内镜超声检查在腹腔镜胆囊切除术前的价值

The preoperative value of the endoscopic ultrasound scanning for laparoscopic cholecystectomy

目的评估内镜超声检查(EUS)对于胆囊结石患者在行腹腔镜胆囊切除术(LC)术前排除胆总管下段良性疾病的价值。方法回顾性分析我院从2004年1月至2008年1月患有胆囊结石并行LC的住院病历资料共1000例,选取常规B超(BUS)提示胆总管直径≥0.7cm病例共202例,分为EUS组和BUS组,计算EUS组的诊断率、敏感度、特异度,BUS组的胆总管下段良性病变的漏诊率。结果 EUS的对胆总管良性疾病的敏感度和特异度分别为98.2%、92.5%,阳性预测价值阴性预测价值分别为94.7%、92.5.4%,术前正确诊断率为95.8%;BUS组对胆总管结石的术前漏诊率为55.7%(21/46),对所有胆总管下段良性疾病的漏诊率为65.2%(30/46);所有EUS组患者未发生严重并发症。结论胆囊结石患者当术前B超提示胆总管直径≥7mm时,胆总管结石或者下段良性病变的比例为65.2%,其中大部分为胆总管结石,EUS对胆总管下段良性疾病诊断的敏感度、特异度、阳性预测价值、阴性预测价值和正确诊断率均高于90%,因此EUS可以作为胆总管良性扩张的诊断筛查方法。

Objective To evaluate the use of endoscopic ultrasound scanning to diagnose benigh diseases of common bile duct prior to laparoscopic cholecystectomy.Methods The information of 1000 patients performed LC between January 2004 to July 2008 in The First Affiliated Hospital of Sun Yat-sen University were reviewed,there were 202 patients whose co mmon bile duct（CBD） diameter was 7 mm or more by trans-abdo minal ultrasound scanning（BUS）.According to whether or not use of endoscopic ultrasound scanning（EUS）prior to laparoscopic cholecystectomy.202 patients were divided two groups（EUS group and BUS group）.The sensitivities,specificities,accuracies,positive and negative predictive values for benigh disease of CBD by EUS were calculated,also the rate of missed diagnosis for benigh disease of CBD by BUS were calculated.Results The successful rate of EUS was 100%,and the rate of serious complications was 0.The sensitivities,specificities,accuracies,positive and negative predictive values for Benigh disease of CBDS by EUS were 98.2%,92.5%,95.8%,94.7%,97.4%.The rate of missed diagnosis for benigh disease of CBD by BUS was 65.2%.Conclusions When a patient who suffered gallbladder stones and whose CBD diameter is 7 mm or more,the rate of benigh disease（include of CBDS）of whose CBD are 65.2%.The sensitivities,specificities,accuracies,positive and negative predictive values for Benigh disease of CBD by EUS are all more than 90%,so EUS is a good screening technique for those patients whose CBD are negative by BUS and whose diameter of CBD is 7 mm or more.