Csendes A, Burdiles P, Diaz J C, Maluenda F, Korn O, Vallejo E, Csendes P
Department Of Surgery, University Hospital Santiago Chile.
Hepatogastroenterology. 1998 Sep-Oct;45(23):1415-21.
BACKGROUND/AIMS: To determine if the use of Intraoperative choliangiography (IOC) should be routinely performed and, if not, which criteria should be used to select patients requiring IOC during open or laparoscopic cholecystectomy.
495 Patients with 1 or more gallstones were included in a two-year study. Twelve clinical, laboratory, ultrasonographic and intraoperative factors were chosen and evaluated in all cases. Prior to cholecystectomy, IOC was performed after having identified the common bile duct (CBD) and cystic duct. The majority of the patients were operated on by the same surgeon to avoid differences in criteria and techniques. Statistical evaluation made use of the exact Fisher test and chi square test and, a p-value less than 0.05 was considered as significant.
IOC could be performed in 479 out of the 495 cases. IOC resulted in a normal CBD in 76.0%, had a false positive in 2.7%, a false negative in 0.48%, and a presence of 1 or more stones in the CBD in 20.9%. The study revealed that when none of the 12 risk factors were present, there were no cases with CBD stones. As the number of risk factors increased, so did the number of cases presenting with CBD stones.
Not all 12 risk factors show the same index of predictability; only 5 in particular (jaundice, ultrasound diameter CBD 7 mm, bilirubin over 26 umol/it, cystic duct > 4 mm and CBI, diameter over 9 mm) showed a high rate of predictability. However, when careful measurement and evaluation of risk factors for CBD stones are undertaken, it is possible to avoid the routine use of IOC.
背景/目的：确定术中胆管造影（IOC）是否应常规进行；若不常规进行，在开腹或腹腔镜胆囊切除术中应使用哪些标准来选择需要进行IOC的患者。
495例有1个或更多胆结石的患者纳入一项为期两年的研究。选择12项临床、实验室、超声和术中因素并在所有病例中进行评估。在胆囊切除术前，在识别出胆总管（CBD）和胆囊管后进行IOC。大多数患者由同一位外科医生进行手术，以避免标准和技术上的差异。统计学评估采用精确Fisher检验和卡方检验，p值小于0.05被认为具有统计学意义。
495例病例中有479例可以进行IOC。IOC显示CBD正常的占76.0%，假阳性占2.7%，假阴性占0.48%，CBD有1个或更多结石的占20.9%。研究表明，当不存在12项危险因素中的任何一项时，没有CBD结石的病例。随着危险因素数量的增加，出现CBD结石的病例数量也增加。
并非所有12项危险因素都具有相同的预测指数；特别是其中5项（黄疸、超声显示CBD直径7mm、胆红素超过26μmol/L、胆囊管>4mm和CBI直径超过9mm）显示出较高的预测率。然而，当对CBD结石的危险因素进行仔细测量和评估时，可以避免常规使用IOC。
