～2020年2月我院收治的68例肝内胆管结石患者,其中观察组38例接受肝部分切除术联合胆肠吻合术治疗,对照组30例接受肝部分切除术联合T管引流术,术后随访12个月。采用ELISA法或双抗体夹心免疫发光法检测血清白细胞介素-6(IL-6)和C反应蛋白(CRP)。结果 观察组手术时间、术中出血量和住院日分别为(106.7±29.8)min、(261.7±64.2)mL和(15.5±3.5)d,显著长于或多与对照组【分别为(64.3±27.7)min、(190.3±49.0)mL和(10.2±2.3)d, P＜0.05】; 在术后7 d,观察组血清CRP和IL-6水平分别为(38.0±5.9)mg/L和(99.6±10.7)μg/L,显著高于对照组【分别为(25.2±5.1)mg/L和(83.6±9.8)μg/L, P＜0.05】;手术前后,两组血清肝功能指标无显著性差异(P>0.05);随访3个月,术后两组出现切口感染、胆漏、胆道出血和胸腹腔积液等并发症发生率比较,差异无统计学意义(13.2%对13.3%,P＞0.05);术后6周行超声检查,发现观察组结石残留率为5.3%,显著低于对照组的23.3%(P＜0.05),在随访12个月末,观察组结石复发率为13.2%,显著低于对照组的33.3%(P＜0.05)。结论 采取肝部分切除术联合胆肠吻合术治疗肝内胆管结石患者可减少结石残留和结石复发,其效果需进一步观察。     

腹部B超、CT和核磁胰胆管成像检查诊断肝外胆管结石的对比研究

目的评价超声、腹部CT（CT）和核磁胰胆管成像（MRCP）三种非侵人性检查方法在肝外胆管结石确诊中的应用价值。方法选择2001年1月-2007年12月在我院消化内镜中心行内镜下逆行胰胆管造影（ERCP）确诊的肝外胆管结石患者261例,并比较B超、CT和MRCP检查对胆外胆管结石的显示率并进行统计学分析。结果ERCP确诊胆总管结石患者261例,B超、CT和MRCP对胆总管结石的显示率分别为41．7％、55．6％和81．5％,两两比较有显著性差异（P〈0．05）;B超检查肝外胆总管内径≤0．8cm的胆总管结石患者共有47例,B超、CT和MRCP对胆总管无扩张胆总管结石的显示率分别为21％、30．8％和56％,B超与CT检查显示率比较无显著性差异（P〉0．05）,与MRCP比较有非常显著性差异（P〈0．01）。结论诊断肝外胆管结石时,MRCP明显优于CT和B超检查,尤其肝外胆管无扩张的患者,B超和CT检查有一定局限性。     

磁共振成像与彩色多普勒超声诊断胆道结石临床价值比较

目的 比较磁共振成像(MRI)与彩色多普勒超声(CDUS)在诊断胆道结石方面的临床应用价值。方法 2016年11月～2018年11月我院诊治的136例患者,均接受MRI和CDUS检查,以内镜下逆行胰胆管造影术( ERCP)检查为“金标准”,比较MRI和CDUS检查的诊断效能。结果 在136例患者中,经ERCP术后证实存在胆道结石115例,其中单发结石65例,多发结石50例,MRI的检出率分别为89.2%和100.0%,显著高于CDUS(分别为76.9%和56.0%,P<0.05);ERCP诊断大于1.0 cm、0.5～1.0 cm和<0.5 cm分别为49例、57例和9例,MRI的检出率分别为100.0%、91.2%和77.8%,显著高于CDUS的79.6%、63.2%和33.3%(P<0.05);MRI检查出胆囊、肝外胆管、肝内胆管和胆总管结石21例、30例、20例和37例,而CDUS只分别检出了18例(85.7%)、 18例(60.0%)、17例(65.4%)和25例(65.8%);本组MRI总体检出率为93.9%,显著高于CDUS的67.8%(P<0.05),MRI的误诊率为4.9%,而CDUS为10.3%。结论 尽管MRI检查诊断胆道结石的总体效能高于CDUS检查,但MRI和CDUS临床应用的价值可能与结石的位置和大小密切相关,临床应根据实际工作需要灵活选择应用。     

腹部CT检查鉴别诊断恶性肿瘤患者小肝脓肿与肝转移瘤经验分析

目的 探讨在肝外恶性肿瘤患者,使用腹部CT检查鉴别小肝脓肿与肝转移癌。方法 2017年1月～2020年12月我院行肝脏增强CT检查且影像学报告中使用了“肝脓肿”或“肝转移癌”的患者,分析CT特征包括病灶直径、病灶数量、动脉期边缘强化、持续边缘强化和边缘低密度水肿带等。结果 在32例肝脓肿患者和28例肝转移癌患者,腹部CT特征分析发现肝脓肿与肝转移癌患者病灶动脉期边缘增强(86.6%对53.3%)、病灶持续边缘强化(74.6%对16.0%)和胆管扩张(62.7%对13.3%)存在显著性差异(P<0.01),多因素分析显示病灶边缘持续强化是预测肝脓肿而不是肝转移癌的独立因素(P<0.01)。结论 在肝外恶性肿瘤患者,CT检查肝内病灶边缘持续强化可能是鉴别肝脓肿与肝转移癌的重要特征。     

术前胆汁CT值测定诊断胆囊泥沙样结石的应用价值分析

目的 探讨术前胆汁CT值测定在胆囊泥沙样结石诊断中的应用价值。方法 2018年9月～2020年9月解放军总医院肝胆外科常规检查假阴性的胆囊泥沙样结石患者72例和同期因肝脏手术切除正常胆囊的患者40例,常规检查腹部CT并测量CT值,比较两组血白细胞、血淀粉酶、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷酰转肽酶(GGT)、白细胞介素-6(IL-6)、降钙素原(PCT)和C反应蛋白(CRP)水平。应用受试者工作特征曲线下面积(AUC)分析CT值诊断的效能。结果 两组肝功能和血象变化无显著性差异(P＞0.05);胆囊结石患者胆汁CT值为(66.01±18.24)Hu,显著高于对照组患者【(25.40±8.23)Hu,P＜0.05】;两组术后血清炎症因子水平比较,也无显著性差异(P＞0.05);受试者工作特征曲线(ROC)分析显示,以胆汁CT值＞25.60 Hu为截断点,其诊断胆囊泥沙样结石的曲线下面积(AUC)为0.954,灵敏性为92.3%,特异性91.0%。结论 常规影像学检查假阴性的胆囊泥沙样结石患者胆汁CT值显著高于正常胆囊者,结合临床表现和胆汁CT值可以诊断胆囊泥沙样结石,值得进一步研究。     

CT引导下经皮肝穿刺胆道镜联合双频激光碎石取石治疗复发性肝内胆管结石患者疗效及安全性分析*

目的 探讨在CT引导下经皮肝穿刺胆道镜联合双频激光碎石取石治疗复发性肝内胆管结石患者的疗效和安全性。方法 2017年9月～2020年2月我院收治的60例复发性肝内胆管结石患者,其中31例(A组)接受CT引导下经皮肝穿刺胆道镜取石术(PTCSL)联合双频激光碎石取石治疗,另29例(B组)接受开腹手术治疗。采用化学发光免疫分析仪检测血清皮质醇(COR)和肾上腺素(EP)水平。结果 A组手术时间、肛门排气时间、首次排便时间和术后住院时间分别为(89.7±10.1)min、(30.3±3.6)h、(2.3±0.3)d和(6.9±1.1)d,显著短于B组【分别为(101.9±12.2)min、(34.7±4.1)h、(2.7±0.4)d和(11.8±1.6)d,P＜0.05】,术中出血量为(40.2±8.8)ml,显著少于B组[(97.4±10.6)ml,P＜0.05];在术后7 d,A组血白细胞计数、中性粒细胞百分比、血清COR和EP水平分别为(9.7±1.0)×10⁹/L、(67.8±5.9)%、(310.1±30.7)mmol/L和(210.7±22.8)pg/mL,显著低于B组【分别为(11.8±1.3)×10⁹/L、(76.4±7.1)%、(385.5±34.4)mmol/L和(247.3±23.1),P＜0.05】;A组血清ALT、AST、ALP和TBIL水平分别为(39.7±3.7)U/L、(39.9±4.1)U/L、(80.1±8.5)和(19.4±1.8)μmol/L,显著低于B组【分别为(45.6±5.1)U/L、(45.5±5.1)U/L、(85.9±6.8)和(23.0±3.4),P＜0.05】;A组术后并发症发生率为9.7%,显著低于B组的41.4%(P＜0.05);A组结石残余率为6.5%(2/31),显著低于B组的31.0%(9/29,P＜0.05)。结论 与传统开腹手术相比,采取在CT引导下经皮肝穿刺胆道镜联合双频激光碎石取石治疗复发性肝内胆管结石患者可减轻手术损伤,加快术后胃肠功能的恢复,可能与诱发的氧化应激和炎性反应较轻有关,同时其手术并发症和结石残留率也低。     

胆管内超声对胆管结石诊断价值的研究

目的 通过对磁共振胰胆管成像（MRCP）、内镜下逆行胆管造影（ERC）和十二指肠镜下胆管腔内超声（IDUS）对肝外胆管结石诊断作用的比较,评价IDUS对胆管结石的诊断价值.方法 对30例临床怀疑肝外胆管结石的患者,先行MRCP,然后行ERC,同时用经导丝的腔内超声探头行胆管内扫查.IDUS检查完成后,行内镜下取石,证实诊断.结果 30例中,MRCP准确诊断结石22例,将胆管絮状物诊断为结石2例,漏诊2例,其诊断结石的准确性、敏感性、特异性分别为86.7%（26/30）、91.7%（22/24）、66.7%（4/6）;ERC准确诊断结石23例,将胆管积气诊断为结石2例,漏诊1例,其诊断结石的准确性、敏感性、特异性分别为90%（27/30）、92%（23/25）、66.7%（4/6）;IDUS准确诊断结石24例,絮状物4例,气泡2例,无漏诊及误诊,其诊断结石的准确率、敏感性、特异性均为100%.结论 IDUS是一项安全可靠的技术,在确定胆管结石方面优于ERCP和MRCP.     

内镜超声检查对胆总管扩张的诊断价值

目的评价内镜超声检查(EUS)对胆总管扩张的病因诊断价值。方法32例患者在EUS 前均做过体表B超检查。患者的病因诊断均在病理或手术(包括奥狄括约肌切开取石)后确定。结果(1)32例患者的B超及EUS对胆总管直径的测定结果分别为(1.04±0.41)cm和(0.97±0.36)cm,两者差异无显著性(P＞0.05)。(2)对胆总管扩张的病因诊断率EUS为29/32(90.6％),明显高于体表B超19/32(59.4％),P＜0.01;X线电子计算机断层扫描(CT)21/32(65.6％),P＜0.05。EUS与磁共振胆胰管成像(MRCP)13/16(81.3％)和内镜逆行胰胆管造影(ERCP)31/32(96.9％)诊断率 相似(P＞0.05)。结论EUS对胆总管扩张的病因有很高的诊断价值。     

Evaluation of a new sequence of magnetic resonance cholangio-pancreatography in thick cut and one shot acquisition

OBJECTIVES: To assess the accuracy and reproducibility of a new magnetic resonance cholangiopancreatography sequence (MRCP), using long echo time and "single shot" acquisition (providing high-contrast thick slices: 20 mm or more), in the morphological analysis of the biliary tree and pancreatic ducts. METHODS: Fifty four patients with biliary and/or pancreatic disease were investigated with MRCP "single shot" thick slices. Biliary ducts were explored with MRCP "single shot", coronal and oblique coronal 20 mm thick slices on a 256 x 256 matrix. Natives pictures were reviewed by three independent radiologists, from three different institutions. MRCP results were compared with reference examinations in 54 cases (direct biligraphy methods: 54, CT scan: 11, endoscopic ultrasonography: 6, surgery: 6). RESULTS: For detection of bile duct dilatation, the agreement of MRCP "single shot" thick slices was more than 96% (Kappa > 0.92) and the inter-observer agreement was excellent (Kappa=0.92). For detection of biliary tree and/or pancreatic duct obstruction, MRCP "single shot" thick slice sensitivity was above 89% and specificity was 75%. The malignant nature of the lesions was determined with a sensitivity of 100% and a specificity of 92%. MRCP "single shot" thick slices could not differentiate pancreatic carcinomas from distal main bile duct cholangiocarcinomas. MRCP "single shot" thick slices did not detect small stones ( 3 mm) of the common bile duct. CONCLUSION: The excellent sensitivity, specificity and inter-observer agreement of MRCP "single shot" thick slices can be used to limit invasive imaging methods in the diagnosis of extrahepatic cholestasis.     

胆管腔内超声与逆行胆管造影诊断胆管结石的对比研究

目的 比较十二指肠镜下胆管腔内超声（IDUS）和内镜下逆行胆管造影（ERC）诊断肝外胆管结石的作用。方法 对30例临床怀疑有肝外胆管结石的患者，先进行ERC，再经内镜活检孔道将超声微探头直接送入胆管腔内探查，而后行乳头切开取石。结果 30例患者中，ERC准确诊断结石26例，将胆管絮状物诊断为结石1例，漏诊2例，其诊断结石的准确率，敏感性分别为86.7%(26/30),92.9%(26/28)；而IDUS准确诊断结石28例，无漏诊，误诊，其诊断结石的准确率，敏感性均为100.0%。结论 IDUS可弥补ERC的视觉误差且在确定胆管结石方面优于ERC。     

Preoperative Diagnosis of Gallbladder Torsion by Magnetic Resonance Cholangiopancreatography

The patient was a 78-year-old woman who was diagnosed as having gallbladder torsion preoperatively. This is the first reported case diagnosed by magnetic resonance cholangiopancreatography (MRCP). Signs and symptoms of this condition are often subtle. Radiologic evaluation by ultrasonography and computed tomography (CT) showed acute cholecystitis with stone. Drip-infusion cholangiography CT failed to outline the gallbladder, and distortion of the extrahepatic bile ducts and interruption of the cystic duct were observed. MRCP showed 1) a v-shaped distortion of the extrahepatic bile ducts due to traction by the cystic duct, 2) tapering and twisting interruption of the cystic duct, 3) a distended and enlarged gallbladder that was deviated to the midline of the abdomen, and 4) a difference in intensity between the gallbladder and the extrahepatic bile ducts and the cystic duct. A definitive diagnosis of gallbladder torsion (volvulus) was made by MRCP preoperatively. If treated surgically, gallbladder detorsion before cholecystectomy is a helpful technique to avoid bile duct injury. This condition should be suspected in elderly women with acute cholecystitis or acute abdominal pain of unknown origin, and MRCP may be very useful in making a definitive diagnosis.     

Preoperative diagnosis of gallbladder torsion by magnetic resonance cholangiopancreatography

The patient was a 78-year-old woman who was diagnosed as having gallbladder torsion preoperatively. This is the first reported case diagnosed by magnetic resonance cholangiopancreatography (MRCP). Signs and symptoms of this condition are often subtle. Radiologic evaluation by ultrasonography and computed tomography (CT) showed acute cholecystitis with stone. Drip-infusion cholangiography CT failed to outline the gallbladder, and distortion of the extrahepatic bile ducts and interruption of the cystic duct were observed. MRCP showed 1) a v-shaped distortion of the extrahepatic bile ducts due to traction by the cystic duct, 2) tapering and twisting interruption of the cystic duct, 3) a distended and enlarged gallbladder that was deviated to the midline of the abdomen, and 4) a difference in intensity between the gallbladder and the extrahepatic bile ducts and the cystic duct. A definitive diagnosis of gallbladder torsion (volvulus) was made by MRCP preoperatively. If treated surgically, gallbladder detorsion before cholecystectomy is a helpful technique to avoid bile duct injury. This condition should be suspected in elderly women with acute cholecystitis or acute abdominal pain of unknown origin, and MRCP may be very useful in making a definitive diagnosis.     

磁共振胰胆管成像对腹腔镜胆囊切除术的风险因素分析

目的 研究磁共振胰胆管成像（MRCP）在腹腔镜胆囊切除术（LC）术前发挥的作用。方法将2004年6月至2007年6月的944例胆囊结石患者在术前随机给予MRCP检查,了解胆囊结石合并胆总管结石,及胆道解剖异常的发生率。将合并胆总管结石或存在胆道解剖异常患者的术前资料和MRCP的结果进行对比分析。结果胆囊结石合并胆总管结石的发生率为8．1％（77／944）,其中无征兆胆总管结石的发生率为1．2％（11／944）,胆道解剖异常的发生率3．7％（35／944）。胆总管直径〉0．8cm者MRCP阳性率83％;胆囊结石病史5年以上者MRCP阳性率11％;有黄疸病史者MRCP阳性率65％;有胆源性胰腺炎病史者MRCP阳性率29％;实验室检查肝功能异常者MRCP阳性率33％;多发胆囊结石者MRCP阳性率13％,其中〈0．3cm的泥沙样结石MRCP阳性率15％。结论MRCP对胆总管结石及胆道解剖异常有很高的诊断价值。对于有危险因素的患者术前给予MRCP检查可降低LC术后胆总管残余结石及胆道损伤的发生率。     

比较彩超与磁共振胰胆管成像诊断胆总管结石的临床价值

目的 分析比较彩超与磁共振胰胆管成像（MRCP）检查诊断胆总管结石的价值。方法 我院疑诊为胆总管结石患者102例,均接受彩超和MRCP检查。以手术后病理学检查为金标准,应用受试者工作特征曲线（ROC）下面积（AUC）计算诊断的灵敏度、特异度和Youden指数。结果 在102例疑诊为胆总管结石患者中,经手术后病理学检查证实为胆总管结石90例;彩超检查发现单发结石39例（43.3%）,多发结石25例（27.8%）,而MRCP则分别检出46例（51.1%）和39例（43.3%）,MRCP检查结石检出率为94.4%,显著高于彩超检查的71.1%（P<0.05）;在直径>1.0 cm、0.5~1.0 cm和<0.5 cm结石,MRCP分别检出33例（36.7%）、45例（50.0%）和7例（7.8%）,与彩超检查比,差异显著（分别为31例（34.4%）、32例（35.6%）和1例（1.1%,P<0.05）;MRCP检出结石直径为（1.1~0.8）cm,显著小于彩超检出的（1.4~0.6）cm（P<0.05）,而两种方法未检出的结石直径无显著性差异【分别为（0.8~0.2）cm和（0.6~0.4）cm,P>0.05】;彩超检查诊断的灵敏度为71.1%,特异度为75.0%,Youden指数为0.5,而MRCP检查诊断的灵敏度为94.4%,特异度为91.7%,Youden指数为0.9（P<0.05）。结论 MRCP较彩超检查能发现更小的胆总管结石,并能准确判断结石数量,诊断价值更高。     

Diagnostic value of magnetic resonance cholangiopancreatography to detect bile duct stones in acute biliary pancreatitis

Objectives

This study aims to evaluate the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) in detecting common bile duct (CBD) stones in acute biliary pancreatitis (ABP).

Prospective study of endoscopic ultrasound performance in suspected choledocholithiasis

Background: The close proximity of the echoendoscope to the extrahepatic bile ductal system and its safety make endoscopic ultrasonography (EUS) an excellent method for examining the common bile duct (CBD). The aim of the present study was to compare EUS diagnostic performance for CBD stones with endoscopic retrograde cholangiography (ERC). Methods: A prospective series of our first 60 patients (65% women, average age 43 years) who were referred for ERC for suspicion of choledocholithiasis based on clinical, biochemical and cross‐sectional imaging (ultrasonography [US] or computed tomography [CT]) data underwent radial EUS. EUS results were recorded as positive or negative for CBD stones before starting the ERC. All patients underwent ERC with a balloon sweep of the bile duct as the standard of reference for CBD stone. All procedures were performed during the same endoscopy session by a single endoscopist who was blinded to the clinical, biochemical and imaging data. Results: Sixty‐five percent of our patients had low to moderate risk for CBD stones. EUS diagnoses were confirmed by ERC as follows: 23 true positive, 33 true negative, three false negative and one false positive (sensitivity of 89%, specificity of 97%, positive predictive value of 96%, and negative predictive value of 92%; overall accuracy of 93%). Compared to the EUS diagnostic accuracy (90%) during the first 30 cases, EUS had a very high diagnostic accuracy (97%) for CBD stones during the last 30 cases (P = 0.31). Conclusion: EUS is highly accurate for the diagnosis of choledocholithiasis. The EUS learning curve is relatively short for CBD stones.