无胆总管结石高危因素的胆囊结石患者行磁共振胆胰管成像的必要性

Necessity of MRCP Examination before Laparoscopic Cholecystectomy for Patients who have Cholecystolithiasis without high Risk Factor of Choledocholith

目的探讨无胆总管结石高危因素的胆囊结石患者行腹腔镜下胆囊切除术(LC)前行磁共振胆胰管成像(MRCP)检查的必要性。方法回顾分析我院450例无胆总管结石高危因素的胆囊结石患者行LC术前常规行彩超、MRCP检查并于术后结果比较。结果 450例无胆总管结石高危因素的患者经MRCP检出胆总管结石38例,术中胆总管探查阳性率100%,无胆道损伤病例,术后随访最少三个月,除一例术后7天因发生胆总管结石再次住院外,无因胆总管结石再次入院及死亡病例。结论对于无胆总管结石高危因素的胆囊结石患者LC术前常规行MRCP检查是很有必要的,可以及时发现隐匿性胆总管结石,减少胆总管结石的漏诊,减少术中胆总管探查阴性率和胆道损伤等并发症。

Objective To discuss the necessity of MRCP examination before laparoscopic eholecystectomy （LC） for patients who have cholecystolithiasis without high risk factor of choledocholith. Methods Retrospective analysis 450 cholecystolithiasis patients who had no high risk factor. We used MRCP and ultrasound as a routine examination for all cholecystolithiasis patients before LC and contrasted with the operation results. Results 38 choledocholithiasis patients had been found from the 450 eholecystolithiasis patients who had no risk factors of choledocholithiasis, The positive rate of intra-operative exploration for bile common duct was 100%. All the patients were followed up for at least three months. There was only one patient readmitted to hospital because of choledocholithiasis and there was no other patient readmitted to hospital because of choledocholithiasis and no death patient. Conclusion It is do necessary to take MRCP as a routine examination for patients who have cholecystolithiasis without risk factor of choledocholith before LC, which can reduce or avoid misdiagnosis of choledocholithiasis, reduce the negative rate of exploration of the bile common duct and reduce the complication of LC.