Barkun A N, Barkun J S, Fried G M, Ghitulescu G, Steinmetz O, Pham C, Meakins J L, Goresky C A
Division of Gastroenterology, McGill University, Montreal, Quebec, Canada.
Ann Surg. 1994 Jul;220(1):32-9. doi: 10.1097/00000658-199407000-00006.
The authors determined the most useful predictors of common bile duct (CBD) stones as diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) in patients who underwent laparoscopic cholecystectomy (LC).
Prospective and retrospective collection of historical, biochemical and ultrasonographic data was used. Receiver operating characteristics curve analysis was used to determine optimal biochemical cut-off values. Multivariate analysis using logistic regression with generation of the best model identifying independent predictors of CBD stones also was employed. Prospective validation of the model was performed on an independent group of patients.
Endoscopic retrograde cholangiopancreatographies were performed before LC in 106 patients, and after LC in 33. Only four of ten clinical variables evaluated independently predicted the presence of CBD stones. The optimal model predicted a 94% probability of CBD stones in a patient older than 55 years of age who presented with an elevated bilirubin (over 30 mumol/L) and positive ultrasound findings (a dilated CBD, and a CBD stone seen on ultrasound). This model was validated prospectively in a subsequent series of 49 patients in which the probability of CBD stone was only 8% when all four predictors were absent.
The identified independent clinical predictors of a CBD stone helps select a population of symptomatic gallstone bearers who benefit most from cholangiographic assessment.
作者确定了在接受腹腔镜胆囊切除术（LC）的患者中，经内镜逆行胰胆管造影术（ERCP）诊断胆总管（CBD）结石最有用的预测指标。
采用前瞻性和回顾性收集历史、生化及超声数据。利用受试者工作特征曲线分析来确定最佳生化临界值。还采用了逻辑回归进行多变量分析，生成识别CBD结石独立预测指标的最佳模型。对一组独立患者进行模型的前瞻性验证。
106例患者在LC术前接受了ERCP，33例在LC术后接受了ERCP。在独立评估的10项临床变量中，只有4项能预测CBD结石的存在。最佳模型预测，对于一名年龄超过55岁、胆红素升高（超过30μmol/L）且超声检查结果阳性（CBD扩张，超声可见CBD结石）的患者，CBD结石的概率为94%。该模型在随后的49例患者中进行了前瞻性验证，当所有4个预测指标均不存在时，CBD结石的概率仅为8%。
所确定的CBD结石独立临床预测指标有助于选择最能从胆管造影评估中获益的有症状胆石症患者群体。
