Vasilescu C, Jovin G H, Popescu I, Esanu C
Clinic of General Surgery Fundeni Hospital, Bucharest, Romania.
Med Interne. 1990 Oct-Dec;28(4):329-40.
The importance of clinical, laboratory and imaging data in the diagnosis of acute cholecystitis (AC) was studied in 825 patients with right upper quadrant pain hospitalized in the Surgical Clinic of the Fundeni Hospital--Bucharest, between January 1, 1986 and June 30, 1988. A number of 21 parameters were analysed in each case. Of these 825 patients, 259 were considered after surgery as AC. These 259 cases were divided, after the microscopical examination of the surgically-obtained specimens, into two groups: 1) pathologically confirmed AC (137 cases) and 2) pathologically non-confirmed AC (122 cases). The importance of every parameter in establishing a histologically confirmed diagnosis of AC was determined by the diagnostic probability calculated according to Bayes'theorem. The hierarchy of the value of parameters in the diagnosis of AC was based on their capacity to distinguish between the cases histologically confirmed and those detected on surgery, but without microscopically demonstrated changes of AC. The same decision criterion was used in building the decision trees in the exploration of the cases of presumed AC. In the 825 cases with right upper quadrant pain, the main and most frequent cause was chronic calculous cholecystitis (31.8%), followed by AC pathologically confirmed (16.6%), AC non-confirmed (14.7%) and chronic acalculous cholecystitis (12.4%). The most useful parameters in distinguishing between pathologically confirmed AC and pathologically non-confirmed AC were: 1) sudden onset of pain; 2) mild resistance to abdominal palpation; 3) frank peritoneal irritation; 4) stone impacted in the gallbladder neck (ultrasonography); 5) fever; 6) palpable gallbladder; 7) lithiasis (ultrasonography); 8) gallbladder wall with double outline (ultrasonography). Ultrasonography supplied a diagnostic probability of 85% for the correct diagnosis of AC in cases without a clinical picture suggestive for AC. The decision tree analysis supported the same conclusion: only ultrasonography gives a good distinction between pathologically confirmed AC and pathologically non-confirmed AC.
1986年1月1日至1988年6月30日期间，在布加勒斯特Fundeni医院外科诊所住院的825例右上腹疼痛患者中，研究了临床、实验室和影像学数据在急性胆囊炎（AC）诊断中的重要性。对每例患者分析了21项参数。在这825例患者中，术后有259例被诊断为AC。在对手术获取的标本进行显微镜检查后，这259例病例被分为两组：1）病理确诊的AC（137例）和2）病理未确诊的AC（122例）。根据贝叶斯定理计算的诊断概率确定了每个参数在建立AC组织学确诊诊断中的重要性。AC诊断中参数值的层次结构基于它们区分组织学确诊病例和手术中发现但无AC显微镜下表现改变病例的能力。在疑似AC病例的探索中构建决策树时使用了相同的决策标准。在825例右上腹疼痛病例中，主要且最常见的病因是慢性结石性胆囊炎（31.8%），其次是病理确诊的AC（16.6%）、未确诊的AC（14.7%）和慢性非结石性胆囊炎（12.4%）。区分病理确诊的AC和病理未确诊的AC最有用的参数是：1）疼痛突然发作；2）腹部触诊轻度抵抗；3）明显的腹膜刺激征；4）胆囊颈部结石嵌顿（超声检查）；5）发热；6）可触及的胆囊；7）结石（超声检查）；8）胆囊壁呈双边影（超声检查）。对于无AC临床提示表现的病例，超声检查对AC正确诊断的诊断概率为85%。决策树分析支持了相同的结论：只有超声检查能很好地区分病理确诊的AC和病理未确诊的AC。
