Department of Surgery, 1371Emory University, Atlanta, GA, USA.
Department of Radiology, 1371Emory University, Atlanta, GA, USA.
Am Surg. 2021 Jun;87(6):903-909. doi: 10.1177/0003134820966283. Epub 2020 Dec 7.
A hyperkinetic gallbladder is defined as a hepatobiliary iminodiacetic acid (HIDA) scan ejection fraction (EF) of >80%. This condition is poorly described, and there is no current consensus on optimal management. The intent of this study was to determine if cholecystectomy improves symptoms in patients with a hyperkinetic gallbladder when compared to those managed nonoperatively and if there were variables predictive of symptom improvement with or without cholecystectomy.
This retrospective study included patients from 3 academic hospitals in the Atlanta metro area between the years 2006 and 2018. All patients with an EF >80% were included. Following voluntary exclusion patients were contacted by phone. Each patient was administered a questionnaire regarding their surgical history, medical management, and current symptom profile via Otago score. Institutional Institutional Review Board approval was obtained.
4785 HIDA scans were performed, and 194 reported an EF >80% (incidence 15.7%). 96% of these scans were reported as normal by the radiologist. 68 patients were able to be contacted by phone and completed the questionnaire. 18 patients underwent cholecystectomy, and 89% reported that their symptoms attributed to gallbladder disease were no longer present. 50 patients did not undergo cholecystectomy, and alternate diagnoses, medication prescriptions, diet modification, emergency department visits, and Otago score were higher in this cohort.
Patients who undergo cholecystectomy for a diagnosis of hyperkinetic gallbladder, on average, report improvement in symptoms when compared to patients managed nonoperatively. This study supports the practice of reporting and managing hyperkinetic gallbladders as a pathologic entity.
高动力胆囊定义为肝胆碘代氨基酸（HIDA）扫描射血分数（EF）>80%。这种情况描述不佳，目前对于最佳治疗方法也没有共识。本研究旨在确定与非手术治疗相比，胆囊切除术是否能改善高动力胆囊患者的症状，以及是否存在可预测胆囊切除术或非手术治疗症状改善的变量。
这项回顾性研究包括 2006 年至 2018 年亚特兰大都会区 3 家学术医院的患者。所有 EF>80%的患者均被纳入研究。在自愿排除患者后，通过电话联系患者。每位患者均通过奥塔哥评分（Otago score）接受了一份关于手术史、药物治疗和当前症状特征的问卷。本研究获得了机构审查委员会的批准。
共进行了 4785 次 HIDA 扫描，其中 194 次报告 EF>80%（发生率为 15.7%）。这些扫描中有 96%被放射科医生报告为正常。68 名患者能够通过电话联系并完成问卷。18 名患者接受了胆囊切除术，89%的患者报告称与胆囊疾病相关的症状已不再存在。50 名患者未接受胆囊切除术，这组患者的替代诊断、药物处方、饮食改变、急诊就诊和奥塔哥评分更高。
与非手术治疗相比，接受胆囊切除术治疗高动力胆囊的患者平均报告症状改善。本研究支持将高动力胆囊作为一种病理性实体进行报告和管理的做法。
