Abboud P A, Malet P F, Berlin J A, Staroscik R, Cabana M D, Clarke J R, Shea J A, Schwartz J S, Williams S V
Division of General Internal Medicine, University of Pennsylvania, Philadelphia, USA.
Gastrointest Endosc. 1996 Oct;44(4):450-5. doi: 10.1016/s0016-5107(96)70098-6.
The decision of whether or not to investigate for common bile duct stones before cholecystectomy utilizes clinical, laboratory, and radiologic information (indicators). There is tremendous individual variation among clinicians in the criteria used for making this decision. Our aim was to perform a meta-analysis of published data to estimate the performance characteristics of the most commonly used preoperative indicators of common bile duct stones.
Using predetermined exclusion criteria, we selected articles from a MEDLINE search and bibliographic review. Weighted averages were used to determine summary sensitivity, specificity, and positive and negative likelihood ratios for each indicator for stones.
From 2221 citations identified, 22 studies met inclusion criteria. The 10 indicators examined were reported in a common fashion in three or more articles, and could be assessed preoperatively. Seven exhibited a specificity greater than 90%. Indicators with positive likelihood ratios of 10 or above were cholangitis, preoperative jaundice, and ultrasound evidence of common bile duct stones. Positive likelihood ratios for dilated common bile duct on ultrasound, hyperbilirubinemia, and jaundice ranged from almost 4 to almost 7. Elevated levels of alkaline phosphatase, pancreatitis, cholecystitis, and hyperamylasemia exhibited positive likelihood ratios of less than 3.
This meta-analysis has identified indicators for duct stones and ranked them according to likelihood ratios. These findings can be applied as guidelines for whether to investigate for duct stones before cholecystectomy.
在胆囊切除术之前是否对胆总管结石进行检查的决策需要综合临床、实验室和影像学信息（指标）。临床医生在做出这一决策时所使用的标准存在很大的个体差异。我们的目的是对已发表的数据进行荟萃分析，以评估最常用的术前胆总管结石指标的性能特征。
我们使用预先确定的排除标准，从MEDLINE检索和文献综述中筛选文章。加权平均值用于确定每个结石指标的汇总敏感性、特异性以及阳性和阴性似然比。
在识别出的2221篇文献中，有22项研究符合纳入标准。所检查的10项指标在三篇或更多文章中以相同方式报告，并且可以在术前进行评估。其中七项指标的特异性大于90%。阳性似然比为10或以上的指标为胆管炎、术前黄疸以及胆总管结石的超声证据。超声显示胆总管扩张、高胆红素血症和黄疸的阳性似然比在4到7之间。碱性磷酸酶水平升高、胰腺炎、胆囊炎和高淀粉酶血症的阳性似然比小于3。
这项荟萃分析确定了胆管结石的指标，并根据似然比进行了排序。这些发现可作为胆囊切除术之前是否对胆管结石进行检查的指导原则。
