Metzger J, Muller C
Chirurgische Klinik, Spital Uster.
Helv Chir Acta. 1994 Jul;60(5):773-8.
The need for a routine preoperative intravenous cholangiogram (IVC) has been controversially discussed. We decided to assess if preoperative criteria such as history, clinical examination or laboratory findings could be used for selective indication for preoperative IVC. In a series of 146 patients with a preoperative IVC before undergoing laparoscopic cholecystectomy, history, clinical findings and laboratory results (bilirubin, transaminases, alkaline phosphatase, amylase) have been correlated with the radiological findings. ERCP was taken as the standard to assess the value of IVC. A normal IVC was quite reliable in excluding any pathology of the bile ducts or common bile duct stones. Thus specificity reached 96% and the negative predictive value was 97%. On the other hand a pathological IVC proved not to be a valid predictor of true pathological alterations. Sensitivity was only 60% and the positive predictive value just 55%. Over all accuracy was quite satisfactory (94%). We could not find a correlation between history, clinical or laboratory findings and the final result as assessed by ERCP. Therefore we could not find any useful parameters to define a selective policy for indication of preoperative IVC. On the other hand the IVC still proved useful to exclude relevant pathological findings. At the time being there is no strong argument for abandoning routine preoperative IVC.
术前常规静脉胆管造影（IVC）的必要性一直存在争议。我们决定评估术前标准，如病史、临床检查或实验室检查结果，是否可用于术前IVC的选择性指征。在一系列146例接受腹腔镜胆囊切除术前行术前IVC的患者中，将病史、临床发现和实验室检查结果（胆红素、转氨酶、碱性磷酸酶、淀粉酶）与放射学检查结果进行了关联分析。以内镜逆行胰胆管造影（ERCP）作为评估IVC价值的标准。正常的IVC在排除胆管或胆总管结石的任何病变方面相当可靠。因此，特异性达到96%，阴性预测值为97%。另一方面，病理性IVC被证明不是真正病理性改变的有效预测指标。敏感性仅为60%，阳性预测值仅为55%。总体准确率相当令人满意（94%）。我们未发现病史、临床或实验室检查结果与ERCP评估的最终结果之间存在关联。因此，我们未能找到任何有用的参数来确定术前IVC指征的选择性策略。另一方面，IVC在排除相关病理发现方面仍然被证明是有用的。目前没有充分的理由放弃术前常规IVC。
