Trabajos científicos

Abstract

RESUMEN Entre septiembre de 1998 y junio de 2000 se practicaron 786 colecistectomías, de las cuales 75 (9,5%) corresponden a abiertas y 711 (90,05%) a laparoscópicas. La colangiografía transcística intra-operatoria (CIO) fue considerada el gold standard para el diagnóstico de coledocolitiasis, la cual fue posible realizarla en el 79,4% (624 casos) del total de las colecistectomías, encontrándose 74 coledocolitiasis (11, 9%). De las 75 colecistectomías abiertas, se efectuaron 63 (84%) CIO y de las 711 laparoscópicas se realizaron 561 (71%) CIO. La incidencia de coledocolitiasis fue de 43% en el grupo de las abiertas versus el 8% en las laparoscópicas, considerando sólo las 624 colecistectomías en que se efectuó CIO. Se consideran y analizan como factores predictivos de coledocolitiasis: ictericia presente o como antecedente, vía biliar ecotomográfica mayor de 7 mm, fosfatasas mayor de 190 UL, bilirrubinemia total mayor de 1,5 mg%. En el grupo de pacientes sin factores de riesgo, la coledocolitiasis estuvo presente en el 6,6% y con cuatro factores presentes en el 85,7%. El hallazgo ecotomográfico de coledocolitiasis se correlacionó sólo con un 79% real. Este porcentaje asciende al 100% cuando se asocia a ictericia. Hubo dos secciones completas de la vía biliar, una después de realizarse la CIO. No hubo mortalidad operatoria. PALABRAS CLAVES: Colangiografía intraoperatoria, coledocolitiasis SUMMARY Between September 1998 and June 2000, 786 cholecystectomies were performed. Of them, 75 (9.5%) were done by the open approach and 711 (90.5%) were performed by laparoscopy. Intraoperative transcystic cholangiography (IOC) was considered the gold standard for the diagnosis of choledocholithiasis. Of the total total, IOC was performed in 624 (79.4%); 74 cases of choledocholithiasis (11.9%) were found. IOC was done in 63 of 75 open cholecystectomies (84%) and 561 of 711 (71%) laparoscopic cholecys-tectomies. The incidence of choledocholithiasis was 43% in open cholecystectomies versus 8% in laparoscopic cholecystectomies, considering only the 624 cholecystectomies in which IOC was done. The following are considered as predictive factors of choledocholithiasis: history of jaundice or jaundice at the time of physical exam, bile duct measuring over 7 mm in diameter by ultrasonographic exam, serum alkaline phosphatase above 190 UL and total serum bilirrubin above 1.5 mg/%. In the group of patients without risk factors, choledocholithiasis was found in 6.6% of them, whereas in patients with 4 risk factors the incidence was 85.7%. The ultrasonographic finding of choledocholithiasis was confirmed only in 79% of the cases. The percentage rises to 100% when jaundice is present. There were 2 cases of complete section of the biliary tract, one of them after IOC had been done. There was no operative mortality.