Mattila Anne, Pynnönen Emilia, Sironen Antti, Elomaa Eeva, Mrena Johanna, Jalkanen Aapo, Nevalainen Mika, Helminen Olli
Dept. of Surgery, Hospital Nova of Central Finland, Hoitajantie 3, 40620, Jyväskylä, Finland.
Dept. of Radiology, Hospital Nova of Central Finland, Jyväskylä, Finland.
Updates Surg. 2023 Apr;75(3):563-570. doi: 10.1007/s13304-022-01390-7. Epub 2022 Oct 7.
Choledocholithiasis is more common in acute cholecystitis than in elective situations. Preoperative diagnosis of choledocholithiasis is essential to facilitate adequate planning of CBD (common bile duct) stone removal, preferably performed as a single-stage procedure. The purpose of this study was to test the feasibility of routine preoperative magnetic resonance cholangiopancreatography (MRCP) in acute cholecystitis followed by consequent cholecystectomy. A total of 180 consecutive patients operated for acute cholecystitis between January 2019 and December 2019 were prospectively enrolled. Preoperative routine MRCP was performed for bile duct evaluation when feasible. The control cohort consisted of 180 consecutive patients undergoing emergency laparoscopic cholecystectomy before the study period. Intraoperative cholangiography was used routinely in both groups when technically achievable. We examined the proportion of patients recruited in preoperative MRCP, possible time delay to MRCP and surgery, and the incidence of CBD stones compared to the control cohort. Routine MRCP in acute cholecystitis was achieved in 114/180 (63%) patients compared to 42/180 (23.3%) patients of the control group. The triage time from emergency to MRCP and the operating theatre was similar in both cohorts. The percentage of patients diagnosed with choledocholithiasis in the study group was notably higher (almost 18% vs 11%), p < 0.05. After a median follow-up time of 2.5 years in the study group and almost 4 years in the control group, recurrent choledocholithiasis was not detected in either group. Routine MRCP in patients with acute cholecystitis can be implemented with a fair execution rate in a population-based setting with minor effects on hospital stay and delays but higher detection of choledocholithiasis. We observed no additional benefit compared to the selective use of MRCP. However, routine preoperative MRCP allows an advantage when considering the appropriate exploration method if choledocholithiasis is detected.
胆总管结石在急性胆囊炎中比在择期手术情况下更为常见。术前诊断胆总管结石对于合理规划胆总管（CBD）结石的清除至关重要，最好作为一期手术进行。本研究的目的是测试在急性胆囊炎患者随后行胆囊切除术时，术前常规磁共振胰胆管造影（MRCP）的可行性。前瞻性纳入了2019年1月至2019年12月期间连续180例因急性胆囊炎接受手术的患者。在可行的情况下，术前进行常规MRCP以评估胆管。对照组由研究期间之前连续180例接受急诊腹腔镜胆囊切除术的患者组成。两组在技术可行时均常规使用术中胆管造影。我们检查了术前接受MRCP的患者比例、MRCP和手术可能的时间延迟以及与对照组相比胆总管结石的发生率。与对照组的42/180（23.3%）患者相比，114/180（63%）例急性胆囊炎患者成功进行了常规MRCP。两组从急诊到MRCP和手术室的分诊时间相似。研究组中诊断为胆总管结石的患者百分比明显更高（近18%对11%），p<0.05。研究组中位随访时间为2.5年，对照组近4年，两组均未检测到复发性胆总管结石。在基于人群的环境中，急性胆囊炎患者的常规MRCP可以以相当高的执行率实施，对住院时间和延迟影响较小，但胆总管结石的检出率更高。与选择性使用MRCP相比，我们未观察到额外的益处。然而，如果检测到胆总管结石，术前常规MRCP在考虑适当的探查方法时具有优势。
