Viriyaroj Vichit, Rookkachart Thammanij
J Med Assoc Thai. 2016 Nov;99 Suppl 8:S112-S117.
Complications of common bile duct stones (choledocholithiasis) can vary from simple biliary colic to lifethreatening conditions. Approximately 10-25% of symptomatic gallstone patients may be associated common bile duct stone (CBDS) at the time of diagnosis. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for diagnosis and treatment of CBDS but this procedure is invasive and has high morbidity and mortality rate. Moreover, routine preoperative ERCP is not cost-effectiveness.
This study aimed to determine the predictive factors for predicting CBDS in symptomatic gallstone patients.
Between March 2008 and February 2011, 149 symptomatic gallstone patients who underwent preoperative ERCP or intraoperative cholangiography (IOC) during laparoscopic cholecystectomy at Her Royal Highness Princess Mahachakri Sirindorn Medical Center (MSMC) were evaluated by clinical presentations, biochemical blood test and transabdominal ultrasonography. The preoperative predictive factors for choledocholithiasis were determined by univariate and multivariate analysis.
Age morethan 55 years, history of jaundice, history of cholangitis, total bilirubin >2.0 mg/dL, Aspartate aminotransferase >2 times the normal value, Alanine aminotransferase >3 times the normal value, Alkaline phosphatase >300 U/L, Gamma glutamyltranspeptidase >90 U/L, sized of CBD >8 mm and visualized CBD stones by ultrasonography were found to be associated with CBD stones by univariate analysis. For multivariate analysis, history of cholangitis (p-value 0.027), sized of CBD >8 mm (p-value 0.003) and detected CBD stones by ultrasonography (p-value 0.000) were found to be predictive factors for choledocholithiasis.
This study presented that the helpful preoperative predictive factors for choledocholithiasis were history of cholangitis, dilatation of CBD >8 mm and visualized CBD stone by ultrasonography.
胆总管结石（胆管结石病）的并发症从简单的胆绞痛到危及生命的情况不等。约10%-25%有症状的胆结石患者在诊断时可能合并胆总管结石（CBDS）。内镜逆行胰胆管造影（ERCP）是诊断和治疗CBDS的金标准，但该操作具有侵入性，且发病率和死亡率高。此外，常规术前ERCP不具有成本效益。
本研究旨在确定有症状胆结石患者中预测CBDS的预测因素。
2008年3月至2011年2月期间，在诗琳通公主殿下医疗中心（MSMC）接受腹腔镜胆囊切除术期间进行术前ERCP或术中胆管造影（IOC）的149例有症状胆结石患者，通过临床表现、血液生化检查和经腹超声进行评估。通过单因素和多因素分析确定胆管结石病的术前预测因素。
单因素分析发现，年龄大于55岁、黄疸病史、胆管炎病史、总胆红素>2.0mg/dL、天冬氨酸转氨酶>正常上限2倍、丙氨酸转氨酶>正常上限3倍、碱性磷酸酶>300U/L、γ-谷氨酰转肽酶>90U/L、胆总管直径>8mm以及超声检查可见胆总管结石与胆总管结石相关。多因素分析发现，胆管炎病史（p值0.027）、胆总管直径>8mm（p值0.003）和超声检查发现胆总管结石（p值0.000）是胆管结石病的预测因素。
本研究表明，胆管炎病史、胆总管直径>8mm以及超声检查可见胆总管结石是胆管结石病有用的术前预测因素。
