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胆囊黏液囊肿:219只犬(2007 - 2016年)与预后相关的变量及超声检查对识别胆囊破裂的效用

Gallbladder Mucocele: Variables Associated with Outcome and the Utility of Ultrasonography to Identify Gallbladder Rupture in 219 Dogs (2007-2016).

作者信息

Jaffey J A, Graham A, VanEerde E, Hostnik E, Alvarez W, Arango J, Jacobs C, DeClue A E

机构信息

Department of Veterinary Medicine and Surgery, Veterinary Health Center, University of Missouri, Columbia, MO.

Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA.

出版信息

J Vet Intern Med. 2018 Jan;32(1):195-200. doi: 10.1111/jvim.14898. Epub 2017 Dec 4.

Abstract

BACKGROUND

Gallbladder mucocele (GBM) is an increasingly recognized extrahepatic biliary disease in dogs.

OBJECTIVES

To investigate cases of GBM and identify variables associated with survival and the sensitivity and specificity of ultrasonography to identify gallbladder rupture.

ANIMALS

Two hundred and nineteen client-owned dogs with GBM.

METHODS

Multicenter, retrospective study of dogs with GBM, presented from January 2007 to November 2016 to 6 academic veterinary hospitals in the United States. Interrogation of hospital databases identified all cases with the inclusion criteria of a gross and histopathologic diagnosis of GBM after cholecystectomy and intraoperative bacteriologic cultures of at least 1 of the following: gallbladder wall, gallbladder contents, or abdominal effusion.

RESULTS

Two hundred and nineteen dogs fulfilled the inclusion criteria. Dogs with GBM and gallbladder rupture with bile peritonitis at the time of surgery were 2.7 times more likely to die than dogs without gallbladder rupture and bile peritonitis (P = 0.001; 95% confidence interval [CI], 1.50-4.68; n = 41). No significant associations were identified between survival and positive bacteriologic cultures, antibiotic administration, or time (days) from ultrasonographic identification of GBM to the time of surgery. The sensitivity, specificity, positive, and negative likelihood ratios for ultrasonographic identification of gallbladder rupture were 56.1% (95% CI, 39.9-71.2), 91.7% (95% CI, 85.3-95.6), 6.74, and 0.44, respectively.

CONCLUSION AND CLINICAL IMPORTANCE

Dogs in our study with GBM and intraoperative evidence of gallbladder rupture and bile peritonitis had a significantly higher risk of death. Additionally, abdominal ultrasonography had low sensitivity for identification of gallbladder rupture.

摘要

背景

胆囊黏液囊肿(GBM)是一种在犬类中越来越被认识到的肝外胆道疾病。

目的

调查GBM病例,并确定与生存相关的变量以及超声检查识别胆囊破裂的敏感性和特异性。

动物

219只客户拥有的患有GBM的犬。

方法

对2007年1月至2016年11月间在美国6家学术兽医医院就诊的患有GBM的犬进行多中心回顾性研究。通过查询医院数据库,确定所有符合纳入标准的病例,纳入标准为胆囊切除术后GBM的大体和组织病理学诊断,以及以下至少一项的术中细菌培养:胆囊壁、胆囊内容物或腹腔积液。

结果

219只犬符合纳入标准。手术时伴有胆囊破裂和胆汁性腹膜炎的GBM犬死亡的可能性是没有胆囊破裂和胆汁性腹膜炎的犬的2.7倍(P = 0.001;95%置信区间[CI],1.50 - 4.68;n = 41)。在生存与细菌培养阳性、抗生素使用或从超声检查确诊GBM到手术的时间(天数)之间未发现显著关联。超声检查识别胆囊破裂的敏感性、特异性、阳性似然比和阴性似然比分别为56.1%(95%CI,39.9 - 71.2)、91.7%(95%CI,85.3 - 95.6)、6.74和0.44。

结论及临床意义

在我们的研究中,患有GBM且术中存在胆囊破裂和胆汁性腹膜炎证据的犬死亡风险显著更高。此外,腹部超声检查识别胆囊破裂的敏感性较低。

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