Edwards Michael A, Mullenbach Benjamin, Chamberlain Sherman M
General and Minimally Invasive Surgery Division, Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA.
Dig Dis Sci. 2014 Nov;59(11):2773-8. doi: 10.1007/s10620-014-3213-4. Epub 2014 May 23.
Chronic acalculous gallbladder disease (CAGD) falls within the spectrum of diseases associated with gallbladder dysmotility. Cholecystokinin-cholescintigraphy (CCK-CS) has been used to evaluate for CAGD, with a gallbladder ejection fraction (GBEF) of <35 % being indicative of gallbladder dysfunction. The reproduction of biliary colic upon administration of CCK has been cited as indicative of CAGD. Our purpose was to determine whether low GBEF or reproduction of pain during CCK-CS was predictor of surgical outcomes related to resolution of symptoms or as a correlate to gallbladder pathology.
A retrospective review of patients was performed to evaluate adults with a diagnosis of CAGD who underwent CCK-CS prior to surgical intervention. CPT and ICD-9 coding queries were used to identify the patient population. Patients with cholelithiasis were excluded.
Sixty-four patients met inclusion criteria. Two patients were lost to follow-up and were excluded. During CCK-CS, 41 patients (66 %) reported symptoms similar to their presenting complaint. Twenty-one patients reported no symptoms with CCK-CS. There was no significant relationship between gallbladder pathology and either GBEF or reproduction of symptoms with CCK-CS (p = 0.14). About 81 % of patients (n = 50) had relief of symptoms following cholecystectomy. Sixty-six percentage of patients (n = 33) with long-term symptom relief after cholecystectomy had reproduction of symptoms with CCK-CS. Nineteen percentage of all patients (n = 12) had long-term symptom recurrence despite surgery. Eight of these patients (66 %) had symptom reproduction with CCK-CS. There was no significant correlation with either the GBEF or symptoms reproduction with CCK-CS as a predictor of postoperative outcome (p = 0.12).
Provocation of pain by CCK-CS and low GBEF are unreliable predictors of postoperative relief of symptoms following cholecystectomy for biliary dyskinesia or chronic acalculous gallbladder disease.
慢性非结石性胆囊炎（CAGD）属于与胆囊运动障碍相关的疾病范畴。胆囊收缩素胆囊闪烁显像（CCK-CS）已被用于评估CAGD，胆囊射血分数（GBEF）<35%表明胆囊功能障碍。注射CCK后再现胆绞痛被认为是CAGD的指征。我们的目的是确定CCK-CS期间低GBEF或疼痛再现是否是与症状缓解相关的手术结果的预测指标，或是否与胆囊病理相关。
对患者进行回顾性研究，以评估在手术干预前接受CCK-CS的诊断为CAGD的成年人。使用CPT和ICD-9编码查询来确定患者群体。排除有胆结石的患者。
64例患者符合纳入标准。2例患者失访并被排除。在CCK-CS期间，41例患者（66%）报告了与其就诊主诉相似的症状。21例患者在CCK-CS期间未报告症状。胆囊病理与GBEF或CCK-CS症状再现之间无显著关系（p = 0.14）。约81%的患者（n = 50）在胆囊切除术后症状缓解。胆囊切除术后长期症状缓解的患者中有66%（n = 33）在CCK-CS时出现症状再现。所有患者中有19%（n = 12）尽管接受了手术仍有长期症状复发。其中8例患者（66%）在CCK-CS时出现症状再现。CCK-CS的GBEF或症状再现与术后结果的预测指标之间无显著相关性（p = 0.12）。
CCK-CS诱发疼痛和低GBEF是胆囊运动障碍或慢性非结石性胆囊炎胆囊切除术后症状缓解的不可靠预测指标。
