腹腔镜胆囊切除术前术前常规磁共振胆管造影:一项前瞻性研究。

M B Jendresen, J E Thorbøll, S Adamsen, H Nielsen, S Grønvall, O Hart-Hansen
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引用次数: 54

摘要

目的:探讨磁共振胆管造影(MRCP)在选择性转诊胆结石疾病患者术前调查中发现胆总管结石的诊断价值,了解无症状胆总管结石的发生率,并将临床症状、病史及肝功能检查(LFT)与胆总管结石实际发生的相关性。设计:前瞻性研究。地点:丹麦综合医院。患者:连续180例有症状性胆结石的非黄疸患者行择期胆囊切除术。干预措施:LFT、腹部超声、MRCP、内窥镜逆行胰胆管造影(ERCP)、问卷调查。主要结局指标:MRCP阳性和阴性预测值和准确性,无症状结石患者人数,症状与结石存在的相关性。结果:共管结石26/180(14%)。只有一个(7mm)胆管(82%)。术后6个月无导管结石患者再入院。结论:MRCP的预测价值较好,但遗漏了一些小结石
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Preoperative routine magnetic resonance cholangiopancreatography before laparoscopic cholecystectomy: a prospective study.

Objectives: To assess the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) in detecting common bile duct stones in the preoperative investigation of patients electively referred for gallstone disease, to find out the incidence of asymptomatic common duct stones, and to correlate clinical symptoms and history and liver function tests (LFT) with the actual occurrence of common duct stones.

Design: Prospective study.

Setting: General hospital, Denmark.

Patients: 180 consecutive non-jaundiced patients referred with symptomatic gallstones for elective cholecystectomy.

Interventions: LFT, abdominal ultrasonography, MRCP, endoscopic retrograde cholangiopancreatography (ERCP), questionnaire.

Main outcome measures: Positive and negative predictive values and accuracy of MRCP, number of patients with asymptomatic stones, and correlation of symptoms with the presence of stones.

Results: 26/180 patients had common duct stones (14%). Only one (<1%) had an asymptomatic stone. For detection of such stones, MRCP's positive predictive value was 0.95 (95% confidence interval (CI): 0.86 to 1.00), negative predictive value 0.96 (0.93 to 0.99), and accuracy 0.85 (0.93 to 0.99). MRCP missed 5 stones 1-4 mm in size in 5 patients; 17/64 patients with raised LFTs had stones (27%). The probability of stones was highest when the patients had both raised LFTs and a dilated common (>7 mm) bile duct (82%). There were no readmissions with ductal stones in the 6-month postoperative period.

Conclusions: The predicive values of MRCP were fairly good, but MRCP misses some small stones <5 mm in size. Asymptomatic stones in the common duct are not common in this population and should not be screened for. The probability of stones increases with the number of predictive factors. Patients should be questioned carefully about signs of biliary obstruction, and only be offered preoperative MRCP should they have a suspicious history, raised LFTs, or a dilated common duct.

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