Utilidad de los factores predictores de coledocolitiasis en pacientes operados en la Clínica Rafael Uribe Uribe - Cali
Palabras clave:
coledocolitiasis, pronóstico, factores de riesgo,, curva ROC, diagnóstico por ultrasonidoResumen
En los últimos años se ha tratado de disminuir el número de exploraciones de la vía biliar (EVB) innecesarias, para lo cual se ha descrito una serie de factores predictores de coledocolitiasis. El objetivo del presente estudio era evaluar la utilidad de estos factores en los pacientes operados por patología vesicular en la CRUU de Cali (Colombia), entre el 1° de julio y el 31 de diciembre de 2000, teniendo en cuenta la falta de oportunidad en la atención de los pacientes y la frecuencia de complicaciones de colecistitis litiásica a causa de esto.
Se incluyeron 392 pacientes operados por patología vesicular y se diagnosticó coledocolitiasis en 32 de ellos (8,16%). Se construyeron Curvas ROC (Características Operativas del Receptor) para encontrar el punto de corte en variables continuas y posteriormente se realizó análisis bivariado cruzando cada una de las variables con coledocolitiasis y se encontró diferencia estadísticamente significativa en:
Edad mayor de 69 años, ictericia (historia clínica o examen físico), fiebre (historia clínica o examen físico, historia de coluria, bilirrubina total (> 3,5 mgldl), bilirrubina directa (> 3,1 mg /dl), fosfatasa alcalina (> 500 Ull), dilatación de vía biliar en ecografía, calculas en vía biliar por ecografía.
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Referencias bibliográficas
l. AIVAREZ, L. and Franco, A. Exploración laparoscópica del colédoco. Rev Colomb Cir 1999; 14: R5.
2. MULETT. E. Cirugía de la vesícula y vías biliares: su evaluación en el hospital de Caldas. Rev Colomb Cir 1994; 9: 26.
3. PIMENTEL, A.; PAIMIERI, A.; MENDOZA, L.; and ZURITA, N. Colecistectomía ambulatoria por mini laparotomía. Rev Colomb Cir 1995; 10: 163.
4. RESTREPO,J.; VEIEZ, J.; LINCE, L. and RAMIREZ,L. Tratamiento del paciente con sospecha de coledocolitiasis: contribución de la colangioscopia flexible. Rcv Colomb Cir 1997; 12: 241.
5. VERGNAUD,J.; PENAGOS,S.; LOPERA, c.; HERRERA,A.; ZERRATE, A. and V ASQUEZ,J. Colecistectomía laparoscópica: experiencia en hospital de segundo nivel. Rev Colomb Gil' 2000; 15: 6. ZUIUAGA, L.; CLAVIJO, W. and VIILALBA, A. Colecistectomía laparoscópica ambulatoria en una unidad quirúrgica no hospitalaria. Rcv Colomb Cir 2000; 15: 2.
7. BARKUN,A.; BARKUN,J.; FRIED, G.; GHITULESCU,G.; Steinmetz, O.; PHAM, c.; MEAKINS,J.; GORESKY,C. ANDthc McGill Gallstone Treatmcnt Group. Useful predictors ofbile duct stones in paticnts undergoing laparoscopic cholccystectomy. Ann Surgery 1994; 220: 32.
8. ABHOUD , P.; MALET, P.; BERLlN, J.; STAROSCIK,R.; CAllANA, M.; CLARKE,J.; SHEA, J.; SCHWSRTZ,S. and WILLlAMS, S. Predictors ol' common bile duct stones prior to cholecystectomy: a metaanalysis. Gastrointestinal endoscopy 1996; 44: 450.
9. CHANGCHIEN,c.; CHUAH, S. and CHIU, K. Is ERCP neccesary for symptomatic gallbladder stone patients bcfore laparoscpic cholecystectomy'! Ame J Gastroent 1995; 90: 2124.
10. MCPHEE, M. and GREENBERGER,N. Diseases of the gallbladder and bile ducts. In Harrison's principIes ol' internal mcdicine. Braunwald, E.; Isselbacher, K. and Petersdorl', R. McGraw-Hill 1987; 1358-68.
11. National Institutes ofhealth consensus development conl'erence statement on gallstones and laparoscopic cholecystectomy. Ame J Surg 1993; 165: 390.
12. ANGEl., A.; ARANC,O,L.; CHAI.A, A.; OSORIO, M.; RAMÍREZ,J. and GARCÍA, F Colelitiasis: Guías de practica clínica basadas en la evidencia. Proyecto ISS - Ascofame 2000.
13. CATHELlNE,J.; TURNER,R.; RIZK, N.; BARRAT,c.; BUENOS,P. and CHAMPAUIT,G. Evaluation ofthe biliary tree during laparoscopic cholecystectomy: laparoscopic ultrasound versus intraoperative cholangiography. A prospective study 01' 150 cases. Surg Laparosc Endosc 1998; 8: 85.
14. LEITMAN,M.; FISHER,M.; MACKINI.EY,M.; ROTHMAN,R.; WARIJ, R.; REINER,D. and TORTOLANI,A. The evaluation and management of known or suspected stones of the common bile duct in the era of minimal access surgery. Surg Gynecol Obstetr 1993; 176: 527.
15. MENEZES, N.; MARSON, P.; DE BEAUX,A.; MUIR, 1. and AUI.IJ, C. Propective analysis of a scoring system to predict choledocholithiasis. Br J Surg 2000; 87: 1176.
16. SANTUCCI,L.; NATALlNI,G.; SARPI, L.; FIORUCCI,S.; SOLINAS,A. and MORELL!, A. Selective endoscopic retrograde cholangiography and preoperative bile duct stone removal in patients scheduled I'or laparoscopic cholecystectomy: a prospective study. Ame J Gastroent 1996; 91: 1326.
17. CERVANTES,J.; ROJAS, G. and ANTON,J. Colecistectomía: análisis de la experiencia personal 5 años antes y 5 después de la cirugía laparoscópica. Rev Colomb Cir 2000; 15: 8.
18. MACFAIlI':N,B. and PASSI, R. The role of endoscopie retrograde cholangiopancreatography in the era of laparoscopic cholecystectomy. Semin Laparoscope Surg 1997; 4: 18.
19. NEOPTOI.EMOS,J.; CARR-Locke, D. and FOSSARIJ,D. Prospective randomized study of preoperative endoscopic sphincterotomy versus surgery alone for common bile duct stones. Br Med J 1987; 294: 470.
20. DEN IlESTEN,L. and DOTY, J. Pathogenesis and management of choledocholithiasis. Surg Clin N.A 1981; 61: 893.
21. PRAT,F.; MEDURI,B.; DucoT, B.; CHICHE,R.; SALlMIlENI-BARTOLlNI, R and PEI.LETIER,G. Prediction of common bile duct stones by noninvasive tests. Ann Surgery 1999; 229: 362.
22. TAYLOR,T.; TORRANCE,B.; RIMMIR, S.; HILLlER, Y. and LUCAS, S. Operative cholangiography: is there a statistical alternative'!. Ame J Surg 1983; 145: 640.
23. SALTZSTEIN, E.; PEACOCK, J. amI TIIOMAS, M. Preoperative bilirrubin, alkaline phosphatase and amylase levcls as predictors of common duet stones. Surg Gyn Obstetr 1982; 154: 381.
24. CSENIJES, A.; BURDII.ES, P.; DíA/ J.; MALUENIJA,F; KORN, O.; V ALlno, E. and CSI'NIJES, P. Prevalence 01' common bile duct stones according to the increasing number of risk I'actors prescnt. A prospective study employing routinely intraoperative cholangiography in 477 cases. Hepatogastroenterology 1998; 45: 1415.
25. HONG, K.; KIMW.; LEE, H. and KI, C. Prediction of common bile duct stones: ils validation in laparoscopic cholecystectomy. Hepatogastroenterology 1997; 44: 1574.
26. HOUDART,R.; PERNICENI,T.; DAMI', R.; SALMERON,M. and SIMON, J. Predicting common bile duct lithiasis: uetermination anu prospective valiuation of a model predictiong low risk. Ame J Surg 1995; 170: 38.
27. Koo, K. and TRAVERSO,W. Do preoperative indicators preuict the presence of common bile duct sUmes during laparoscopic cholecystcctomy'! Ame J Surg 1996; 171: 495.
28. LEIJINGHI'N,Y.; LECESNE,R.; RAYMONIJ,J.; GENSI', Y.; AMOURI'TTI, M.; DROUILI,ARIJ,1.; COUZIGOU,P. and SILVAIN,C. Diagnosis of choledocholithiasis: EUS 01' magnetic resonance cholangiography'! A prospective controlled study. Gastrointestinal endoscopy 1999; 49: 26.
29. PITT, H. Role of open choledochotomy in the treatment 01' choledocholithiasis. Ame J Surg 1993; 165: 483.
30. TRONIJSEN, E.; EIJWIN, B,; REIERTSEN, D.; FACiERTlJN,H. and ROSSELANIJ, A. Selection criteria for endoscopic retrograde cholangiopancreaticography (ERCP) in patients with gallstone disease. World J Surg 1995; 19: 852.
31. VOYLES, c.; SANDERS, O, and HO(;AN, R. Common bile duct evaluation in the era 01' laparoscopic cholecystectomy: 1050 cases later. Ann Surgery 1994; 219: 744,
32. WIDDlSON,A.; LONGSTRAFr,A. and ARMSTRONCi,C. Tratamiento combinado, laparoscópico y endoscópico, de los cálculos de la vesícula y de las vías biliares: un estudio prospectivo. Br J Surg (ed. esp.). 1994; 12: 36.
33. WILSON,T.; HALL,J, and WATTS,J. Is operative cholangiography always necessary'!. Br J Surg 1986: 73: 637.
34. COTTON,P. Endoscopic retrograde cholangiopancreatography and laparoscopic cholecyslectomy. Ame J Surg 1993; 165: 474.
35. HAUER-JENSEN, M.; KARESEN, R.; NYC,AARD,K.: SOI.HEIM, K.; AMLIE,E.; HAVIG,O. and ROSSELANIJ,A. Prospective randomized study of routine intraoperative cholangiography during open cholccyslectomy: long-term follow-up and multivariate analysis of predictors of choledocholithiasis. Surgery 1993; 113: 318.
36. PRAT, F; AMOUYAI.,G.; AMOUYAI.,P.; PELLETII,R,G.; FRITsnl, J.; CHOURY,A.; BUFrET, C. and ETIENNE,J. Prospective controlled study 01'endoscopic ultrasonography and endoscopic retrograde cholangiography in patients with suspected common-bileuuct lithiasis. Lancet 1996; 347: 75.
37. REISS, R.; OEUTSCH,A.; NUDELMAN,1. and KOTT, 1. Statistical value of various clinical parameters in predicting the presence of choledocal stones. Surg. Gyn Obstetr 1984; 159: 273.
38. WALSH, M and HERMANN,R. The conventional management of common bile duct stones before laparoscopic cholecystectomy. Semin Laparosc Surg 1997; 4: 2.
39. ALVAREZ,L. and NAVARRETE,C. Esfinterotomía endoscópica. Rev Colomb Cir 1994; 9: 251.
40. ALVAREZ,L. Tratamiento de la coledocolitiasis en la era de la colecistectomía laparoscópica. Rev Colomb Cir 1997; 12: 199.
41. ANCIAUX,M.; PELLETIER,G.; ATTALI,P.; MEDURI,B.; LIGUORY,C. and ETIENNE,J. Prospective study of clinical and biochemical features of symptomatic choledocholithiasis. Oig Ois Scie 1986; 14: 449.
42. Flore, N.; LEDNICZKY,G.; WIEBKE, E.; BROADJE,T.; PRUITT,A.; GOULET, R.; GROSFELD, J. and CANAL, O. An analysis of perioperative cholangiography in one thousand laparoscopic cholecystectomies. Surgery 1997; 122: 817.
43. JACüSS, J.; CEBUL, R. and ADAMSON, T. Acute cholecystitis: Evaluation of factors influencing common duct exploration. Ame Surgeon 1986; 52: 177.
44. LINDSEY,l.; NOTTLE,P. and SAl"I1ARIAS,N. Preoperative screening for common bile duct stones with infusion cholangiography: review of 1000 patients. Ann Surg 1997; 226: 174.
45. STIEGMANN,G.; GOFF, J.; MANSOUR,A.; PEARLMAN,N.; REVEILLE, R. and NORToN, L. PR cholecystectomy endoscopic cholangiography and stone removal is not superior to cholecystectomy, cholangiography and common duct exploration. Ame J Surg 1992; 163: 227
46. HAMMARSTROM,L. and RANSTAM,J. Factors predictive of bile duct stones in patients with acute calculous cholecystitis. Dig Surg 1998; 15: 323.
2. MULETT. E. Cirugía de la vesícula y vías biliares: su evaluación en el hospital de Caldas. Rev Colomb Cir 1994; 9: 26.
3. PIMENTEL, A.; PAIMIERI, A.; MENDOZA, L.; and ZURITA, N. Colecistectomía ambulatoria por mini laparotomía. Rev Colomb Cir 1995; 10: 163.
4. RESTREPO,J.; VEIEZ, J.; LINCE, L. and RAMIREZ,L. Tratamiento del paciente con sospecha de coledocolitiasis: contribución de la colangioscopia flexible. Rcv Colomb Cir 1997; 12: 241.
5. VERGNAUD,J.; PENAGOS,S.; LOPERA, c.; HERRERA,A.; ZERRATE, A. and V ASQUEZ,J. Colecistectomía laparoscópica: experiencia en hospital de segundo nivel. Rev Colomb Gil' 2000; 15: 6. ZUIUAGA, L.; CLAVIJO, W. and VIILALBA, A. Colecistectomía laparoscópica ambulatoria en una unidad quirúrgica no hospitalaria. Rcv Colomb Cir 2000; 15: 2.
7. BARKUN,A.; BARKUN,J.; FRIED, G.; GHITULESCU,G.; Steinmetz, O.; PHAM, c.; MEAKINS,J.; GORESKY,C. ANDthc McGill Gallstone Treatmcnt Group. Useful predictors ofbile duct stones in paticnts undergoing laparoscopic cholccystectomy. Ann Surgery 1994; 220: 32.
8. ABHOUD , P.; MALET, P.; BERLlN, J.; STAROSCIK,R.; CAllANA, M.; CLARKE,J.; SHEA, J.; SCHWSRTZ,S. and WILLlAMS, S. Predictors ol' common bile duct stones prior to cholecystectomy: a metaanalysis. Gastrointestinal endoscopy 1996; 44: 450.
9. CHANGCHIEN,c.; CHUAH, S. and CHIU, K. Is ERCP neccesary for symptomatic gallbladder stone patients bcfore laparoscpic cholecystectomy'! Ame J Gastroent 1995; 90: 2124.
10. MCPHEE, M. and GREENBERGER,N. Diseases of the gallbladder and bile ducts. In Harrison's principIes ol' internal mcdicine. Braunwald, E.; Isselbacher, K. and Petersdorl', R. McGraw-Hill 1987; 1358-68.
11. National Institutes ofhealth consensus development conl'erence statement on gallstones and laparoscopic cholecystectomy. Ame J Surg 1993; 165: 390.
12. ANGEl., A.; ARANC,O,L.; CHAI.A, A.; OSORIO, M.; RAMÍREZ,J. and GARCÍA, F Colelitiasis: Guías de practica clínica basadas en la evidencia. Proyecto ISS - Ascofame 2000.
13. CATHELlNE,J.; TURNER,R.; RIZK, N.; BARRAT,c.; BUENOS,P. and CHAMPAUIT,G. Evaluation ofthe biliary tree during laparoscopic cholecystectomy: laparoscopic ultrasound versus intraoperative cholangiography. A prospective study 01' 150 cases. Surg Laparosc Endosc 1998; 8: 85.
14. LEITMAN,M.; FISHER,M.; MACKINI.EY,M.; ROTHMAN,R.; WARIJ, R.; REINER,D. and TORTOLANI,A. The evaluation and management of known or suspected stones of the common bile duct in the era of minimal access surgery. Surg Gynecol Obstetr 1993; 176: 527.
15. MENEZES, N.; MARSON, P.; DE BEAUX,A.; MUIR, 1. and AUI.IJ, C. Propective analysis of a scoring system to predict choledocholithiasis. Br J Surg 2000; 87: 1176.
16. SANTUCCI,L.; NATALlNI,G.; SARPI, L.; FIORUCCI,S.; SOLINAS,A. and MORELL!, A. Selective endoscopic retrograde cholangiography and preoperative bile duct stone removal in patients scheduled I'or laparoscopic cholecystectomy: a prospective study. Ame J Gastroent 1996; 91: 1326.
17. CERVANTES,J.; ROJAS, G. and ANTON,J. Colecistectomía: análisis de la experiencia personal 5 años antes y 5 después de la cirugía laparoscópica. Rev Colomb Cir 2000; 15: 8.
18. MACFAIlI':N,B. and PASSI, R. The role of endoscopie retrograde cholangiopancreatography in the era of laparoscopic cholecystectomy. Semin Laparoscope Surg 1997; 4: 18.
19. NEOPTOI.EMOS,J.; CARR-Locke, D. and FOSSARIJ,D. Prospective randomized study of preoperative endoscopic sphincterotomy versus surgery alone for common bile duct stones. Br Med J 1987; 294: 470.
20. DEN IlESTEN,L. and DOTY, J. Pathogenesis and management of choledocholithiasis. Surg Clin N.A 1981; 61: 893.
21. PRAT,F.; MEDURI,B.; DucoT, B.; CHICHE,R.; SALlMIlENI-BARTOLlNI, R and PEI.LETIER,G. Prediction of common bile duct stones by noninvasive tests. Ann Surgery 1999; 229: 362.
22. TAYLOR,T.; TORRANCE,B.; RIMMIR, S.; HILLlER, Y. and LUCAS, S. Operative cholangiography: is there a statistical alternative'!. Ame J Surg 1983; 145: 640.
23. SALTZSTEIN, E.; PEACOCK, J. amI TIIOMAS, M. Preoperative bilirrubin, alkaline phosphatase and amylase levcls as predictors of common duet stones. Surg Gyn Obstetr 1982; 154: 381.
24. CSENIJES, A.; BURDII.ES, P.; DíA/ J.; MALUENIJA,F; KORN, O.; V ALlno, E. and CSI'NIJES, P. Prevalence 01' common bile duct stones according to the increasing number of risk I'actors prescnt. A prospective study employing routinely intraoperative cholangiography in 477 cases. Hepatogastroenterology 1998; 45: 1415.
25. HONG, K.; KIMW.; LEE, H. and KI, C. Prediction of common bile duct stones: ils validation in laparoscopic cholecystectomy. Hepatogastroenterology 1997; 44: 1574.
26. HOUDART,R.; PERNICENI,T.; DAMI', R.; SALMERON,M. and SIMON, J. Predicting common bile duct lithiasis: uetermination anu prospective valiuation of a model predictiong low risk. Ame J Surg 1995; 170: 38.
27. Koo, K. and TRAVERSO,W. Do preoperative indicators preuict the presence of common bile duct sUmes during laparoscopic cholecystcctomy'! Ame J Surg 1996; 171: 495.
28. LEIJINGHI'N,Y.; LECESNE,R.; RAYMONIJ,J.; GENSI', Y.; AMOURI'TTI, M.; DROUILI,ARIJ,1.; COUZIGOU,P. and SILVAIN,C. Diagnosis of choledocholithiasis: EUS 01' magnetic resonance cholangiography'! A prospective controlled study. Gastrointestinal endoscopy 1999; 49: 26.
29. PITT, H. Role of open choledochotomy in the treatment 01' choledocholithiasis. Ame J Surg 1993; 165: 483.
30. TRONIJSEN, E.; EIJWIN, B,; REIERTSEN, D.; FACiERTlJN,H. and ROSSELANIJ, A. Selection criteria for endoscopic retrograde cholangiopancreaticography (ERCP) in patients with gallstone disease. World J Surg 1995; 19: 852.
31. VOYLES, c.; SANDERS, O, and HO(;AN, R. Common bile duct evaluation in the era 01' laparoscopic cholecystectomy: 1050 cases later. Ann Surgery 1994; 219: 744,
32. WIDDlSON,A.; LONGSTRAFr,A. and ARMSTRONCi,C. Tratamiento combinado, laparoscópico y endoscópico, de los cálculos de la vesícula y de las vías biliares: un estudio prospectivo. Br J Surg (ed. esp.). 1994; 12: 36.
33. WILSON,T.; HALL,J, and WATTS,J. Is operative cholangiography always necessary'!. Br J Surg 1986: 73: 637.
34. COTTON,P. Endoscopic retrograde cholangiopancreatography and laparoscopic cholecyslectomy. Ame J Surg 1993; 165: 474.
35. HAUER-JENSEN, M.; KARESEN, R.; NYC,AARD,K.: SOI.HEIM, K.; AMLIE,E.; HAVIG,O. and ROSSELANIJ,A. Prospective randomized study of routine intraoperative cholangiography during open cholccyslectomy: long-term follow-up and multivariate analysis of predictors of choledocholithiasis. Surgery 1993; 113: 318.
36. PRAT, F; AMOUYAI.,G.; AMOUYAI.,P.; PELLETII,R,G.; FRITsnl, J.; CHOURY,A.; BUFrET, C. and ETIENNE,J. Prospective controlled study 01'endoscopic ultrasonography and endoscopic retrograde cholangiography in patients with suspected common-bileuuct lithiasis. Lancet 1996; 347: 75.
37. REISS, R.; OEUTSCH,A.; NUDELMAN,1. and KOTT, 1. Statistical value of various clinical parameters in predicting the presence of choledocal stones. Surg. Gyn Obstetr 1984; 159: 273.
38. WALSH, M and HERMANN,R. The conventional management of common bile duct stones before laparoscopic cholecystectomy. Semin Laparosc Surg 1997; 4: 2.
39. ALVAREZ,L. and NAVARRETE,C. Esfinterotomía endoscópica. Rev Colomb Cir 1994; 9: 251.
40. ALVAREZ,L. Tratamiento de la coledocolitiasis en la era de la colecistectomía laparoscópica. Rev Colomb Cir 1997; 12: 199.
41. ANCIAUX,M.; PELLETIER,G.; ATTALI,P.; MEDURI,B.; LIGUORY,C. and ETIENNE,J. Prospective study of clinical and biochemical features of symptomatic choledocholithiasis. Oig Ois Scie 1986; 14: 449.
42. Flore, N.; LEDNICZKY,G.; WIEBKE, E.; BROADJE,T.; PRUITT,A.; GOULET, R.; GROSFELD, J. and CANAL, O. An analysis of perioperative cholangiography in one thousand laparoscopic cholecystectomies. Surgery 1997; 122: 817.
43. JACüSS, J.; CEBUL, R. and ADAMSON, T. Acute cholecystitis: Evaluation of factors influencing common duct exploration. Ame Surgeon 1986; 52: 177.
44. LINDSEY,l.; NOTTLE,P. and SAl"I1ARIAS,N. Preoperative screening for common bile duct stones with infusion cholangiography: review of 1000 patients. Ann Surg 1997; 226: 174.
45. STIEGMANN,G.; GOFF, J.; MANSOUR,A.; PEARLMAN,N.; REVEILLE, R. and NORToN, L. PR cholecystectomy endoscopic cholangiography and stone removal is not superior to cholecystectomy, cholangiography and common duct exploration. Ame J Surg 1992; 163: 227
46. HAMMARSTROM,L. and RANSTAM,J. Factors predictive of bile duct stones in patients with acute calculous cholecystitis. Dig Surg 1998; 15: 323.
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2003-06-20
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Bejerano, M. Utilidad De Los Factores Predictores De Coledocolitiasis En Pacientes Operados En La Clínica Rafael Uribe Uribe - Cali. Rev Colomb Cir 2003, 18, 73-83.
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