Department of Surgery, School of Medicine and Surgery, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy.
Centre of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy.
Dig Surg. 2019;36(6):530-538. doi: 10.1159/000495696. Epub 2019 Jan 11.
The diagnosis of choledocholithiasis is challenging. Previously published scoring systems designed to calculate the risk of choledocholithiasis were evaluated to appraise the diagnostic performance.
Data of patients who were admitted between 2013 and 2015 with the following characteristics were retrieved: bile stone-related symptoms and signs, and indication to laparoscopic cholecystectomy. To validate and appraise the performance of the 6 scoring systems, the acknowledged domains of each metrics were applied to the present cohort. Sensitivity, specificity, positive, negative predictive, Youden index, and receiver operating characteristic curve with the area under the curve (AUC) values of the scores were calculated.
Two-hundred patients were analyzed. The highest sensitivity and specificity were obtained from the Menezes' (96.6%) and Telem's (99.3%) metrics respectively. The Telem's and Menezes' scores had the best positive (75.0%) and negative (96.4%) predictive values respectively. The best accuracy, as computed by the Youden index and AUC, was found for the Soltan's scoring system (0.628 and 0.88, respectively).
The available scoring systems are precise only in identifying patients with a negligible risk of common bile duct stone, but overall insufficiently accurate to suggest the routine use in clinical practice.
胆总管结石的诊断具有挑战性。先前发表的旨在计算胆总管结石风险的评分系统被评估以评价其诊断性能。
回顾性分析 2013 年至 2015 年间因以下特征入院的患者数据：胆石相关症状和体征，以及腹腔镜胆囊切除术的适应证。为了验证和评估 6 种评分系统的性能，将每个指标的公认领域应用于本队列。计算评分的敏感性、特异性、阳性、阴性预测值、Youden 指数和接收者操作特征曲线下的面积 (AUC) 值。
分析了 200 例患者。Menezes 评分（96.6%）和 Telem 评分（99.3%）的敏感性和特异性最高。Telem 评分和 Menezes 评分的阳性（75.0%）和阴性（96.4%）预测值最好。Soltan 评分系统的约登指数和 AUC 计算出的最佳准确性最高（分别为 0.628 和 0.88）。
现有的评分系统仅能精确识别出胆总管结石风险较小的患者，但总体来说，其准确性不足以在临床实践中常规使用。
