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Khirurgii

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Year 2019 Vol. 27 No 4

GENERAL & SPECIAL SURGERY

V.I. KOLOMIYTSEV, O.M. TERLETSKIY, M.M. BUFAN

ANALYSIS OF DIAGNOSTIC CRITERIA OF OLIGOSYMPTOMATIC CHOLEDOCHOLITHIASIS IN PATIENTS WITH ACUTE CALCULOUS CHOLECYSTITIS

Danylo Halytsky Lviv National Medical University, Lviv,
Ukraine

Objective. To identify the diagnostic criteria associated with oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis based on the combination of laboratory data and instrumental methods of examination.
Methods. The study included 219 patients, treated at the surgical department ¹ 1 of Danylo Halytsky Lviv National Medical University in the period of 2007-2017. Patients were divided into 2 groups: the1st group included patients with acute calculous cholecystitis and oligosymptomatic choledocholithiasis confirmed by endoscopic retrograde cholangiopancreatography (169 patients); the 2nd group comprised of patients with acute calculous cholecystitis without choledocholithiasis (50 patients), i.e. the comparison group.
Results. As follows from the single-factor analysis using the method of logistic regression, 5out of 47 factors were determined, indicating the presence of oligosymptomatic choledocholithiasis: the common bile duct diameter (according to transabdominal ultrasonography), alkaline phosphatase activity, alanine aminotransferase, aspartate aminotransferase, and total bilirubin level. The model of the combined effect of the above-mentioned factors on the probability of the oligosymptomatic choledocholithiasis in a patient was elaborated. The ROC curve analysis (The Receiver Operating Characteristic) of the model demonstrated its high-quality prediction for the presence of oligosymptomatic choledocholithiasis (AUC=0.97). According to the results of the analysis of the specificity, sensitivity and accuracy of the proposed model, the optimal threshold for establishing the patient belonging to the group with the oligosymptomatic choledocholithiasis was calculated accounting for 0.62. At a defined threshold, the sensitivity of the test is 93.02%, the specificity is 92.06%, and the accuracy is 92.31%.
Conclusions. Diagnostic criteria for the presence of oligosymptomatic choledocholithiasis (p<0.05) are the following: common bile duct diameter, alanine aminotransferase activity, aspartate aminotransferase, alkaline phosphatase, and total bilirubin level as well. The application of the developed multifactorial model for predicting the presence of oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis enables to reduce the need for such additional methods of examination as magnetic resonance cholangiopancreatography, computed tomography, endosonography, endoscopic retrograde cholangiography.

Keywords: acute calculous cholecystitis, choledocholithiasis, model for predicting choledocholithiasis, diagnostic criteria, endoscopic retrograde cholangiography
p. 394-401 of the original issue
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Address for correspondence:
79010, Ukraine,
Lviv, Pekarskaya Str., 69,
Danylo Halytsky Lviv National
Medical University,
Surgery Department ¹1,
tel. mobile: + 380974655895,
e-mail: olegterletskiy@ukr.net,
Oleg M. Terletskiy
Information about the authors:
Kolomiytsev Vasyl I., MD, Professor of the Surgery Department ¹1, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0003-0646-6306
Terletskiy Oleg M., Post-Graduate Studet of the Surgery Department ¹1, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0001-6675-6159
Bufan Mariia M., PhD, Associate Professor of the Department of Propaedeutics of Internal Medicine ¹1, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0002-4814-0964
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