胆石病

对于伴有或不伴有发热的胆源性疼痛，WBC 升高提示由胆石症并发症引起的炎症：急性胆囊炎、胆管炎或胰腺炎。

在单纯性（无并发症）胆绞痛中正常

胆道疼痛伴或不伴黄疸。碱性磷酸酶升高提示胆囊或胆管阻塞。甚至在碱性磷酸酶升高之前，一过性 ALT 升高即可提示结石通过胆总管。

胆结石：正常；胆总管结石：碱性磷酸酶升高，胆红素升高

主要在上腹部的疼痛，伴或不伴其放射到后背。推荐检测血清脂肪酶。

在急性胰腺炎中升高（＞3 倍正常上限）

针对胆道疼痛。这是胆囊结石和胆泥最好的单一检查方法（准确率＞95%），也是诊断关键。

针对胆管扩张。对胆总管结石症敏感性低。如果检测到胆囊结石伴有胆囊周围积液和胆囊壁变厚，考虑急性胆囊炎。[46]Ross M, Brown M, McLaughlin K, et al. Emergency physician-performed ultrasound to diagnose cholelithiasis: a systematic review. Acad Emerg Med. 2011 Mar;18(3):227-35.http://www.ncbi.nlm.nih.gov/pubmed/21401784?tool=bestpractice.com[Figure caption and citation for the preceding image starts]: 急性胆囊炎合并结石的超声影像：箭头所指为胆囊底部结石及其下方的回声阴影由 Charles Bellows 和 W. Scott Helton 提供；经许可后使用 [Citation ends].[Figure caption and citation for the preceding image starts]: 胆囊超声显示胆结石并特征性声影由 Kuojen Tsao 提供；经许可后使用 [Citation ends].

EUS 对于小结石病更敏感（小结石＜3 mm）

胆石症：胆囊有结石；胆总管结石：胆管结石伴或不伴胆管扩张。

针对不能通过腹部超声确定的疑似胆总管结石病。尽管 MRCP 对检测小结石 (＜5 mm) 的价值有限，但总体而言特异性较高。[48]Bahram M, Gaballa G. The value of pre-operative magnetic resonance cholangiopancreatography (MRCP) in management of patients with gall stones. Int J Surg. 2010;8(5):342-5.http://www.ncbi.nlm.nih.gov/pubmed/20450989?tool=bestpractice.com[55]Kondo S, Isayama H, Akahane M, et al. Detection of common bile duct stones: comparison between endoscopic ultrasonography, magnetic resonance cholangiography, and helical-computed-tomographic cholangiography. Eur J Radiol. 2005 May;54(2):271-5.http://www.ncbi.nlm.nih.gov/pubmed/15837409?tool=bestpractice.com

胆囊或胆管结石

适用于不能经腹部超声证实的可疑胆总管结石，尤其是无法接受 MRCP（幽闭恐怖症、植入装置）的患者，或用于在行治疗性 ERCP 之前确认高风险患者的胆总管结石。[49]Karakan T, Cindoruk M, Alagozlu H, et al. EUS versus endoscopic retrograde cholangiography for patients with intermediate probability of bile duct stones: a prospective randomized trial. Gastrointest Endosc. 2009 Feb;69(2):244-52.http://www.ncbi.nlm.nih.gov/pubmed/19019364?tool=bestpractice.com[50]Janssen J, Halboos A, Greiner L. EUS accurately predicts the need for therapeutic ERCP in patients with a low probability of biliary obstruction. Gastrointest Endosc. 2008 Sep;68(3):470-6.http://www.ncbi.nlm.nih.gov/pubmed/18547571?tool=bestpractice.com[51]Lee YT, Chan FK, Leung WK, et al. Comparison of EUS and ERCP in the investigation with suspected biliary obstruction caused by choledocholithiasis: a randomized study. Gastrointest Endosc. 2008 Apr;67(4):660-8.http://www.ncbi.nlm.nih.gov/pubmed/18155205?tool=bestpractice.com[52]Liu CL, Fan ST, Lo CM, et al. Comparison of early endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in the management of acute biliary pancreatitis: a prospective randomized study. Clin Gastroenterol Hepatol. 2005 Dec;3(12):1238-44.http://www.ncbi.nlm.nih.gov/pubmed/16361050?tool=bestpractice.com[53]Polkowski M, Regula J, Tilszer A, et al. Endoscopic ultrasound versus endoscopic retrograde cholangiography for patients with intermediate probability of bile duct stones: a randomized trial comparing two management strategies. Endoscopy. 2007 Apr;39(4):296-303.http://www.ncbi.nlm.nih.gov/pubmed/17427065?tool=bestpractice.com

EUS 可能比 MRCP 更准确，但其价值取决于当地专业性。[56]De Castro VL, Moura EG, Chaves DM, et al. Endoscopic ultrasound versus magnetic resonance cholangiopancreatography in suspected choledocholithiasis: a systematic review. Endosc Ultrasound. 2016 Mar-Apr;5(2):118-28.http://www.eusjournal.com/article.asp?issn=2303-9027;year=2016;volume=5;issue=2;spage=118;epage=128;aulast=Dehttp://www.ncbi.nlm.nih.gov/pubmed/27080611?tool=bestpractice.com

胆囊或胆管结石

是胆管结石高风险患者（影像学、症状和/或血液测试呈阳性）的首选干预手段，因为其具有取出梗阻结石的治疗能力。 [ ]How does early routine endoscopic retrograde cholangiopancreatography compare with early conservative management in people with acute gallstone pancreatitis?https://cochranelibrary.com/cca/doi/10.1002/cca.867/full显示答案

胆囊或胆管结石

使用静脉造影剂的腹部 CT 可用于检查疑似上行性胆管炎或胆石性胰腺炎。[57]Zhang J, Li NP, Huang BC, et al. The value of performing early non-enhanced CT in developing strategies for treating acute gallstone pancreatitis. J Gastrointest Surg. 2016 Mar;20(3):604-10.http://www.ncbi.nlm.nih.gov/pubmed/26743886?tool=bestpractice.com[58]Katz DS, Rosen MP, Blake MA, et al. ACR Appropriateness Criteria: right upper quadrant pain. 2013 [internet publication].https://acsearch.acr.org/docs/69474/Narrative/

可能正常；上行性胆管炎：胆管扩张伴胆总管结石病；急性胰腺炎：弥漫性或节段性胰腺增大，伴有胆囊中有结石，胆管和胰管中可能有结石