Department of Surgery, Central Hospital, Västerås, Sweden.
HPB (Oxford). 2011 Aug;13(8):519-27. doi: 10.1111/j.1477-2574.2011.00317.x. Epub 2011 May 11.
The purpose of this study was to explore the accuracy of elevated liver function values, age, gender, pancreatitis and cholecystitis as predictors of common bile duct stones (CBDS).
All patients operated on for gallstone disease over a period of 3 years in a Swedish county of 302,564 citizens were registered prospectively. Intraoperative cholangiography (IOC) was used to detect CBDS.
A total of 1171 patients were registered; 95% of these patients underwent IOC. Common bile duct stones were found in 42% of patients with elevated liver function values, 20% of patients with a history of pancreatitis and 9% of patients with cholecystitis. The presence of CBDS was significantly predicted by elevated liver function values, but not by age, gender, history of acute pancreatitis or cholecystitis. A total of 93% of patients with normal liver function tests had a normal IOC. The best agreement between elevated liver function values and CBDS was seen in patients undergoing elective surgery without a history of acute pancreatitis or cholecystitis.
Although alkaline phosphatase (ALP) and bilirubin levels represented the most reliable predictors of CBDS, false positive and false negative values were common, especially in patients with a history of cholecystitis or pancreatitis, which indicates that other mechanisms were responsible for elevated liver function values in these patients.
本研究旨在探讨肝功能升高、年龄、性别、胰腺炎和胆囊炎作为胆总管结石（CBDS）预测指标的准确性。
在瑞典一个拥有 302564 名居民的县，对 3 年内因胆石病接受手术的所有患者进行前瞻性登记。术中胆管造影术（IOC）用于检测 CBDS。
共登记了 1171 例患者；其中 95%的患者接受了 IOC。肝功能升高患者中 CBDS 的检出率为 42%，胰腺炎病史患者为 20%，胆囊炎患者为 9%。肝功能升高显著预测 CBDS 的存在，但与年龄、性别、急性胰腺炎或胆囊炎病史无关。肝功能正常试验的患者中，93%的 IOC 正常。在无急性胰腺炎或胆囊炎病史的择期手术患者中，肝功能升高与 CBDS 之间的一致性最佳。
尽管碱性磷酸酶（ALP）和胆红素水平是预测 CBDS 的最可靠指标，但假阳性和假阴性值很常见，尤其是在有胆囊炎或胰腺炎病史的患者中，这表明这些患者的肝功能升高可能由其他机制引起。
