Omiya Kojiro, Hiramatsu Kazuhiro, Shibata Yoshihisa, Fukaya Masahide, Fujii Masahiro, Aoba Taro, Arimoto Atsuki, Yamaguchi Takayuki, Kato Takehito
Department of General Surgery, Toyohashi Municipal Hospital, 50 Hakken-Nishi, Aotake-Cho, Toyohashi City, Aichi Prefecture 440-8570, Japan.
Diagnostics (Basel). 2021 Feb 24;11(3):383. doi: 10.3390/diagnostics11030383.
Previous studies have shown that signal intensity variations in the gallbladder wall on magnetic resonance imaging (MRI) are associated with necrosis and fibrosis in the gallbladder of acute cholecystitis (AC). However, the association between MRI findings and operative outcomes remains unclear. We retrospectively identified 321 patients who underwent preoperative magnetic resonance cholangiopancreatography (MRCP) and early laparoscopic cholecystectomy (LC) for AC. Based on the gallbladder wall signal intensity on MRI, these patients were divided into high signal intensity (HSI), intermediate signal intensity (ISI), and low signal intensity (LSI) groups. Comparisons of bailout procedure rates (open conversion and laparoscopic subtotal cholecystectomy) and operating times were performed. The recorded bailout procedure rates were 6.8% (7/103 cases), 26.7% (31/116 cases), and 40.2% (41/102 cases), and the median operating times were 95, 110, and 138 minutes in the HSI, ISI, and LSI groups, respectively (both < 0.001). During the multivariate analysis, the LSI of the gallbladder wall was an independent predictor of both the bailout procedure (odds ratio [OR] 5.30; 95% CI 2.11-13.30; < 0.001) and prolonged surgery (≥144 min) (OR 6.10, 95% CI 2.74-13.60, < 0.001). Preoperative MRCP/MRI assessment could be a novel method for predicting surgical difficulty during LC for AC.
先前的研究表明，磁共振成像（MRI）上胆囊壁的信号强度变化与急性胆囊炎（AC）患者胆囊的坏死和纤维化相关。然而，MRI表现与手术结果之间的关联仍不明确。我们回顾性纳入了321例行术前磁共振胰胆管造影（MRCP）及早期腹腔镜胆囊切除术（LC）治疗AC的患者。根据MRI上胆囊壁的信号强度，将这些患者分为高信号强度（HSI）组、中等信号强度（ISI）组和低信号强度（LSI）组。比较了补救手术率（中转开腹和腹腔镜胆囊次全切除术）及手术时间。记录的补救手术率分别为6.8%（7/103例）、26.7%（31/116例）和40.2%（41/102例），HSI组、ISI组和LSI组的中位手术时间分别为95、110和138分钟（均P<0.001）。多因素分析显示，胆囊壁LSI是补救手术（比值比[OR]5.30；95%CI 2.11-13.30；P<0.001）及手术时间延长（≥144分钟）（OR 6.10，95%CI 2.74-13.60，P<0.001）的独立预测因素。术前MRCP/MRI评估可能是预测AC患者LC手术难度的一种新方法。
