Bueno Lledó Jose, Ibáñez Cirión Jose Luis, Torregrosa Gallud Antonio, López Andújar Rafael
Unidad Hepatobiliopancreatica, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari i Politecnic La Fe, Valencia, España.
Unidad Hepatobiliopancreatica, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari i Politecnic La Fe, Valencia, España.
Gastroenterol Hepatol. 2014 Nov;37(9):511-8. doi: 10.1016/j.gastrohep.2014.04.001. Epub 2014 Jun 16.
Choledocholithiasis is the most common cause of obstructive jaundice and occurs in 5-10% of patients with cholelithiasis.
To design a preoperative predictive score for choledocholithiasis.
A prospective study was carried out in 556 patients admitted to our department for biliary disease. Preoperative clinical, laboratory, and ultrasound variables were compared between patients without choledocholithiasis and 65 patients with this diagnosis. A multivariate logistic analysis was performed to obtain a predictive model of choledocholithiasis, determining sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
Predictors of choledocholithiasis were the presence of a prior history of biliary disease (history of biliary colic, acute cholecystitis, choledocholithiasis or acute biliary pancreatitis) (p=0.021, OR=2.225, 95% CI: 1.130-4.381), total bilirubin values >4mg/dl (p=0.046, OR=2.403, 95% CI: 1.106-5.685), alkaline phosphatase values >150mg/dl (p=0.022 income, OR=2.631, 95%: 1.386-6.231), gamma-glutamyltransferase (GGT) values >100mg/dl (p=0.035, OR=2.10, 95% CI: 1.345-5.850), and an ultrasound finding of biliary duct >8mm (p=0.034, OR=3.063 95% CI: 1086-8649). A score superior to 5 had a specificity and PPV of 100% for detecting choledocholithiasis and a score less than 3 had a sensitivity and NPV of 100% for excluding this diagnosis.
The preoperative score can exclude or confirm the presence of choledocholithiasis and allows patients to directly benefit from laparoscopic cholecystectomy (LC) or prior endoscopic retrograde cholangiopancreatography (ERCP).
胆总管结石是梗阻性黄疸最常见的病因，在胆结石患者中发生率为5% - 10%。
设计一种用于胆总管结石的术前预测评分系统。
对我院收治的556例胆道疾病患者进行前瞻性研究。比较无胆总管结石患者与65例确诊胆总管结石患者的术前临床、实验室及超声检查变量。进行多因素逻辑回归分析以获得胆总管结石的预测模型，并确定敏感度、特异度、阳性预测值（PPV）和阴性预测值（NPV）。
胆总管结石的预测因素包括既往有胆道疾病史（胆绞痛、急性胆囊炎、胆总管结石或急性胆源性胰腺炎病史）（p = 0.021，OR = 2.225，95% CI：1.13 – 4.381）、总胆红素值>4mg/dl（p = 0.046，OR = 2.403，95% CI：1.106 – 5.685）、碱性磷酸酶值>150mg/dl（p = 0.022，OR = 2.631，95%：1.386 – 6.231）、γ-谷氨酰转移酶（GGT）值>100mg/dl（p = 0.035，OR = 2.10，95% CI：1.345 – 5.850）以及超声检查发现胆管直径>8mm（p = 0.034，OR = 3.063，95% CI：1.086 – 8.649）。评分大于5对于检测胆总管结石具有100%的特异度和PPV，评分小于3对于排除该诊断具有100%的敏感度和NPV。
术前评分可排除或确认胆总管结石的存在，使患者能直接从腹腔镜胆囊切除术（LC）或先行内镜逆行胰胆管造影术（ERCP）中获益。
