B超、T管造影及电子胆道镜对胆管残余结石的诊断价值

目的 探讨胆道术后残余结石的诊断方法。方法 回顾分析167例进行胆道镜检查和取石病人的B超、T管造影和胆道镜检查记录，对3种诊断方法的诊断准确率和诊断效率进行比较分析。结果 B超、T管造影和胆道镜三者的诊断准确率、假阳性率及假阴性率分别为84．5，5．6，9．9，74．6，1．4，23．9，98．6，0和1．4％。但电子胆道镜与B超(P=0．791)、T管造影(P=0．457)的诊断效率差异性比较无统计学意义。结论 三种检查方法各有优点，B超能提供结石位置与数量、胆管扩张情况，T管造影能提供有无残余结石、胆管狭窄、胆道引流是否通畅，胆道镜能直接了解结石、肿瘤、狭窄、炎症、出血和发现B超、T管造影不能发现的结石，并可同步进行取石。三者在胆道术后残余结石的诊断过程中发挥各自优势，不能相互替代，建议胆道结石的术后病人常规进行三者检查，在最大程度上降低胆管结石残余率。

Diagnostic value of type-B ultrasonography,T-Tube cholangiography and electronic choledochoscopy to retained bile duct stones

Objective: To investigate the diagnostic methods to retained bile duct stones after surgery. Methods: The records with type-B ultrasonography, T-Tube cholangiography and electronic choledochoscopy were retrospectively analyzed on 167 cases for cleaning the retained bile duct stones with choledochoscopy, and their diagnostic validity rate and diagnostic effect were compared. Results: The diagnostic validity rate, false positive rate, false negative rate of type-B ultrasonography, T-Tube cholangiography and electronic choledochoscopy was 84.5%, 5.6%, 9.9%, 74.6%, 1.4%, 23.9%,98.6%, 0, 1.4%, respectively. But there were no significant difference in diagnostic effect between electronic choledochoscope and Type-B Ultrasonography(P=0.791), electronic choledochoscope and T-Tube cholangiography(P=0.457). Conclusions: Each had his advantages in three diagnostic methods. Type-B ultrasonography can find the retained stones position and amounts, bile duct dilation. T-Tube cholangiography can find the retained stones, bile duct stricture and duct drainage. Electronic choledochoscopy can find directly the retained stones, tumor, stricture, inflammation, bleeding and the missed out stones by type-B ultrasonography and T-Tube cholangiography. At the same time the found stones can be cleaned during choledochoscopy. Three methods exerted their powers in diagnosing the retained bile duct stones after surgery and cannot be substituted with each other. It suggested that threemethods should be used routinely in order to ultimately reduce the retained stones rate after surgery.