术中胆道造影联合腹腔镜超声诊断胆道结石的临床价值

Clinical evaluation of Intraoperative cholangiography and laparoscopic ultrasound in common bile duct(CBD) stone exploration

目的探讨腹腔镜胆囊切除(LC)术中胆道造影(IOC)和腹腔镜超声(LUS)诊断胆总管结石的临床价值。方法对2001年3月～2003年12月行LC手术、有胆总管探查指证、且符合纳入标准的98例住院患者进行临床研究。所有患者在切除胆囊前均先行LUS检查再行IOC检查,统计两种检查方法的操作成功率和操作时间。结果IOC操作成功率为94.9%,LUS为100%。IOC的操作时间为(11.37±3.53)min,LUS为(7.68±2.14)min。LUS和IOC在操作时间上差异有显著性(P<0.01)。IOC的敏感性为85.0%,特异性为96.2%,准确性为91.4%,阳性预测值为94.4%,阴性预测值为89.5%,阳性似然比为22.4,阴性似然比为0.156;LUS的敏感性为82.5%,特异性为98.1%,准确性为91.4%,阳性预测值为97.1%,阴性预测值为88.1%,阳性似然比为43.40,阴性似然比为0.178;LUS联合IOC的敏感性为97.%,特异性为94.3%,准确性为95.7%,阳性预测值为92.9%,阴性预测值为98.0%,阳性似然比为17.1,阴性似然比为0.027。LUS联合IOC对胆道结石诊断的敏感性、准确性差异均有显著性(P<0.01)。结论在LC术中,LUS操作时间明显要比IOC短,且成功率要高,LC术中建议先行LUS检查,对LUS检查阴性的患者再行IOC检查,可提高诊断效果。LUS联合IOC对胆总管结石的诊断率97.5%以上。

[Objective] To evaluate the value of laparoscopic ultrasound （LUS） and intraoperative cholangiography （IOC） in common bile duet stone exploration by comparing the results and feasibility of IOC and LUS. [Methods] 98 patients with LC and CBD exploration indication had been included this clinical diagnostic test from March of 2001 to December of 2003. All patients were examined LUS and LOC before eholeeysteetomy and the successful rates and examining time were recorded with these two ways. [Result] Success rate of LOC is 94.9%, LUS is 100%. Operative time of LOC is （11.37±3.53） min, LUS is （7.68±2.14） rain. There are significant difference between LUS and IOC （P 〈0.01）. LOC sensitivity is 85.0%, specificity is 96.2%, accuracy 91.4%, positive predictive value is 94.4%, negative predictive value is 89.5%, positive likelihood ratio is 22.4, negative likelihood ratio is 0.156. LUS sensitivity is 82.5%, specificity is 98.1%, accuracy is 91.4%. Positive predictive value is 97.1%, negative predictive value is 88.1%, positive likelihood ratio is .43.4, negative likelihood ratio is 0.178.LUS＋LOC sensitivity is 97.5%, specificity is 943%, accuracy is 95.7%, positive predictive vahie is 92.9%, negative,predictive value is 98.0%; positive likelihood ratio is 17.1, negative predictive value is 0.027. LUS and IOC There are significant difference between CBD stone exploration of sensitivity and specificity. [Conclusion] LUS can increase the accuracy of diagnosing CBD stone for whom can not be IOC. The accuracy diagnosing of LUS and IOC for the CBD stone exploration is above 97.5%.