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首页> 外文期刊>World Journal of Gastroenterology >Selection criteria for preoperative endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy and endoscopic treatment of bile duct stones: Results of a retrospective, single center study between 1996-2002
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Selection criteria for preoperative endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy and endoscopic treatment of bile duct stones: Results of a retrospective, single center study between 1996-2002

机译：腹腔镜胆囊切除术前术前内镜逆行胰胆管造影的选择标准和内镜治疗胆管结石：1996-2002年间一项回顾性，单中心研究的结果

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AIM: The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is unclear. The aim of our study was to determine the predictive factors for preoperative endoscopic retrograde cholangiopancreatography (ERCP). METHODS: Patients undergoing preoperative ERCP ( ≤ 90 d before laparoscopic cholecystectomy) were evaluated in this retrospective study from the 1st of January 1996 to the 31st of December 2002. The indications for ERCP were elevated serum bilirubin, elevated liver function tests (LFT), dilated bile duct ( ≥ 8 mm) and/or stone at US examination, coexisting acute pancreatitis and/or acute pancreatitis or jaundice in patient's history. Suspected prognostic factors and the combination of factors were compared to the result of ERCP. RESULTS: Two hundred and six preoperative ERCPs were performed during the observed period. The rate of successful cannulation for ERC was (97.1%). Bile duct stones were detected in 81 patients (39.3%), and successfully removed in 79 (97.5%). The number of prognostic factors correlated with the presence of bile duct stones. The positive predictive value for one prognostic factor was 1.2%, for two 43%, for three 72.5%, for four or more 91.4%. CONCLUSION: Based on our data preoperative ERCP is highly recommended in patients with three or more positive factors (high risk patients). In contrast, ERCP is not indicated in patients with zero or one factor (low risk patients). Preoperative ERCP should be offered to patients with two positive factors (moderate risk patients), however the practice should also be based on the local conditions (e.g. skill of the endoscopist, other diagnostic tools).
机译：目的：尚不清楚胆管结石的最佳治疗方法（在费用，并发症和准确性方面）。我们研究的目的是确定术前内镜逆行胰胆管造影（ERCP）的预测因素。方法：本回顾性研究从1996年1月1日至2002年12月31日对术前ERCP（腹腔镜胆囊切除术前≤90 d）的患者进行了评估。ERCP的适应症包括血清胆红素升高，肝功能检查（LFT）升高，在美国检查时，胆管扩张（≥8 mm）和/或结石，并存急性胰腺炎和/或急性胰腺炎或黄疸。将可疑的预后因素和因素组合与ERCP结果进行比较。结果：在观察期间进行了260例术前ERCP。 ERC的成功插管率为（97.1％）。在81例患者中检出了胆管结石（39.3％），在79例中成功清除了胆管结石（97.5％）。预后因素的数量与胆管结石的存在相关。一个预后因素的阳性预测值为1.2％，两个为43％，三个为72.5％，四个或更多为91.4％。结论：根据我们的数据，强烈建议对具有三个或更多阳性因素的患者（高危患者）进行术前ERCP。相反，ERCP不适用于零或一个因素的患者（低风险患者）。应为有两个阳性因素的患者（中度风险患者）提供术前ERCP，但实践也应基于当地条件（例如内镜医师的技能，其他诊断工具）。

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