담낭 담석으로 인한 복강경 담낭절제술시 총수담관결석 동반 유무의 예측인자

초록

Background/Aims: Accurate preoperative prediction of choledocholithiasis is essential in order to minimize patients' risk and to avoid unnecessary procedures. We preforme 1 this study identify independent risk factors for choledocholithiasis in patients who had undergone cholecystectomy for symptomatic cholelithiasis. Methods: The medical records of patients who had undergone cholecystectomy between September, 1993 and December, 1996 were reviewed. Patients who were already found to have either extrahepatic or intrahepatic biliary stones on sonogram were excluded. 79 of these patients in whom the presence or absence of choledocholithiasis had been confirmed(preoperative ERCP in 69, operative choangiography in 10) were eligible for analysis. Candidate predictor variables included age, sex, presence of fever, and maximum preoperative values for each of the followings: common bile duct(CBD) diameter, white blood cell counts, AST, ALT, alkaline phosphatase, total bilirubin, and amylase. The analysis was conducted using SPSS(V 5.0.2). Results: Choledocholithiasis was confirmed in 16(20.3%) of the 79 eligible patients. Univariate analysis identified age, alkaline phosphatase, and CBD diameter as predictors. Multivariate analysis subsequently identified alkaline phosphatase and CBD diameter as independent predictors of choledocholithiasis. The probability of choledocholithiasis was 86% when two independent predictors were present, but was 3% when all two predictors were absent. Conclusions: ERCP or operative cholangiography is not thought to be necessary for patients with symptomatic cholelithiasis who have both normal biliary tree on sonogram and normal serum alkaline phosphatase. However patients with symptomatic cholelithiasis who have both dilated CBD on sonogram and elevated serum alkaline phosphatase, or are found to have CBD stone on abdominal sonogram, do necessarily require do not necessarily require what? RCP? to confirm the presence of CBD stone.

키워드