Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Surgery, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA.
J Laparoendosc Adv Surg Tech A. 2022 Jul;32(7):794-799. doi: 10.1089/lap.2021.0349. Epub 2022 Apr 11.
Biliary dyskinesia is typically defined as a gallbladder ejection fraction (EF) <35% on hepatobiliary iminodiacetic acid scan with cholecystokinin stimulation (CCK-HIDA) testing. Cholecystectomy often leads to resolution of associated biliary colic symptoms. Alternatively, there is a subset of symptomatic patients with normal gallbladder EF on CCK-HIDA. It has been proposed that pain with CCK injection is more predictive of symptom resolution after cholecystectomy than low gallbladder EF. We reviewed our experience with pediatric patients with positive CCK provocation testing and a normal gallbladder EF in the absence of gallstones. We retrospectively reviewed the records of all pediatric patients with normal hepatobiliary iminodiacetic acid EFs (35%-80%) and pain with CCK injection at a tertiary care center between 2016 and 2020. Age, gender, body mass index (BMI), CCK-HIDA results, and pathology analysis were noted. Short- and long-term resolution of symptoms was determined by patient self-reporting at a mean of 3 weeks and 46 months, respectively. Seventeen patients met inclusion criteria. Average age was 15.1 years (range, 12-17 years) with median BMI 24.9 (± 4.9 kg/m). Mean CCK-HIDA EF was 56.3% (± 11.4%). In total, 62.5% of patients had evidence of chronic cholecystitis and/or cholesterolosis on pathology analysis. Of patients available for short-term and long-term postoperative follow-up, 80% and 83% reported complete or near complete resolution of symptoms, respectively. Normokinetic biliary dyskinesia is poorly understood but appears to be associated with chronic inflammation and cured by surgical intervention. Laparoscopic cholecystectomy results in resolution of symptoms for a majority of patients and should be considered in those with pain with CCK injection despite normal imaging studies. Clinical Trial Registration Number: 1657640-2.
胆功能不良通常定义为在胆囊收缩素刺激（CCK-HIDA）试验时肝胆碘代氨基酸扫描的胆囊排空分数（EF）<35%。胆囊切除术通常可消除相关的胆绞痛症状。或者，在 CCK-HIDA 上有正常胆囊 EF 的症状患者亚组。有人提出，CCK 注射后疼痛比低胆囊 EF 更能预测胆囊切除术后症状的缓解。我们回顾了在没有胆结石的情况下，进行 CCK 激发试验且胆囊 EF 正常的小儿患者的经验。我们回顾性分析了 2016 年至 2020 年期间在一家三级护理中心进行正常肝胆碘代氨基酸 EF（35%-80%）和 CCK 注射疼痛的所有小儿患者的记录。记录了年龄、性别、体重指数（BMI）、CCK-HIDA 结果和病理学分析。通过患者在平均 3 周和 46 个月时的自我报告确定症状的短期和长期缓解情况。17 名患者符合纳入标准。平均年龄为 15.1 岁（范围，12-17 岁），中位 BMI 为 24.9（±4.9kg/m）。平均 CCK-HIDA EF 为 56.3%（±11.4%）。在所有患者中，有 62.5%的患者在病理学分析中存在慢性胆囊炎和/或胆固醇沉着症的证据。在可进行短期和长期术后随访的患者中，80%和 83%的患者分别报告症状完全或几乎完全缓解。运动功能正常的胆功能不良尚不清楚，但似乎与慢性炎症有关，并通过手术干预治愈。腹腔镜胆囊切除术可使大多数患者的症状得到缓解，对于尽管影像学检查正常但有 CCK 注射后疼痛的患者，应考虑手术。临床试验注册号：1657640-2。
