Choledocholithiasis: Evolving standards for diagnosis and management

胆石病，导致外科的干预的最普通的医药条件之一，在美国影响成年人口的约 10 % 。胆总管石病与胆囊石头在大约病人的 10%-20% 发展，文学建议至少经历胆囊炎的病人的 3%-10% 将有胆总管(CBD ) 石头。CBD 石头可以外科手术前地， intraoperatively 或手术后地被发现多重形式为包括实验室测试，超声，计算断层摄影术扫描(CT ) ，和磁性的回声 cholangiopancreatography (MRCP ) 为胆总管石病估计病人是可得到的。Intraoperative 胆管造影术能习惯性地或有选择地在胆囊炎期间被使用诊断 CBD 石头。为 CBD 石头的最普通的干预是 ERCP。另外的通常使用的干预包括 intraoperative 胆汁管探索，任何一个 laparoscopic 或 open。经皮， transhepatic 石头移动胆汁的清理的另外的新奇技术被设计了。与这些技术灵巧的设备和有技能的专业人员的可获得性在机构之中变化。预定干预被临床的状况经常支配。

Cholelithiasis, one of the most common medical conditions leading to surgical intervention, affects approximately 10 % of the adult population in the United States. Choledocholithiasis develops in about 10%-20% of patients with gallbladder stones and the literature suggests that at least 3%-10% of patients undergoing cholecystectomy will have common bile duct （CBD） stones. CBD stones may be discovered preoperatively, intraoperatively or postoperatively Multiple modalities are available for assessing patients for choledocholithiasis including laboratory tests, ultrasound, computed tomography scans （CT）, and magnetic resonance cholangiopancreatography （MRCP）. Intraoperative cholangiography during cholecystectomy can be used routinely or selectively to diagnose CBD stones. The most common intervention for CBD stones is ERCP. Other commonly used interventions include intraoperative bile duct exploration, either laparoscopic or open. Percutaneous, transhepatic stone removal other novel techniques of biliary clearance have been devised. The availability, of equipment and skilled practitioners who are facile with these techniques varies among institutions. The timing of the intervention is olden dictated by the clinical situation.