Velázquez MJD, Medina DA, Vega MAJ

Language: Spanish
References: 21
Page: 39-44
PDF size: 124.30 Kb.

ABSTRACT

Objective: To determine the usefulness of predictive factors for the diagnosis of choledocholithiasis based on clinical and laboratory studies.
Setting: Second health care level hospital.
Design: Prospective, observational, and comparative study.
Statistical analysis: Central tendency and dispersion tests. Groups comparison was made with Student’s t-test and c2, depending on the type of variable. We calculated sensitivity, specificity, positive and negative predictive values of the diagnostic test.
Patients and methods: The study was performed at the Regional PEMEX Hospital, in Salamanca, State of Guanajuato, Mexico, in the period from January to December 2007. All patients with a diagnosis suggestive of choledocholithiasis were included. Study parameters were the clinical symptoms (pain, fever, jaundice), laboratory tests (glutamic oxaloacetic transaminase, pyruvic glutamic transaminase, alkaline phosphatase, gamma glutamyl transferase, total bilirubin and direct bilirubin), ultrasonograph of the gallbladder and bile ducts to discard the presence of calculi in the gallbladder and the choledochus, as well as dilation of intra- and extra-hepatic bile ducts.
Results: We studied 36 patients, 16 men (42.10%) and 22 women (57.89%), with a woman:man relation of 1:2, the mean age was 56 years (± 15.88). Patients were divided in two groups; group 1 (n = 28) with positive algorithm, and group 2 (n = 10) with negative algorithm. All patients were subjected to transoperative cholangiography. Twenty-eight patients were true positive, none was false positive, four were false negative, and six were true negative. Sensitivity was of 87%, specificity of 100%, positive predictive value of 100%, negative predictive value of 60% when using gamma-glutamyl transferase, ultrasonogram, and direct bilirubin as parameters to define the positive test.
Conclusion: The proposed predictive values, using ultrasonogram, gamma-glutamyl transferase, and total or direct bilirubin, are useful for the diagnosis of choledocholithiasis.

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