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.	黄洁夫主编.腹部外科学.北京:人民卫生出版社, 2001: 1330-1336.
2.	黄志强.胆道外科基础与临床. 2版, 北京:人民卫生出版社, 2003: 3-7.
3.	李华林, 陈安平, 索运生.腹腔镜胆总管探查经腹鼻胆管引流的临床应用.中华腔镜外科杂志, 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, 陈安平, 索运生, 等.腹腔镜胆总管探查即时缝合术983例报告.中华腔镜外科杂志, 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, 陈安平, 李波, 等.腹腔镜、胆道镜同期治疗胆囊结石合并正常直径胆总管结石.中华普外科手术学杂志, 2012, 6(1): 38-41.
8.	陈心焕, 许兆祥.胆道探查一期缝合与T管引流的疗效对比.肝胆胰外科杂志, 2010, 22(4): 327-329.
9.	王佳牧, 陈安平, 山长星, 等.腹腔镜胆总管探查术2 161例报告.外科研究与新技术, 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.	索运生, 陈安平, 肖宏, 等.腹腔镜下再次胆道手术83例报告.中华普外科手术学杂志, 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, 陈安平, 索运生, 等.腹腔镜胆囊切除术术中联合十二指肠镜治疗正常直径胆总管结石158例.中华腔镜外科杂志, 2011, 4(1): 33-37.
14.	潘步建, 周蒙滔, 徐迈宇, 等.腹腔镜胆总管探查术治疗胆总管结石合并胆囊结石.中华肝胆外科杂志, 2011, 17(10): 816-819.
15.	陈安平, 胡铤, 李华林, 等.同期腹腔镜、胆道镜、十二指肠镜多入路治疗胆囊结石合并细径胆总管结石71例.中国普外基础与临床杂志, 2014, 21(8): 946-950.
16.	倪志平, 刘隽, 汤可立, 等.胆总管探查术后一期缝合的临床经验及适应症探讨.中国普外基础与临床杂志, 2011, 18(3): 320-323.
17.	李华林, 陈安平, 胡铤, 等.经胆囊管入路同期三镜治疗细径胆总管结石的临床应用.肝胆胰外科杂志, 2015, 27(5): 358-360, 364.
18.	张启瑜主编.钱礼腹部外科学.北京:人民卫生出版社, 2006: 879-881.
19.	陈安平, 王佳牧, 山长星, 等.三镜同期联合手术治疗胆结石174例分析.中华普外科手术学杂志, 2013, 7(2): 30-32.
20.	杨孙虎, 侯军丽, 阿不都斯木, 等.腹腔镜治疗胆囊结石合并肝外胆管结石临床研究.中国普外基础与临床杂志, 2014, 21(7): 872-874.
21.	郭鑫, 陈安平, 李波, 等.腹腔镜联合十二指肠镜早期治疗轻型急性胆源性胰腺炎57例报告.中华普外科手术学杂志, 2012, 6(2): 47-49.
22.	田大广, 黄洁, 张捷, 等. LC与EST联合应用治疗胆囊结石继发性胆总管结石.中国普通外科杂志, 2006, 15(8): 579-581.
23.	王佳牧, 陈安平, 山长星, 等.腹腔镜、胆道镜、十二指肠镜(三镜)同期手术扩大一期缝合术应用199例报告.外科研究与新技术, 2013, 2(3): 170-172.
24.	胡三元.肝内、外胆管结石的腹腔镜处理.中国普外基础与临床杂志, 2008, 15(10): 711-713.
25.	李波, 陈安平, 索运生, 等.腹腔镜胆总管探查术1 712例报告.中华腔镜外科杂志, 2010, 3(4): 40-43.

1. 黄洁夫主编.腹部外科学.北京:人民卫生出版社, 2001: 1330-1336.
2. 黄志强.胆道外科基础与临床. 2版, 北京:人民卫生出版社, 2003: 3-7.
3. 李华林, 陈安平, 索运生.腹腔镜胆总管探查经腹鼻胆管引流的临床应用.中华腔镜外科杂志, 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, 陈安平, 索运生, 等.腹腔镜胆总管探查即时缝合术983例报告.中华腔镜外科杂志, 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, 陈安平, 李波, 等.腹腔镜、胆道镜同期治疗胆囊结石合并正常直径胆总管结石.中华普外科手术学杂志, 2012, 6(1): 38-41.
8. 陈心焕, 许兆祥.胆道探查一期缝合与T管引流的疗效对比.肝胆胰外科杂志, 2010, 22(4): 327-329.
9. 王佳牧, 陈安平, 山长星, 等.腹腔镜胆总管探查术2 161例报告.外科研究与新技术, 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. 索运生, 陈安平, 肖宏, 等.腹腔镜下再次胆道手术83例报告.中华普外科手术学杂志, 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, 陈安平, 索运生, 等.腹腔镜胆囊切除术术中联合十二指肠镜治疗正常直径胆总管结石158例.中华腔镜外科杂志, 2011, 4(1): 33-37.
14. 潘步建, 周蒙滔, 徐迈宇, 等.腹腔镜胆总管探查术治疗胆总管结石合并胆囊结石.中华肝胆外科杂志, 2011, 17(10): 816-819.
15. 陈安平, 胡铤, 李华林, 等.同期腹腔镜、胆道镜、十二指肠镜多入路治疗胆囊结石合并细径胆总管结石71例.中国普外基础与临床杂志, 2014, 21(8): 946-950.
16. 倪志平, 刘隽, 汤可立, 等.胆总管探查术后一期缝合的临床经验及适应症探讨.中国普外基础与临床杂志, 2011, 18(3): 320-323.
17. 李华林, 陈安平, 胡铤, 等.经胆囊管入路同期三镜治疗细径胆总管结石的临床应用.肝胆胰外科杂志, 2015, 27(5): 358-360, 364.
18. 张启瑜主编.钱礼腹部外科学.北京:人民卫生出版社, 2006: 879-881.
19. 陈安平, 王佳牧, 山长星, 等.三镜同期联合手术治疗胆结石174例分析.中华普外科手术学杂志, 2013, 7(2): 30-32.
20. 杨孙虎, 侯军丽, 阿不都斯木, 等.腹腔镜治疗胆囊结石合并肝外胆管结石临床研究.中国普外基础与临床杂志, 2014, 21(7): 872-874.
21. 郭鑫, 陈安平, 李波, 等.腹腔镜联合十二指肠镜早期治疗轻型急性胆源性胰腺炎57例报告.中华普外科手术学杂志, 2012, 6(2): 47-49.
22. 田大广, 黄洁, 张捷, 等. LC与EST联合应用治疗胆囊结石继发性胆总管结石.中国普通外科杂志, 2006, 15(8): 579-581.
23. 王佳牧, 陈安平, 山长星, 等.腹腔镜、胆道镜、十二指肠镜(三镜)同期手术扩大一期缝合术应用199例报告.外科研究与新技术, 2013, 2(3): 170-172.
24. 胡三元.肝内、外胆管结石的腹腔镜处理.中国普外基础与临床杂志, 2008, 15(10): 711-713.
25. 李波, 陈安平, 索运生, 等.腹腔镜胆总管探查术1 712例报告.中华腔镜外科杂志, 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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