| Background:Cholelithiasis is a common disease and a frequent occurrence in China.Its major characteristics include the wide range of lesions,the complex disease analysis,the high incidence of complications,and the high residual stone rate after surgery treatments.And it is a persistent problem in the field of hepatobiliary and pancreatic surgery.As the main treatment of benign disease of biliary tract,surgery is now the mainstay of treatment whose principles are removing lesions,obliterating stones,correcting narrows,unblocking drainages and preventing recurrence.A number of factors including anatomical variations caused by biliary calculi,biliary infection and inflammation,one-side preoperative examination,imprudent operation,inadequate stone elimination by large amount and etc.contribute to the high incidence of bile duct residual stones after surgery.And bile duct residual stones can cause of biliary obstruction,biliary infection and inflammation,lobe lesions and other complications.This condition will greatly influence the patient’s quality of life and also reduce the final effect of treatment of cholelith disease patients.Above of all,the diagnosis of biliary postoperative residual bile duct stones holds an important place in the process of the treatment of diseases according to that the preoperative clinical pathological changes determine if the patients could be pulled out T-tube and also estimate the quantity and position of residual calculi.The diagnosis performs the preoperative guidance in order to develop the surgical strategy for further stone surgery.At present for the diagnosis of biliary postoperative bile duct residual stones method mainly includes Ultrasound,CT,T-tube angiography,Magnetic Resonance Cholangiopancreatography(MRCP),Endoscopic Retrograde Cholangiopancreatography(ERCP),Endoscopic Ultrasonography(EUS),Electronic choledochoscopy and etc.Different methods for the diagnosis of bile duct residual stones have diverse effect because of inspection principle,past operation,the position of the bile duct residual stones,T-tube indwelling time and position and other related factors.The Second Department of Hepatobiliary and Pancreatic Surgery in the First Hospital of Jilin University,which has a large number of clinical cases and data,has rich clinical experience in the diagnosis and treatment of bile duct residual stones.Therefore,it is necessary to systematically analyze and summarize these clinical materials in order to provide some suitable clinical experience for the future work.Objective:Analyze the diagnostic efficacy of residual calculus in bile duct after biliary tract surgery in Ultrasonography,CT,T-tube angiography and Electronic choledochoscopy,and explore the factors that may affect its diagnostic efficacy and select the suitable auxiliary inspection projects.Methods:Use the randomized controlled trials.Review and analysis the data about the results of biliary postoperative indwelling T-tube,as well as Ultrasonic,CT,T-tube angiography and Electronic choledochoscope of 1564 cases of patients in the Second Department of Hepatobiliary and Pancreatic Surgery in the First Hospital of Jilin University for nearly three years(from January 2015 to December 2017).Analyzed the statistical difference among diagnostic accuracy,false negative rate and false positive rate of the four diagnostic methods.Explore if the position of the residual stones in bile duct is the independent factor of the four diagnostic methods and choose the appropriate auxiliary inspection projects.Results:1.Among the Electronic choledochoscope,Ultrasonography,CT and T-tube angiography,the results have statistical difference in the diagnostic accuracy and the diagnostic validity of postoperative bile duct stones after surgery.2.Among of Ultrasonography,CT,and T-tube angiography,the results have partly statistical difference in the diagnostic accuracy and the diagnostic validity of postoperative bile duct stones after surgery.3.The results of Ultrasonography,T-tube angiography and the Electronic choledochoscopy on the diagnosis of biliary postoperative residual bile duct stones have statistical differences in different location;but the results of CT for different positions of the diagnosis of bile duct residual stones have no statistical difference.Conclusion:1.Electronic choledochoscopy is the unbeatable method significantly superior to the three others in the diagnosis of residual bile duct stones after biliary tract surgery.Electronic choledochoscopy can directly detect bile duct under mirror,and can clear bile duct residual stones(especially small stone),bile duct wall inflammation and flocculation,parasites and eggs,biliary polyps or tumors,bile duct stricture,biliary hemorrhage and so on.It can also monitor the functional status of Oddi sphincter and duodenal regurgitation.Therefore,Electronic choledochoscopy is suggested that it should be a primary method for the diagnosis of residual bile duct stones after biliary tract surgery.2.The patients after biliary duct surgery are recommended to receive inspection of Ultrasonography,T-tube angiography and Electronic choledochoscopy before removing the T-tube so as to decrease the incidence of residual biliary duct stone maximumly.3.The position of residual bile duct stones after biliary tract surgery may be a factor for influencing the diagnostic accuracy and diagnostic validity of the two auxiliary examinations of Ultrasound,T-tube angiography and Electronic choledochoscopy. |
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