腹腔镜胆囊切除术前超声内镜检查胆总管必要性的探讨

目的 探讨腹腔镜胆囊切除（laparoscopic cholecystectomy,LC）术前超声内镜（endoscopic ultrasonography,EUS）检查胆总管的临床价值。方法 对25例术前经腹超声检查诊断胆囊结石,胆总管内径〉0.7 cm可疑胆总管梗阻的患者进行EUS检查,并与手术结果或内镜十二指肠乳头切开术（endoscopic sphincterotomy,EST）取石结果进行比较。结果 EUS对于胆总管病变诊断的敏感性、准确性和阴性预测值[100%（17/17）、92%（23/25）、100%（6/6）]均优于经腹超声[35%（6/17）、56%（14/25）、42%（8/19）]（P=0.000,0.008,0.020）。结论EUS对胆总管病变诊断优于经腹超声检查,可作为术前常规检查,特别是当胆总管内径〉1.0 cm时,EUS应作为术前必检项目。

On the significance of endoscopic ultrasonography before laparoscopic cholecystectomy

Objective To investigate the value of endoscopic ultrasonography(EUS) for the exploration of the common bile duct before laparoscopic cholecystectomy. Methods Twenty-five patients with cholecystolithiasis and expanded common bile duct(> 0.7 cm in diameter) under preoperative transabdominal ultrasonography were suspicious of extrahepatic biliary obstruction.All of them underwent EUS before laparoscopic cholecystectomy.The diagnosis was confirmatively clarified by operation or endoscopic sphincterotomy.Results The EUS was superior to transabdominal ultrasonography for the diagnosis of lesions in the common bile duct in sensitivity [100%(17/17) vs 35%(6/17),P=0.000],accuracy [92%(23/25) vs 56%(14/25),P=0.008],and negative prediction value [100%(6/6) vs 42%(8/19),P=0.020].Conclusions The diagnostic capability of EUS is superior to transabdominal ultrasonography.It should be selected as a routine preoperative examination,especially in patients with common bile duct > 1.0 cm in diameter.