Department of Surgery and Center for Digestive & Metabolic Surgery, Orlando Health, 77 West Underwood Street, Orlando, FL 32806, USA.
Surg Endosc. 2012 Nov;26(11):3088-93. doi: 10.1007/s00464-012-2342-0. Epub 2012 May 31.
Biliary dyskinesia diagnosed with CCK-HIDA scan and ejection fraction less than 35 % has been successfully treated by laparoscopic cholecystectomy. However, a population of patients with symptomatic biliary pain and a normal CCK-HIDA scan never receive a diagnosis, and thus no definitive treatment. Some of these patients report a reproducible pain during their CCK-HIDA scan. It is hypothesized that these patients have a novel diagnosis, normokinetic biliary dyskinesia, and may have resolution of pain when treated with cholecystectomy.
A retrospective chart review was completed looking for patients with biliary pain in accordance with the ROME III criteria. Additional inclusion criteria were (1) greater than age 18 years, (2) reproducible biliary symptoms during the CCK-HIDA scan, and (3) an ejection fraction greater than 35 %. Treatment modality was laparoscopic cholecystectomy. Descriptive statistics were preformed, and data were reported as mean ± standard deviation and range.
Nineteen patients met the inclusion criteria for this study from August 2008 to July 2011. There were 15 women and 4 men with a mean age of 48.4 ± 13.0 years. The mean ejection fraction was 75.1 ± 19.4 %. The average duration of preoperative symptoms was 6.8 ± 5.9 months and postoperative follow-up was 21.8 ± 10.6 months. Seventeen patients had complete resolution of symptoms, one had partial resolution, and one had no change. There was a complete resolution rate of 89.5 % and an improvement rate of 94.7 %.
We suggest that patients who present with biliary pain, a normal CCK-HIDA scan with an ejection fraction greater than 35 %, and with reproducible symptoms on infusion of CCK could have a novel diagnosis: normokinetic biliary dyskinesia. Currently, these patients are excluded from the diagnosis of biliary dyskinesia and thus treatment. We hypothesize a potential new diagnosis, suggest cholecystectomy as treatment, and recommend a prospective study design for further evaluation.
通过 CCK-HIDA 扫描和射血分数低于 35%诊断出的胆汁运动障碍已成功通过腹腔镜胆囊切除术治疗。然而，有一部分有症状性胆绞痛且 CCK-HIDA 扫描正常的患者从未得到诊断，因此也没有得到明确的治疗。这些患者中的一些人在 CCK-HIDA 扫描期间报告有可重现的疼痛。据推测，这些患者有一种新的诊断，即正常动力性胆汁运动障碍，通过胆囊切除术治疗可能会缓解疼痛。
我们进行了一项回顾性图表审查，以寻找符合罗马 III 标准的胆绞痛患者。其他纳入标准为：（1）年龄大于 18 岁，（2）CCK-HIDA 扫描期间有可重现的胆绞痛症状，（3）射血分数大于 35%。治疗方式为腹腔镜胆囊切除术。我们进行了描述性统计分析，数据以平均值±标准差和范围表示。
2008 年 8 月至 2011 年 7 月期间，共有 19 例患者符合本研究的纳入标准。其中 15 例为女性，4 例为男性，平均年龄为 48.4±13.0 岁。平均射血分数为 75.1±19.4%。术前症状平均持续时间为 6.8±5.9 个月，术后随访时间为 21.8±10.6 个月。17 例患者症状完全缓解，1 例部分缓解，1 例无变化。完全缓解率为 89.5%，总有效率为 94.7%。
我们建议，有胆绞痛、CCK-HIDA 扫描正常且射血分数大于 35%，且 CCK 输注时有可重现症状的患者可能有一个新的诊断：正常动力性胆汁运动障碍。目前，这些患者被排除在胆汁运动障碍的诊断和治疗之外。我们推测一个潜在的新诊断，建议胆囊切除术作为治疗方法，并建议进行前瞻性研究设计以进一步评估。
