Järvinen H
Ann Clin Res. 1978 Dec;10(6):323-7.
In a prospective series of 155 patients with acute cholecystitis preoperative liver function tests were determined with the aim of predicting the presence of common duct stones. Elevated serum bilirubin, aminotransferases and alkaline phosphatase levels were observed in 32, 34 and 22% of cases, respectively. The frequency of common duct stones was 17.4%. The sensitivity of bilirubin and aminotransferases with regard to ductal stones was higher (70-81%), but alkaline phosphatase showed the best predictive values (46%). The probability of common duct stones increased with higher degrees of elevation in the case of alkaline phosphatase, but not in the case of bilirubin or aminotransferases, A frequency of 31-67% of choledocholithiasis was found when one or all of the tests were positive. After random assignment the patients were operated on early or after delay. In the delayed surgery group more failures occurred in the conservative treatment of acute cholecystitis if the tests were elevated (36%) than if normal (15%, p less than 0.05). The frequencies of common duct stones were 11 and one in these groups (p less than 0.001). There was no increase in postoperative morbidity after early surgery (15%) compared with delayed surgery (22%, p greater than 0.1), when liver function was disturbed. Liver function tests thus allow patients with common duct stones to be selected for early surgery in acute cholecystitis.
在一项针对155例急性胆囊炎患者的前瞻性研究中，术前进行肝功能检查以预测胆总管结石的存在。分别有32%、34%和22%的病例观察到血清胆红素、氨基转移酶和碱性磷酸酶水平升高。胆总管结石的发生率为17.4%。胆红素和氨基转移酶对胆管结石的敏感性较高（70%-81%），但碱性磷酸酶显示出最佳的预测价值（46%）。碱性磷酸酶升高程度越高，胆总管结石的可能性增加，但胆红素或氨基转移酶升高时并非如此。当一项或所有检查呈阳性时，胆总管结石的发生率为31%-67%。随机分组后，患者接受早期手术或延迟手术。在延迟手术组中，如果检查结果升高，急性胆囊炎保守治疗失败的发生率（36%）高于检查结果正常时（15%，p<0.05）。这些组中胆总管结石的发生率分别为11例和1例（p<0.001）。当肝功能受到干扰时，早期手术（15%）与延迟手术（22%，p>0.1）相比，术后发病率没有增加。因此，肝功能检查可用于选择急性胆囊炎合并胆总管结石的患者进行早期手术。
