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。

Magnetic resonance cholangiopancreatography to analyze the risk factor before laparoscopic cholecystectomy

Objective To assess the diagnostic value of MRCP before LC.Methods 944 cases with chronic calculous cholecystitis underwent MRCP before LC from June 2004 to June 2007 in our department.incidence rate of cholecvstolithiasis together with common bile duct stones and incidence rate of anatomic abnormity of bile duct were collected.Results The incidence rate of cholecvstolithiasis together with common bile duct stones were 8.1%(77/944),and the oecurence ofACBDS were 1.2%(11/944).The incidence rate of anatomic abnormity of bile duct were 3.7%(35/944).Conclusion MRCP can not only offer a excellent diagnostic value of ACBDS and anatomic abnormity of bile duct,but also reduce the occurrence of CBDS remainder and iatrogenic bile duct iniuries.