Gouveia Catarina, Loureiro Rui, Ferreira Rosa, Oliveira Ferreira Alexandre, Santos António Alberto, Santos Maria Pia Costa, Palmela Carolina, Cravo Marília
Serviço de Gastrenterologia, Hospital Beatriz Ângelo, Lisbon, Portugal.
GE Port J Gastroenterol. 2018 Jan;25(1):24-29. doi: 10.1159/000479973. Epub 2017 Sep 15.
The prevalence of choledocholithiasis among patients with acute cholecystitis is estimated to be between 9 and 16.5%. There are no validated algorithms to predict choledocholithiasis in this group of patients.
The aim of this study was to evaluate the performance of the choledocholithiasis diagnostic score proposed by the American Society for Gastrointestinal Endoscopy, in patients with acute cholecystitis.
MATERIAL/METHODS: A retrospective cross-sectional study, covering a 4-year period at a secondary care hospital, was performed. All patients with an encoded diagnosis of acute cholecystitis and with at least one of the following procedures were included: endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound, magnetic resonance cholangiopancreatography, and intraoperative cholangiography.
Among 4,369 patients with the diagnosis of acute cholecystitis, 40 (0.92%) had clinical or sonographic suspicion of choledocholithiasis. Their mean age was 68.1 ± 15 years, and 22 (55%) were men. Thirty-one of the patients included (77.5%) had a high risk of choledocholithiasis, and 9 (22.5%) had an intermediate risk. In 16 (51.6%) of the 31 patients with a high risk, the diagnosis of choledocholithiasis was confirmed. In 2 (22.2%) of the 9 patients with an intermediate risk, the diagnosis of choledocholithiasis was also confirmed. The high risk score for choledocholithiasis had a positive predictive value of 52% and a sensitivity of 89%. The intermediate risk score for choledocholithiasis had a positive predictive value of 22% and a sensitivity of 11%.
Suspicion of choledocholithiasis in patients with acute cholecystitis was a rare event (<1%). The sensitivity of the high risk score was approximately the same as found in published series with patients with suspected choledocholithiasis overall (86%), while the positive predictive value was substantially lower (52 vs. 79.8%). Therefore, in patients with acute cholecystitis and suspected choledocholithiasis, this score should not be used to screen for common bile duct stones, and a sensitive method should be used prior to ERCP.
据估计，急性胆囊炎患者中胆总管结石的患病率在9%至16.5%之间。目前尚无经过验证的算法可用于预测该组患者是否患有胆总管结石。
本研究旨在评估美国胃肠内镜学会提出的胆总管结石诊断评分系统在急性胆囊炎患者中的性能。
材料/方法：进行了一项回顾性横断面研究，涵盖一家二级护理医院4年期间的病例。纳入所有编码诊断为急性胆囊炎且至少接受过以下一项检查的患者：内镜逆行胰胆管造影（ERCP）、内镜超声、磁共振胰胆管造影和术中胆管造影。
在4369例诊断为急性胆囊炎的患者中，40例（0.92%）临床或超声检查怀疑患有胆总管结石。他们的平均年龄为68.1±15岁，其中22例（55%）为男性。纳入的患者中，31例（77.5%）有胆总管结石的高风险，9例（22.5%）有中度风险。在31例高风险患者中，16例（51.6%）确诊为胆总管结石。在9例中度风险患者中，2例（22.2%）也确诊为胆总管结石。胆总管结石高风险评分的阳性预测值为52%，敏感性为89%。胆总管结石中度风险评分的阳性预测值为22%，敏感性为11%。
急性胆囊炎患者中怀疑患有胆总管结石的情况很少见（<1%）。高风险评分的敏感性与已发表的总体疑似胆总管结石患者系列研究中的结果大致相同（86%），而阳性预测值则显著较低（52%对79.8%）。因此，对于急性胆囊炎且怀疑患有胆总管结石的患者，不应使用该评分来筛查胆总管结石，而应在ERCP之前使用敏感方法进行检查。
