Department of Radiology, University of Montréal and CRCHUM, Hôpital Saint-Luc, Montréal, Québec, Canada.
Department of Radiology, University of Montréal and CRCHUM, Hôpital Saint-Luc, Montréal, Québec, Canada.
Can Assoc Radiol J. 2014 Feb;65(1):29-34. doi: 10.1016/j.carj.2012.09.004. Epub 2013 Feb 27.
Retrospective assessment of impact of cholecystectomy, age, and sex on bile duct (BD) diameter.
We retrospectively reviewed abdominal contrast-enhanced multidetector computed tomography and laboratory reports of 290 consecutive patients (119 men; mean age, 55.9 years) who presented without cholestasis to the emergency department of our institution between June 2009 and August 2010. BD diameters were measured in 3 locations, by 2 independent observers, twice, at 1-month intervals. Reproducibility and agreement were evaluated by intraclass correlation coefficients and Bland-Altman analyses. The effects of cholecystectomy, age, and sex on BD diameter were analysed with linear mixed models.
BD diameter inter-reader reproducibility and agreement were excellent at the level of the right hepatic artery (intraclass correlation coefficient, 0.94). Sixty-one patients (21.0%) had a history of cholecystectomy. Among them, the 95th percentile of BD diameters at hepatic artery level was 7.9 mm (<50 years) and 12.3 mm (≥50 years). Among those without cholecystectomy, BD diameter was 6.2 mm (<50 years) and 7.7 mm (≥50 years). Cholecystectomy was associated with significantly larger BD diameters in both age groups (P < .001). Older age was associated with larger BD diameters (P = .004). Sex had no impact on BD diameter (P = .842).
Patients after cholecystectomy may present with an enlarged BD unrelated to cholestasis. The BD diameter increases with age. Clinicians should rely on cholecystectomy status, age, and laboratory results to determine needs of further investigation.
回顾性评估胆囊切除术、年龄和性别对胆管（BD）直径的影响。
我们回顾性分析了 2009 年 6 月至 2010 年 8 月期间，我院急诊科就诊的 290 例连续患者（119 例男性；平均年龄 55.9 岁）的腹部增强多排 CT 和实验室报告，这些患者均无胆汁淤积。BD 直径由 2 位独立观察者在 3 个位置测量，间隔 1 个月进行 2 次测量。通过组内相关系数和 Bland-Altman 分析评估可重复性和一致性。采用线性混合模型分析胆囊切除术、年龄和性别对 BD 直径的影响。
右肝动脉水平的 BD 直径观察者间可重复性和一致性极好（组内相关系数 0.94）。61 例（21.0%）有胆囊切除术病史。其中，肝动脉水平 BD 直径的第 95 百分位数为 7.9mm（<50 岁）和 12.3mm（≥50 岁）。无胆囊切除术病史者，BD 直径为 6.2mm（<50 岁）和 7.7mm（≥50 岁）。胆囊切除术与两组年龄患者的 BD 直径显著增大相关（P<0.001）。年龄较大与 BD 直径增大相关（P=0.004）。性别对 BD 直径无影响（P=0.842）。
胆囊切除术后患者可能出现与胆汁淤积无关的增大胆管。BD 直径随年龄增长而增加。临床医生应根据胆囊切除术病史、年龄和实验室结果来确定进一步检查的需求。
