Objective:To investigate the diagnosis of suspected choledocholithiasis before elective laparoscopic cholecystectomy (LC), and the value of intraoperative cholangiography and preoperative magnetic resonance cholangiopancreatography (MRCP) for diagnosis of suspected choledocholithiasis.
Methods:The clinical data of 1 758 patients undergoing elective LC from May 2005 to May 2010 were retrospectively analyzed. Of the patiens, 1 519 cases were not suspected of having choledocholithiasis (group A) and the remaining 239 cases were suspected of having choledocholithiasis, and the latter were divided into 4 groups (group B, C, D and E) according to their clinicopathological characteristics.The incidence of postoperative choledocholithiasis was compared among the groups. Meanwhile, the independent risk factors for the development of choledocholithiasis were analyzed. The coincidence rate between intraoperative cholangiography and preoperative MRCP for diagnosis of choledocholithiasis in each group with suspected choledocholithiasis was compared.
Results:The incidence of postoperative choledocholithiasis of all groups with suspected choledocholithiasis was significantly higher than that of group A (all P＜0.01), but no significant difference was noted among the four groups with suspected choledocholithiasis (P＞0.05). Multivariate unconditional Logistic regression analysis revealed that common bile duct greater than or equal to 8 mm in diameter, previous history of biliary pancreatitis and previous history of choledocholithiasis were independent risk factors for choledocholithiasis (P＜0.05). There was no significant difference in the coincidence rate between intraoperative cholangiography and preoperative MRCP for diagnosis of choledocholithiasis in each group with suspected choledocholithiasis (P＞0.05).
Conclusions:The incidence of choledocholithiasis greatly increases under the conditions of common bile duct dilation, abnormal liver function, and past history of biliary pancreatitis or of common bile duct stones detected by B ultrasounic examination. Common bile duct dilation (≥8 mm), past history of biliary pancreatitis and past history of common bile duct stones are independent risk factors for choledocholithiasis. There is no difference between intraoperative cholangiography and preoperative MRCP for diagnosis of choledocholithiasis.