Application of MRCP in 998 Cases of Common Bile Duct Stones of Diameter in The Normal Range_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CHENAn-ping , LIHua-lin , GAOYuan , HUTing , SUOYuen-sheng , YIBing , LIUJin-heng , ZHANGSheng-long

Department of Hepatobiliary Surgery, The Second Hospital of Chengdu City, Chengdu 610017, Sichuan Province, China;

Corresponding?author：

CHENAn-ping, Email: chenanping1954@163.com

Keywords：

Magnetic resonance cholangiopancreatography; Laparoscopy; Choledochoscopy; Duodenoscopy; Cholelithiasis

DOI：

10.7507/1007-9424.20160219

Video：

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Objective To investigate the clinical value of MRCP and (or) MRI on combination of choledochoscopy and duodenoscopy during the course of therapeutic laparoscopy with preoperative or intraoperative help diagnosis and treatment of gallbladder stone with common bile duct stones of diameter in the normal range. Methods The clinical data of 998 patients with calculus of bile duct with diameter in the normal range of common bile duct (common bile duct diameter of 0.2-0.8 cm) by MRCP and (or) MRI assist in diagnosis and treatment from Oct. 2001 to Dec. 2015 in the Second People's Hospital of Chengdu City were retrospectively analized. Results The 998 cases of common bile duct diameter≤0.8 cm were diagnosed and treated by using MRCP and (or) MRI examination. Choledochoscopy group: There were 399 cases, 352 cases (88.2%) were successful removed the bile duct residual stones through the choledochoscopic procedure, converted to intraoperative endoscopic sphincterotomy in 47 cases (11.8%). The false positive rate of MRCP and (or) MRI was 3.7% (13/352), the false negative rate of color Doppler ultrasound was 79.3% (279/352). Duodenoscopy treatment group: It was performed in 408 cases. The stones of common bile duct removed with duodenoscopic papillo-tomy in 381 cases (93.4%), the stone expulsion after duodenoscopic papillotomy in 18 cases (4.4%), 9 cases (2.2%) were shifted to other operation. False negative rate of color Doppler ultrasound was 79.5% (303/381). Three endoscopy group: There were 191 cases that intraoperative choledochoscopic exploration or intraoperative endoscopic papillotomy. The false positive rate of MRCP and (or) MRI was 2.6% (5/191), the false negative rate of color Doppler ultrasound was 76.4% (146/191). Conclusions Routine use of MRCP and MRI, in preoperative or intraoperative help diagnosis and treatment of gallbladder stone with common bile duct stones of diameter in the normal range, on combination of choledochoscopy and duodenoscopy during the course of therapeutic laparoscopy. It is necessary, feasible, effective and safe.

Citation： CHENAn-ping, LIHua-lin, GAOYuan, HUTing, SUOYuen-sheng, YIBing, LIUJin-heng, ZHANGSheng-long. Application of MRCP in 998 Cases of Common Bile Duct Stones of Diameter in The Normal Range. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(7): 847-850. doi: 10.7507/1007-9424.20160219 Copy

1.	黃潔夫主編.腹部外科學.北京:人民衛生出版社, 2001: 1330-1336.
2.	黃志強.膽道外科基礎與臨床. 2版, 北京:人民衛生出版社, 2003: 3-7.
3.	李華林, 陳安平, 索運生.腹腔鏡膽總管探查經腹鼻膽管引流的臨床應用.中華腔鏡外科雜志, 2015, 8 (4): 36-40.
4.	Topal B, Aerts R, Penninckx F. Laparoscopic common bile duct stone clearance with flexible choledochoscopy. Surg Endosc, 2007, 21(12): 2317-2321．.
5.	李波, 陳安平, 索運生, 等.腹腔鏡膽總管探查即時縫合術983例報告.中華腔鏡外科雜志, 2010, 3(5): 26-30.
6.	Elgeidie AA, Elebidy GK, Naeem YM. Preoperative versus intraopera-tive endoscopic sphincterotomy for management of common bile duct stones. Surg Endosc, 2011, 25(4): 1230-1237.
7.	郭鑫, 陳安平, 李波, 等.腹腔鏡、膽道鏡同期治療膽囊結石合并正常直徑膽總管結石.中華普外科手術學雜志, 2012, 6(1): 38-41.
8.	陳心煥, 許兆祥.膽道探查一期縫合與T管引流的療效對比.肝膽胰外科雜志, 2010, 22(4): 327-329.
9.	王佳牧, 陳安平, 山長星, 等.腹腔鏡膽總管探查術2 161例報告.外科研究與新技術, 2013, 2(3): 152-166.
10.	Zhao LD, Bie P, Wang SG, et al. Arangdomized comparison of primary closure and T-tube drainage of the common bile duct after laparoscopic choledochotomy. Sury Endosc, 2008, 22(7): 1595-1600.
11.	索運生, 陳安平, 肖宏, 等.腹腔鏡下再次膽道手術83例報告.中華普外科手術學雜志, 2012, 6(4): 10-12.
12.	Zhu QD, Tao CL, Zhou MT, et al. Primary closure versus T-tube drainage after common bile duct exploration for choledocholithiasis. Langenbecks Arch Surg, 2010, 14(5): 844-848.
13.	李波, 陳安平, 索運生, 等.腹腔鏡膽囊切除術術中聯合十二指腸鏡治療正常直徑膽總管結石158例.中華腔鏡外科雜志, 2011, 4(1): 33-37.
14.	潘步建, 周蒙滔, 徐邁宇, 等.腹腔鏡膽總管探查術治療膽總管結石合并膽囊結石.中華肝膽外科雜志, 2011, 17(10): 816-819.
15.	陳安平, 胡鋌, 李華林, 等.同期腹腔鏡、膽道鏡、十二指腸鏡多入路治療膽囊結石合并細徑膽總管結石71例.中國普外基礎與臨床雜志, 2014, 21(8): 946-950.
16.	倪志平, 劉雋, 湯可立, 等.膽總管探查術后一期縫合的臨床經驗及適應癥探討.中國普外基礎與臨床雜志, 2011, 18(3): 320-323.
17.	李華林, 陳安平, 胡鋌, 等.經膽囊管入路同期三鏡治療細徑膽總管結石的臨床應用.肝膽胰外科雜志, 2015, 27(5): 358-360, 364.
18.	張啟瑜主編.錢禮腹部外科學.北京:人民衛生出版社, 2006: 879-881.
19.	陳安平, 王佳牧, 山長星, 等.三鏡同期聯合手術治療膽結石174例分析.中華普外科手術學雜志, 2013, 7(2): 30-32.
20.	楊孫虎, 侯軍麗, 阿不都斯木, 等.腹腔鏡治療膽囊結石合并肝外膽管結石臨床研究.中國普外基礎與臨床雜志, 2014, 21(7): 872-874.
21.	郭鑫, 陳安平, 李波, 等.腹腔鏡聯合十二指腸鏡早期治療輕型急性膽源性胰腺炎57例報告.中華普外科手術學雜志, 2012, 6(2): 47-49.
22.	田大廣, 黃潔, 張捷, 等. LC與EST聯合應用治療膽囊結石繼發性膽總管結石.中國普通外科雜志, 2006, 15(8): 579-581.
23.	王佳牧, 陳安平, 山長星, 等.腹腔鏡、膽道鏡、十二指腸鏡(三鏡)同期手術擴大一期縫合術應用199例報告.外科研究與新技術, 2013, 2(3): 170-172.
24.	胡三元.肝內、外膽管結石的腹腔鏡處理.中國普外基礎與臨床雜志, 2008, 15(10): 711-713.
25.	李波, 陳安平, 索運生, 等.腹腔鏡膽總管探查術1 712例報告.中華腔鏡外科雜志, 2010, 3(4): 40-43.

1. 黃潔夫主編.腹部外科學.北京:人民衛生出版社, 2001: 1330-1336.
2. 黃志強.膽道外科基礎與臨床. 2版, 北京:人民衛生出版社, 2003: 3-7.
3. 李華林, 陳安平, 索運生.腹腔鏡膽總管探查經腹鼻膽管引流的臨床應用.中華腔鏡外科雜志, 2015, 8 (4): 36-40.
4. Topal B, Aerts R, Penninckx F. Laparoscopic common bile duct stone clearance with flexible choledochoscopy. Surg Endosc, 2007, 21(12): 2317-2321．.
5. 李波, 陳安平, 索運生, 等.腹腔鏡膽總管探查即時縫合術983例報告.中華腔鏡外科雜志, 2010, 3(5): 26-30.
6. Elgeidie AA, Elebidy GK, Naeem YM. Preoperative versus intraopera-tive endoscopic sphincterotomy for management of common bile duct stones. Surg Endosc, 2011, 25(4): 1230-1237.
7. 郭鑫, 陳安平, 李波, 等.腹腔鏡、膽道鏡同期治療膽囊結石合并正常直徑膽總管結石.中華普外科手術學雜志, 2012, 6(1): 38-41.
8. 陳心煥, 許兆祥.膽道探查一期縫合與T管引流的療效對比.肝膽胰外科雜志, 2010, 22(4): 327-329.
9. 王佳牧, 陳安平, 山長星, 等.腹腔鏡膽總管探查術2 161例報告.外科研究與新技術, 2013, 2(3): 152-166.
10. Zhao LD, Bie P, Wang SG, et al. Arangdomized comparison of primary closure and T-tube drainage of the common bile duct after laparoscopic choledochotomy. Sury Endosc, 2008, 22(7): 1595-1600.
11. 索運生, 陳安平, 肖宏, 等.腹腔鏡下再次膽道手術83例報告.中華普外科手術學雜志, 2012, 6(4): 10-12.
12. Zhu QD, Tao CL, Zhou MT, et al. Primary closure versus T-tube drainage after common bile duct exploration for choledocholithiasis. Langenbecks Arch Surg, 2010, 14(5): 844-848.
13. 李波, 陳安平, 索運生, 等.腹腔鏡膽囊切除術術中聯合十二指腸鏡治療正常直徑膽總管結石158例.中華腔鏡外科雜志, 2011, 4(1): 33-37.
14. 潘步建, 周蒙滔, 徐邁宇, 等.腹腔鏡膽總管探查術治療膽總管結石合并膽囊結石.中華肝膽外科雜志, 2011, 17(10): 816-819.
15. 陳安平, 胡鋌, 李華林, 等.同期腹腔鏡、膽道鏡、十二指腸鏡多入路治療膽囊結石合并細徑膽總管結石71例.中國普外基礎與臨床雜志, 2014, 21(8): 946-950.
16. 倪志平, 劉雋, 湯可立, 等.膽總管探查術后一期縫合的臨床經驗及適應癥探討.中國普外基礎與臨床雜志, 2011, 18(3): 320-323.
17. 李華林, 陳安平, 胡鋌, 等.經膽囊管入路同期三鏡治療細徑膽總管結石的臨床應用.肝膽胰外科雜志, 2015, 27(5): 358-360, 364.
18. 張啟瑜主編.錢禮腹部外科學.北京:人民衛生出版社, 2006: 879-881.
19. 陳安平, 王佳牧, 山長星, 等.三鏡同期聯合手術治療膽結石174例分析.中華普外科手術學雜志, 2013, 7(2): 30-32.
20. 楊孫虎, 侯軍麗, 阿不都斯木, 等.腹腔鏡治療膽囊結石合并肝外膽管結石臨床研究.中國普外基礎與臨床雜志, 2014, 21(7): 872-874.
21. 郭鑫, 陳安平, 李波, 等.腹腔鏡聯合十二指腸鏡早期治療輕型急性膽源性胰腺炎57例報告.中華普外科手術學雜志, 2012, 6(2): 47-49.
22. 田大廣, 黃潔, 張捷, 等. LC與EST聯合應用治療膽囊結石繼發性膽總管結石.中國普通外科雜志, 2006, 15(8): 579-581.
23. 王佳牧, 陳安平, 山長星, 等.腹腔鏡、膽道鏡、十二指腸鏡(三鏡)同期手術擴大一期縫合術應用199例報告.外科研究與新技術, 2013, 2(3): 170-172.
24. 胡三元.肝內、外膽管結石的腹腔鏡處理.中國普外基礎與臨床雜志, 2008, 15(10): 711-713.
25. 李波, 陳安平, 索運生, 等.腹腔鏡膽總管探查術1 712例報告.中華腔鏡外科雜志, 2010, 3(4): 40-43.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of MRCP in 998 Cases of Common Bile Duct Stones of Diameter in The Normal Range

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