目的：比较不同部位胆结石患者实验室指标与影像学检查的差异，为临床诊断及鉴别诊断提供参考。方法：回顾性分析2011 年2 月—2013 年9 月收治的146 例胆结石患者相关资料，按照发病部位的不同分为胆囊组（35 例）、肝内组（49 例）和肝外组（62 例），分析比较3 组相关实验室指标检测结果与影像学检查结果。结果：⑴ 肝功能相关指标：胆囊组胆红素和转氨酶水平明显低于肝内组和肝外组，肝内组碱性磷酸酶与γ- 谷氨酰基转移酶水平明显低于胆囊组和肝外组（均P<0.05）。⑵ 三大常规检查：肝内组白细胞数、中性粒百分比明显低于胆囊组和肝外组，胆囊组尿胆原水平明显高于肝内组和肝外组（均P<0.05）；胆囊组尿胆红素呈阴性或弱阳性，而肝内组和肝外组呈强阳性；胆囊组粪颜色为黄色，肝内组和肝外组为陶土样或变浅。⑶ 影像学检查：胆囊组B 超与CT 的显示率较高（88.6%，91.4%），肝内组CT的显示率较高（87.8%），肝外组MRCP 显示率较高（90.3%）。结论：实验室指标与影像学检查结果对于不同部位胆结石的诊断与鉴别诊断具有一定参考价值，应该充分了解各自特点，实现优势互补，做出正确的判断。
Comparative analysis of laboratory indexes and imaging results among patients with gallstones in different locations
Objective: To compare the difference in laboratory indexes and imaging results among patients with gallstones in different locations, so as to provide reference for clinical diagnosis and differential diagnosis. Methods: The data of 146 patients with gallstones admitted from February 2011 to September 2013 were retrospectively analyzed. According to the location of stones, the patients were divided into gallbladder group (35 cases), intrahepatic group (49 cases) and extrahepatic group (62 cases), and the results of relevant laboratory indexes and imaging examinations among the three groups were compared and analyzed. Results: Liver function-related parameters: the levels of bilirubin and transaminases in gallbladder group were significantly lower than those in intrahepatic group and extrahepatic group, and the levels of alkaline phosphatase and γ-glutamyltransferase in intrahepatic group were significantly lower than those in gallbladder group and extrahepatic group (all P<0.05). Three routine tests: the number of white blood cells percentage of neutrophils in intrahepatic group were significantly lower than those in gallbladder group and extrahepatic group, and the urobilinogen level in in gallbladder group was significantly higher than that in intrahepatic group and extrahepatic group (all P<0.05); urine bilirubin test showed negative or weakly positive result in gallbladder group, and strongly positive result in intrahepatic and extrahepatic group; the color of stool in the gallbladder group was yellow, which was pale or clay-colored in intrahepatic and extrahepatic group. Imaging examinations: the detection rates of B-ultrasound and CT were relatively high in gallbladder group (88.6%, 91.4%), the detection rate of CT in intrahepatic group was relatively high (87.8%), and the detection rate of MRCP in extrahepatic group was relatively high (90.3%). Conclusion: The laboratory indexes and imaging results have certain reference value for diagnosis and differential diagnosis of gallstones in different locations, so a better understanding of their respective characteristics and complementary advantages may help in making a correct judgment.