Elaboración de un score predictivo preoperatorio de coledocolitiasis |
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Authors: | Jose Bueno Lledó Jose Luis Ibáñez CiriónAntonio Torregrosa Gallud Rafael López Andújar |
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Institution: | Unidad Hepatobiliopancreatica, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari i Politecnic La Fe, Valencia, España |
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Abstract: | IntroductionCholedocholithiasis is the most common cause of obstructive jaundice and occurs in 5-10% of patients with cholelithiasis.ObjectivesTo design a preoperative predictive score for choledocholithiasis.Material and methodsA prospective study was carried out in 556 patients admitted to our department for biliary disease. Preoperative clinical, laboratory, and ultrasound variables were compared between patients without choledocholithiasis and 65 patients with this diagnosis. A multivariate logistic analysis was performed to obtain a predictive model of choledocholithiasis, determining sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).ResultsPredictors of choledocholithiasis were the presence of a prior history of biliary disease (history of biliary colic, acute cholecystitis, choledocholithiasis or acute biliary pancreatitis) (p = 0.021, OR = 2.225, 95% CI: 1.130-4.381), total bilirubin values > 4 mg/dl (p = 0.046, OR = 2.403, 95% CI: 1.106-5.685), alkaline phosphatase values > 150 mg/dl (p = 0.022 income, OR = 2.631, 95%: 1.386-6.231), gamma-glutamyltransferase (GGT) values > 100 mg/dl (p = 0.035, OR = 2.10, 95% CI: 1.345-5.850), and an ultrasound finding of biliary duct > 8 mm (p = 0.034, OR = 3.063 95% CI: 1086-8649). A score superior to 5 had a specificity and PPV of 100% for detecting choledocholithiasis and a score less than 3 had a sensitivity and NPV of 100% for excluding this diagnosis.ConclusionsThe preoperative score can exclude or confirm the presence of choledocholithiasis and allows patients to directly benefit from laparoscopic cholecystectomy (LC) or prior endoscopic retrograde cholangiopancreatography (ERCP). |
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Keywords: | Coledocolitiasis Colelitiasis Score predictivo Colecistectomí a laparoscó pica |
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