Although peroperative cholangiography is valuable and highly accurate in detection of common bile duct(CBD) stones, its routine use is controversial, particularly, in era of laparoscopic cholecystectomy because of its inherent disavantages.
The aims of this study are to determine the risk factors predicting the presence of CBD stones in cholelithiasis, and to select patients with high risk of CBD stones in whon peroperative cholangiography is indicated.
A data base of 561 patients with cholelithiasis who underwent routine intraoperative cholangiography during conventional cholecystectomy, was compiled during an 9 year period, and reviewed retrospectively. CBD stones were identified at CBD
exploration
in 95 patients(16.9%). Based on clinical, biochemical and sonographic data, risk factors for CBD stones were determine by both univariate and multivariate analysis. Statistical significance was considered for P<0.05.
By univariate analysis using chi-square test, 7 clinical variables(age >50, duration of biliary symptom <1 month, previous or current jaundice, fever >38.5'c, pulse rate 100/min, and right upper quadrant tenderness), 6 biochemical variables(WBC
>10.000/mm3, serum GOT or GPT >50U/L, ALP >160U/L, total bilirubin >2.0mg%, and amylase >180U/dl), and 2 sonographic variables (size of GB stones <10mm, diameter of CBD >10mm) were identified as significant risk factors predicting the presence of
CBD
stones.
By multivariate analysis using stepwise logistic regression, dilated CBD, clinical jaundice and elevated liver function tests (LFT; one or more of serum GOT, GPT, ALP or bilirubin) were determined as independent predictors. Of these, dilated CBD
was the
most important predictor. Dilated CBD predicted the presence of CBD stones in 48.8% of patients with normal LFT(moderate risk group) and 66.7% of patients with elevated LFT(high risk group).
Combination of all of dilated CBD, clinical jaundice, and elevated LFT predicted the CBD stones in 83.3% of patients(highest risk group). Conversely, nondilated CBD predicted the CBD stones in 1.5% of patients (low risk group).
Based on these results, we can conclude that preoperative assessment in cholelithiasis can predict the CBD stones and so selective cholangiography is warranted in moderate to high risk patients.
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