What are the specific tests for gallstones?

Gallstones are a disease that is more common in middle-aged and elderly women. This is mainly because women generally lack exercise, which leads to high cholesterol in the body. Once you suffer from gallstones, you will need surgical treatment. There are many examinations that need to be done before the operation. Many friends are not particularly clear about this and do not know what examinations are needed for gallstone surgery. Therefore, this article will give you a detailed introduction to the specific gallstone examinations.

Generally speaking, preoperative examinations for gallstones mainly include a series of examination methods such as B-ultrasound, biliary X-ray examination, CT, PTCD, ERCP, biliary endoscopy, MRCP, and choledochoscopy.

1. Ultrasonic manifestations of gallstones diagnosed by B-ultrasound B-ultrasound is a non-invasive examination, convenient and easy to perform. It is the preferred method for diagnosing gallstones. The diagnostic accuracy is generally estimated to be 50%-70%.

2. CT diagnosis: Since gallstones are mainly pigmented stones containing bilirubin calcium with a high calcium content, they can be clearly shown in CT images. The diagnostic compliance rate of CT is 50%-60%. CT can also show the position, expansion, hypertrophy and atrophy of the gallbladder. By systematically observing the CT images at each level, we can understand the distribution of stones in the gallbladder.

3. X-ray cholangiography X-ray cholangiography (including PTC, ERCP, TCG) is a classic method for diagnosing gallstones. It can generally make a correct diagnosis. The diagnostic consistency rates of PTC, ERCP, and TCG are 80%-90%, 70%-80%, and 60%-70%, respectively. X-ray cholangiography should meet the needs of diagnosis and surgery. A good cholangiography film should be able to fully understand the anatomical variations of the gallbladder and the distribution range of stones.

4. Percutaneous transhepatic cholangiography (PTC, PTCD) There are three puncture routes for PTC and PTCD: anterior, posterior, and lateral. The lateral route has a high success rate, few complications, easy operation, and clear images during angiography. For patients with gallstones diagnosed by B-ultrasound, PTC and PTCD have good differential diagnostic value. Especially PTC under ultrasound guidance has a higher success rate. For those who have not undergone surgery but want to confirm the presence of gallstones, this method can be considered.

5. Clinical application of selective retrograde cholangiopancreatography (ERCP), choledochoscope and choledochoscope. Choledochoscope ERCP can perform selective bile duct imaging and has a high diagnostic value for gallstones. It can clearly display gallstones, determine the location, size, number of stones, and gallbladder stenosis or distal dilatation. The biliary mother-and-child endoscope is a thinner daughter endoscope that is inserted through the biopsy channel of the mother endoscope. The diameter of the biopsy channel of the mother mirror is 5.5mm, and the outer diameter of the daughter mirror is 4.5mm. Only the mother endoscope is used for ERCP, and then high-frequency electrosurgical resection (ECT) is performed on the duodenal papilla. Generally, a small incision of 0.5~1.0cm is made or the duodenal papilla is dilated to facilitate the entry of the daughter endoscope into the common bile duct, so that the common bile duct and level 1~2 intrahepatic bile ducts can be directly observed. It can determine the presence, size, location, and number of intrahepatic bile duct stones, as well as whether the intrahepatic bile duct is narrowed or dilated. It has great diagnostic value. However, choledochoscopes are expensive and easily damaged, making them difficult to popularize.

7. Choledochoscopy includes three methods: preoperative, intraoperative and postoperative. Preoperative choledochoscopy is used to perform PTC only, and a thicker catheter is replaced every week. After 5 to 6 weeks, the sinus tract is formed. Then, the endoscope is inserted from the sinus to directly visualize the intrahepatic bile duct, which can be used to diagnose intrahepatic bile duct stones and perform stone removal. Intraoperative choledochoscopy is to cut the common bile duct during surgery, insert the endoscope through the incision to observe the intrahepatic bile duct stones and remove the stones. Postoperative choledochoscopy is the insertion of the endoscope through the sinus tract formed by the "T"-shaped drainage tube after surgery (usually 6 weeks after surgery). Choledochoscopy has a clear diagnostic and therapeutic value for intrahepatic bile duct stones.

Many patients feel that there is no need to do so many gallstone tests after surgery. In fact, these tests are very necessary before surgery. Only by doing these tests can the patient's physical condition be determined, which can reduce the risk of surgery and make gallstone surgery more successful. Patients can recover sooner.