儿童轻度胆石性胰腺炎患者行确定性诊断检查对胆总管结石的临床应用价值。

Clinical Utility of Definitive Diagnostic Tests for Choledocholithiasis in Pediatric Patients with Mild Gallstone Pancreatitis.

机构信息

Division of General Surgery, J.P. Garrahan Hospital, Buenos Aires, Argentina.

出版信息

J Pediatr Surg. 2023 Dec;58(12):2352-2355. doi: 10.1016/j.jpedsurg.2023.06.011. Epub 2023 Jun 25.

DOI:10.1016/j.jpedsurg.2023.06.011

PMID:37460346

Abstract

BACKGROUND

Gallstone pancreatitis was historically considered a risk factor for choledocholithiasis (CD). However, recent studies of adult patients evidenced a weak association between gallstone pancreatitis and CD. The aim of this study was to analyze this association in pediatric patients.

METHODS

We conducted a retrospective study on patients with mild gallstone pancreatitis who underwent any definitive testing for CD (MRCP, ERCP, IOC), managed between March 2010 and September 2022. Patients were classified according to the presence or absence of risk factors for CD (total bilirubin ≥2 mg/dl; common bile duct >6 mm on ultrasound; and/or CD on ultrasound). We evaluated the diagnosis of CD on definitive testing in both groups and analyzed the predictive capacity of the presence of risk factors.

RESULTS

Eighty-four patients were included in the final analysis. Seventy-nine percent were females. The median age was 13 (4-17) years. Forty-seven (55.9%) patients had one or more risk factors. The definitive testing confirmed 13 (15.5%) cases of CD, 12 (25.5%) in the group of patients with risk factors and 1 (2.7%) in those without risk factors. The sensitivity, specificity, positive predictive value and negative predictive value of the presence of associated risk factors were 92.3, 50.7, 25.5 and 97.3%, respectively.

CONCLUSION

Pediatric patients with gallstone pancreatitis without associated risk factors have a very low incidence of CD. In these patients we suggest performing a laparoscopic cholecystectomy without intraoperative cholangiography or any other definitive test for CD.

LEVEL OF EVIDENCE

Level II, retrospective study.

摘要

背景

胆石性胰腺炎曾被认为是胆总管结石（CD）的危险因素。然而，最近对成年患者的研究表明，胆石性胰腺炎与 CD 之间的关联较弱。本研究旨在分析儿科患者中的这种关联。

方法

我们对 2010 年 3 月至 2022 年 9 月期间接受任何明确 CD 检测（MRCP、ERCP、IOC）的轻度胆石性胰腺炎患者进行了回顾性研究。根据是否存在 CD 的危险因素（总胆红素≥2mg/dl；超声检查胆总管>6mm；和/或超声检查 CD）对患者进行分类。我们评估了两组患者在明确检查中 CD 的诊断，并分析了危险因素存在的预测能力。

结果

最终分析纳入了 84 例患者。79%为女性，中位年龄为 13（4-17）岁。47 例（55.9%）患者有一个或多个危险因素。明确检查证实了 13 例（15.5%）CD 病例，其中 12 例（25.5%）存在危险因素的患者中，1 例（2.7%）不存在危险因素的患者中。存在相关危险因素的敏感性、特异性、阳性预测值和阴性预测值分别为 92.3%、50.7%、25.5%和 97.3%。