Mahida Justin B, Sulkowski Jason P, Cooper Jennifer N, King Austin P, Deans Katherine J, King Denis R, Minneci Peter C
Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio.
Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
J Surg Res. 2015 Oct;198(2):393-9. doi: 10.1016/j.jss.2015.03.056. Epub 2015 Mar 25.
Rates of cholecystectomy for biliary dyskinesia are rising. Our objective was to identify clinical determinants of symptom improvement in children undergoing cholecystectomy for biliary dyskinesia.
This retrospective cohort study included patients undergoing cholecystectomy for biliary dyskinesia from 2006-2013 who had their gallbladder ejection fraction (EF) measured by either cholecystokinin-stimulated hepatobiliary iminodiacetic acid scan and/or fatty meal ultrasound. Patients presenting from 2010-2013 were interviewed >1 y after cholecystectomy to determine symptom improvement, complete symptom resolution, and any postoperative clinical interventions related to biliary dyskinesia. Sensitivity and positive predictive values for the diagnostic tests for symptom improvement were calculated. Multivariable logistic regression models were used to identify preoperative characteristics associated with symptom improvement.
Of the 153 included patients, 76% were female, 89% were Caucasian, and 39% were obese. At postoperative evaluation, symptom improvement was reported by 82% of the patients and complete symptom resolution in 56%. For both the hepatobiliary iminodiacetic acid and fatty meal ultrasound, the sensitivity of the test to predict symptom improvement increased with higher EF, whereas the positive predictive values remained around 80%. Of the 41 patients who participated in phone interview for long-term follow-up, 85% reported symptom improvement and 44% reported complete symptom resolution. Factors associated with symptom improvement included a shorter duration of pain, a history of vomiting, and a history of epigastric pain.
Despite not identifying an EF level that predicted symptom improvement, over 80% of patients undergoing cholecystectomy for biliary dyskinesia reported symptom improvement. These results support continuing to offer cholecystectomy to treat biliary dyskinesia in children.
因胆囊运动障碍而行胆囊切除术的比率正在上升。我们的目标是确定因胆囊运动障碍接受胆囊切除术的儿童症状改善的临床决定因素。
这项回顾性队列研究纳入了2006年至2013年因胆囊运动障碍接受胆囊切除术且通过胆囊收缩素刺激的肝胆亚氨基二乙酸扫描和/或脂肪餐超声测量胆囊射血分数（EF）的患者。对2010年至2013年就诊的患者在胆囊切除术后1年以上进行访谈，以确定症状改善情况、症状完全缓解情况以及与胆囊运动障碍相关的任何术后临床干预措施。计算症状改善诊断试验的敏感性和阳性预测值。使用多变量逻辑回归模型确定与症状改善相关的术前特征。
在纳入的153例患者中，76%为女性，89%为白种人，39%为肥胖患者。术后评估时，82%的患者报告症状改善，56%的患者症状完全缓解。对于肝胆亚氨基二乙酸扫描和脂肪餐超声检查，预测症状改善的试验敏感性随着EF升高而增加，而阳性预测值保持在80%左右。在41例参与长期随访电话访谈的患者中，85%报告症状改善，44%报告症状完全缓解。与症状改善相关的因素包括疼痛持续时间较短、有呕吐史和上腹痛史。
尽管未确定能预测症状改善的EF水平，但超过80%因胆囊运动障碍接受胆囊切除术的患者报告症状改善。这些结果支持继续为儿童提供胆囊切除术以治疗胆囊运动障碍。
