To the surgeon, the dilemma of the retained common duct stone versus unnecessary exploration of the common duct remains an ever present problem since the sequelae of each may significantly increase morbidity and mortality in patients.
The object of this study is to assess the predictive ability of various indicators of common bile duct stone.
The records of 468 patients who underwent primary cholecystectomy at the department of surgery of Soonchunhyang University from January 1985 to December 1993 were retrospectively studied. Ten predefined criteria with possible choledocholithiasis
analysed by computer with both univariate and multivariate methods to determine which factors identify patients with stones in the common bile duct.
We recently analyzed our experience using routine operative cholangiography through cystic duct(253 case, 54%) or T-tube choledochostomy(215 case, 46%) undergoing cholecystectomy.
@ES The results were as follows:
@EN 1) The male to female ratio was 1:1.28 with common bile duct stone group (Group I), 1:1.71 without common bile duct stone (Group II) and the peak incidence of age was the 6th decade.
2) Univariate analysis confirmed that common bile duct stones were associated with increased age and dilated common bile duct, increased laboratory finding, diagnosis of biliary colic, jaundice, and pancreatitis(P<0.05).
3) Multivariate analysis revealed that common bile duct diameter and alkaline phosphatase emerged as the most important variables; additional historical, including the total bilirubin, age, multiple gallbladder stones significantly predicted the
presence of common bile duct stones. The presence of jaundice, pancreatitis, biliary colic and elevated transaminase did not add to their predictive index.
As a result of these findings, we suggested that if operative cholangiographic facilties are not available(particularly) in emergency situations), simple mathematical formula could be devised using readily available clinical data as predictive
index for
the presence of common bile duct stones.
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