Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, 4180076, Japan.
Division of Radiology, Fujinomiya City General Hospital, Shizuoka, Japan.
Emerg Radiol. 2022 Aug;29(4):723-728. doi: 10.1007/s10140-022-02055-z. Epub 2022 May 14.
Gangrenous cholecystitis (GC) is a severe type of acute cholecystitis that implies higher mortality and morbidity rates than uncomplicated cholecystitis. The characteristics of GC are various for each case. However, preoperative predictors of GC with extensive necrotic change have not been investigated well.
A total of 239 patients who were pathologically diagnosed with GC underwent laparoscopic cholecystectomy at our hospital between January 2013 and December 2021. Of these, 135 patients were included in this study and were subdivided into the extensive necrosis group (patients with necrotic change extending to the neck of the gallbladder, n = 18) and the control group (patients with necrotic change limited to the fundus or body, not extending to the neck, n = 117) according to each operation video. Patient characteristics and perioperative factors predicting extensive necrotic change were investigated.
Pericholecystic fat stranding (83.3 vs. 53.8%, p = 0.018) and absence of wall enhancement on preoperative CT images (50.0 vs. 24.7%, p = 0.026) were significantly associated with extensive necrosis. Seven of 18 patients in the extensive necrosis group showed necrotic changes beyond the infundibulum. The absence of wall enhancement on preoperative CT images (71.4 vs. 28.8%, p = 0.018) was significantly associated with necrotic changes beyond the infundibulum.
Pericholecystic fat stranding and absence of wall enhancement on preoperative enhanced CT are predictors of extensive necrotic change in patients with GC. In addition, the absence of wall enhancement also predicts the presence of necrotic changes beyond the infundibulum.
坏疽性胆囊炎（GC）是一种严重的急性胆囊炎，其死亡率和发病率高于单纯性胆囊炎。GC 的特征因个体病例而异。然而，术前预测广泛坏死性改变的 GC 尚未得到很好的研究。
本研究共纳入 239 例经病理诊断为 GC 的患者，均于 2013 年 1 月至 2021 年 12 月在我院行腹腔镜胆囊切除术。其中，135 例患者纳入本研究，并根据手术视频分为广泛坏死组（胆囊颈部有坏死性改变的患者，n=18）和对照组（胆囊底部或体部有坏死性改变，未延伸至颈部的患者，n=117）。调查了预测广泛坏死性改变的患者特征和围手术期因素。
胆囊周围脂肪条索征（83.3%比 53.8%，p=0.018）和术前 CT 图像上无壁强化（50.0%比 24.7%，p=0.026）与广泛坏死性改变显著相关。广泛坏死组 18 例患者中有 7 例显示胆囊颈部以外的坏死性改变。术前 CT 图像上无壁强化（71.4%比 28.8%，p=0.018）与胆囊颈部以外的坏死性改变显著相关。
胆囊周围脂肪条索征和术前增强 CT 上无壁强化是 GC 患者广泛坏死性改变的预测因素。此外，无壁强化也预示着胆囊颈部以外存在坏死性改变。
