Is preoperative MRCP necessary for patients with gallstones? An analysis of the factors related to missed diagnosis of choledocholithiasis by preoperative ultrasound
Is preoperative MRCP necessary for patients with gallstones? An analysis of the factors related to missed diagnosis of choledocholithiasis by preoperative ultrasound
复制标题
胆结石患者术前有必要进行MRCP吗？
DOI：
10.1186/s12876-015-0392-1
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发表时间：
2015-11-14
影响因子：
2.4
通讯作者：
Xue, Dongbo
中科院分区：
文献类型：
--
作者：
Qiu, Yan;Yang, Zhengpeng;Xue, Dongbo
胆囊结石患者胆囊切除术前对合并胆总管结石的诊断对手术决策和治疗效果具有重要意义。然而，超声是否足以用于胆总管结石的术前诊断仍然存在争议，对于是否需要常规磁共振胰胆管造影（MRCP）来检测胆总管（CBD）结石的可能存在，存在不同的意见。哈尔滨医科大学附属第一医院普外科收治胆囊结石患者413例，方法回顾性分析1998年至2000年在国内行超声和MRCP检查的30例乳腺癌患者的临床资料。对413例患者进行回顾性分析，筛选出性别、年龄、谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素、间接胆红素、碱性磷酸酶、γ-氨基转移酶、胆总管直径、合并急性胆囊炎等11项指标进行对比分析。占全部病例的26.39%。其中超声检查发现胆总管结石60例，占55.05%，超声检查未发现胆总管结石49例，经MRCP证实（超声漏诊率为44.95%）。统计学分析结果表明，丙氨酸氨基转移酶、急性胆囊炎和胆总管直径是超声漏诊的3个最相关因素。结论术前超声诊断胆总管结石的准确性不高。然而，丙氨酸氨基转移酶升高，并发急性胆囊炎和CBD直径被确定为可能影响诊断准确性的关键因素。因此，常规术前MRCP检查，建议胆结石患者排除可能的并发胆总管结石。
BackgroundThe diagnosis of associated choledocholithiasis prior to cholecystectomy for patients with gallstones is important for the surgical decision and treatment efficacy. However, whether ultrasound is sufficient for preoperative diagnosis of choledocholithiasis remains controversial, with different opinions on whether routine magnetic resonance cholangiopancreatography (MRCP) is needed to detect the possible presence of common bile duct (CBD) stones.MethodsIn this study, a total of 413 patients with gallstones who were admitted to the Department of General Surgery of the First Affiliated Hospital of Harbin Medical University in China for a period of 3 years and underwent both ultrasound and MRCP examinations were retrospectively analysed. After reviewing and screening these cases according to the literature, 11 indicators including gender, age, alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, indirect bilirubin, alkaline phosphatase, γ-aminotransferase, CBD diameter, and concurrent acute cholecystitis were selected and comparatively analysed.ResultsAmong the 413 patients, a total of 109 cases showed concurrent gallstones and choledocholithiasis, accounting for 26.39 % of all cases. Among them, 60 cases of choledocholithiasis were revealed by ultrasound examination, accounting for 55.05 %, while 49 cases of choledocholithiasis were not detected by ultrasound examination but were confirmed by MRCP instead (the missed diagnosis rate of ultrasound was 44.95 %). The results of statistical analysis suggested that alanine aminotransferase, acute cholecystitis, and CBD diameter were the three most relevant factors for missed diagnosis by ultrasound.ConclusionThe accuracy of preoperative ultrasonography for the diagnosis of associated CBD stones for patients with gallstones is not high. However, elevated alanine aminotransferase, concurrent acute cholecystitis, and CBD diameter were identified as key factors that may affect the accuracy of the diagnosis. Thus, routine preoperative MRCP examination is suggested for patients with gallstones to rule out possible concomitant CBD stones.