木村 克己, 藤田 直孝, 李 茂基, 小林 剛, 渡邊 浩光, 矢野 明, 長南 明道, 安藤 正夫, 望月 福治

Katsumi KIMURA, Naotaka FUJITA, Shigeki LEE, Go KOBAYASHI, Hiromitsu WATANABE, Akira YANO, Akimichi CHONAN, Masao ANDO, Fukuji MOCHIZUKI

仙台市医療センター消化器内科

Department of Gastroenterology, Sendai City Medical Center

キーワード : Choledocholithiasis, Ultrasonography, Endoscopic ultrasonography

In 201 cases of choledocolithiasis diagnosed using ERC or PTC in the past 7 years, we analyzed the rate of ultrasonographic diagnosis and several factors which influence it. Moreover we calculated the detectability by endoscopic ultrasonography (EUS).
The overall rate of detectability by ultrasonography (US) was 32.3% (65/201). Sex and obesity had no remarkable influence on the detectability of choledocholithiasis. There was no statistical difference in the rate of diagnosis among the following 3 groups: gallbladder is present and gallstone is absent, gallbladder is present and gallstone is present, and gallbladder is absent. The larger the diameter of the stone or the bile duct, the higher the rate of diagnosis. We could not diagnose choledocholithiasis in undilated common bile ducts. The detectability when a linear type probe was used was 21.7% (18/83), and when a convex type probe was used, it was 39.8% (47/118). We performed EUS in 31 cases and the detectability was no less than 93.5% (29/31). EUS was very useful for diagnosing choledocholithiasis.
We concluded that there is a limit in diagnosing choledocholithiasis by US. Thus, it is very improtant to perform EUS, ERC or PTC when choledocholithiasis is suspected from present illness, physical status or laboratory data.