ObjectiveTo investigate the value of magnetic resonance (MR) imaging in the assessment of bile duct complications after cholecystectomy. MethodsFifty patients of having bile duct complications after cholecystectomy underwent MR imaging and had some positive manifestations. The indication for cholecystectomy was symptometic cholelithiasis in all cases. MR imaging was performed with a 1.5T clinical imager including all of the sequences of: ①T1 weighted imaging (T1WI) was performed in transverse and coronal plane before and after gadolinium-enhanced. ②T2 weighted imaging (T2WI) was performed in transverse plane. ③A true fast imaging with steadystate precession sequence (True fisp) was performed in coronal plane. ④MR cholangiopancreatography was also obtained. ResultsThe bile duct complications after cholecystectomy including: 22 cases of cholelithiasis, 15 cases of chronic cholangitis with or without bile duct abscess. Bile duct strictures or abruption at the confluence of hepatic and common bile duct in 6 and 3 cases respectively. Tumors of bile duct or pancreas in 9 cases. The other complications after cholecystectomy including bile leak with choleperitonitis and/or biloma and acute pancreatitis.ConclusionMR imaging was a valuable method for the assessment of bile duct complications after cholecystectomy. MR imaging could assess the etiology of bile duct complications. If there were bile duct obstruction, MR imaging could assess the location and the severe of obstruction. For bile duct or pancreatic tumors, MR imaging could assess the areas of tumor infiltration and resection and was helpful to select treatment methods. Before lapatoscopic cholecystectomy, the overall and careful imaging assessment for bile duct and gallbladder and its adjacent hepatic tissue and pancreas so to avoid missing the relative tumors.
ObjectiveTo evaluate the value of magnetic resonance cholangiopancreatography (MRCP) on prevention of the complications in laparoscopic cholecystectomy (LC). MethodsThe clinical data of 1 079 patients underwent LC from January 2006 to June 2010 in this hospital were retrospectively analyzed. According to the use of MRCP or not in the different period, the patients were divided into nonMRCP group (n=523) and MRCP group (n=556). The occurrence of bile duct injuries (BDI) and retained common duct stone (RCDS) were compared between two groups. ResultsConversion to open surgery was performed in 35 cases in nonMRCP group and in 41 cases in MRCP group. The intraoperative and postoperative BDI were found in five patients and RCDS were found in 27 patients in nonMRCP group, and those were not found in patients in MRCP group. The differences of BDI and RCDS of patients were significant between two groups (P=0.026 and P=0.000). In nonMRCP group, 23 of 55 patients were found common bile duct stones by intraoperative cholangiography. Common bile duct stones were found by intraoperative cholangiography other than preoperative MRCP in three patients in MRCP group, while another three patients did not find common bile duct stones by intraoperative cholangiography although preoperative MRCP suggested. By MRCP, double gallbladders were found in one patient, Mirizzi syndrome in eight patients, variant cystic duct in 34 patients, accessory hepatic duct in 28 patients, and complicating common bile duct stones in 27 patients in MRCP group, the diagnostic accuracy of those were 100%, 87.5%, 94.1%, 89.3% and 88.9%, respectively. ConclusionPreoperative MRCP is helpful to prevent BDI and RCDS for the patients with LC.
【Abstract】ObjectiveTo evaluate the clinical value of magnetic resonance cholangiopancreatography (MRCP) in diagnosis of extrahepatic bile duct obstruction. MethodsMRCP images of 42 patients presented clinically with obstructive jaundice were retrospectively reviewed to assess the lumen morphological abnormalities of benign versus malignant bile duct obstructions, with clinicalpathological correlation. ResultsThe bile duct of the 30 cases of benign biliary obstruction presented regular and symmetric dilation, gradual tapering,regular thickening and had a “beaklike” tip. The accuracy of MRCP for evaluating the site and the etiology of the benign biliary obstruction were 100%(30/30) and 97%(29/30) respectively. The bile duct of the 12 cases of malignant biliary obstruction presented irregular and asymmetric dilation,abrupt narrowing or iterruption,irregular thickening and had “dualduct sign”. The accuracy of MRCP for evaluating the site and the etiology of the malignant biliary obstruction were 100%(12/12) and 92%(11/12) respectively. ConclusionMRCP is the noninvasive technique of choice with excellent accuracy for the evaluation of obstructive biliary pathology.
ObjectiveTo evaluate the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) for biliary strictures post-orthotopic liver transplantation (OLT). MethodsA systematic review was performed by searching electronic bibliographic databases, including the Cochrane Library, Medline, EMbase, CNKI, and WanFang from 1994 to 2014. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were used to describe the diagnostic value. Summary receiver operating characteristic (SROC) curve with area under the SROC curve (AUC) were used to summarize overall diagnostic performance. ResultsSix studies involving 261 subjects were eligible for the analysis. The summary estimates of pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and AUC of MRCP for the diagnosis of biliary strictures after OLT were 89% (95% CI:0.83-0.94), 94% (95% CI:0.88-0.98), 8.04 (95% CI:2.83-22.85), 0.11 (95% CI:0.04-0.37), and 0.961, respectively. ConclusionMRCP is a sensitive and specific technique to diagnose biliary strictures after OLT.
ObjectiveTo 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. MethodsThe 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. ResultsThe 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). ConclusionsRoutine 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.