Hadigan Colleen, Fishman Steven J, Connolly Leonard P, Treves S Ted, Nurko Samuel
Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Pediatr Gastroenterol Nutr. 2003 Aug;37(2):178-82. doi: 10.1097/00005176-200308000-00017.
Chronic acalculous cholecystitis previously has been diagnosed by hepatobiliary scan stimulated with intravenous octapeptide of cholecystokinin. This compound may soon be unavailable in the United States. The goal of this study was to describe the characteristics of children with chronic acalculous cholecystitis diagnosed by hepatobiliary scintigraphy with oral Lipomul challenge, and to evaluate their clinical response to cholecystectomy.
Retrospective chart review of patients with no gall stones detected by abdominal ultrasound or computed tomography with gallbladder ejection fraction (GBEF) <35% after Lipomul challenge who subsequently underwent cholecystectomy. Fifteen patients with a mean age of 14.9 +/- 0.9 years were included. The mean duration of symptoms before evaluation was 8.2 +/- 2.5 months.
The mean GBEF after Lipomul challenge was 16.7% +/- 2.7%. All patients had abdominal pain. Ninety percent had right upper quadrant pain and 86% had typical biliary colic. Pain was precipitated by fatty meals in 73.3%. Histopathologic analysis of the gallbladder demonstrated chronic cholecystitis in 80% of cases. The mean postoperative follow-up was 20 +/- 5 months. Six months after the surgery, nine patients (60%) were asymptomatic, five (33%) had marked improvement of symptoms, and one (6%) was unchanged. At the time of latest follow-up, symptoms had reappeared in two patients who had been asymptomatic at the 6-month visit (13%). Seven patients (46%) remained asymptomatic, five (33%) had marked improvement but continued to have some persistent symptoms, and one (6%) was unchanged.
Chronic acalculous cholecystitis may be responsible for right upper quadrant pain in children without gallstones. A GBEF <35% at 30 minutes after Lipomul challenge may be useful in identifying patients who could benefit from cholecystectomy. Lipomul may be a good alternative to cholecystokinin for gallbladder stimulation during scintigraphy.
慢性非结石性胆囊炎以往通过静脉注射胆囊收缩素八肽激发的肝胆扫描来诊断。该化合物在美国可能很快无法获取。本研究的目的是描述经口服Lipomul激发的肝胆闪烁显像诊断为慢性非结石性胆囊炎的儿童的特征，并评估他们对胆囊切除术的临床反应。
对腹部超声或计算机断层扫描未发现胆结石且在Lipomul激发后胆囊排空分数（GBEF）<35%随后接受胆囊切除术的患者进行回顾性病历审查。纳入15例平均年龄为14.9±0.9岁的患者。评估前症状的平均持续时间为8.2±2.5个月。
Lipomul激发后的平均GBEF为16.7%±2.7%。所有患者均有腹痛。90%有右上腹疼痛，86%有典型胆绞痛。73.3%的患者疼痛由油腻食物诱发。胆囊组织病理学分析显示80%的病例为慢性胆囊炎。术后平均随访时间为20±5个月。手术后6个月，9例患者（60%）无症状，5例（33%）症状明显改善，1例（6%）无变化。在最近一次随访时，2例在6个月时无症状的患者（13%）症状复发。7例患者（46%）仍无症状，5例（33%）有明显改善但仍有一些持续症状，1例（6%）无变化。
慢性非结石性胆囊炎可能是无胆结石儿童右上腹疼痛的原因。Lipomul激发后30分钟GBEF<35%可能有助于识别可从胆囊切除术中获益的患者。在闪烁显像期间，Lipomul可能是胆囊收缩素刺激胆囊的良好替代品。
