Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan.
Department of Diagnostic Pathology, Oita University Faculty of Medicine, Oita, Japan.
J Hepatobiliary Pancreat Sci. 2024 Sep;31(9):637-646. doi: 10.1002/jhbp.12044. Epub 2024 Jul 17.
Although findings from drip infusion cholangiography with computed tomography (DIC-CT) are useful in preoperative anatomic evaluation for laparoscopic cholecystectomy (LC), their relationship with intraoperative surgical difficulty based on the difficulty score (DS) proposed by Tokyo Guidelines 2018 is unclear. We examined this relationship.
Data were collected from 202 patients who underwent LC for benign gallbladder (GB) disease with preoperative DIC-CT in our department. DIC-CT findings were classified into GB-positive and GB-negative groups based on GB opacification, and clinical characteristics were compared. DS assessed only on findings from around Calot's triangle was considered "cDS", and patients were divided into cDS ≤2 and ≥3 groups. Preoperative data including DIC-CT findings were evaluated using multivariate analysis.
DIC-CT findings showed 151 (74.8%) GB-positive and 51 (25.2%) GB-negative patients. Surgical outcomes were significantly better in the GB-positive versus GB-negative group for operation time (107 vs. 154 min, p < .001), blood loss (8 vs. 25 mL, p < .001), cDS (0.8 vs. 2.2, p < .001), and critical view of safety score (4.0 vs. 3.1, p < .001). cDS was ≤2 in 174 (86.1%) and ≥3 in 28 (13.9%) patients. By multivariate analysis, DIC-CT findings and alkaline phosphatase values were independent factors predicting intraoperative difficulty.
DIC-CT findings are useful for predicting cDS in LC.
虽然计算机断层扫描下滴注胆管造影（DIC-CT）的结果有助于腹腔镜胆囊切除术（LC）的术前解剖评估，但它们与 2018 年东京指南提出的手术难度评分（DS）之间的关系尚不清楚。我们对此进行了研究。
我们收集了我院 202 例行 LC 治疗良性胆囊（GB）疾病患者的术前 DIC-CT 资料。根据 GB 显影情况，将 DIC-CT 结果分为 GB 阳性和 GB 阴性组，比较临床特征。仅基于 Calot 三角周围发现评估的 DS 被认为是“cDS”，并将患者分为 cDS≤2 和≥3 组。使用多变量分析评估包括 DIC-CT 结果在内的术前数据。
DIC-CT 结果显示 151 例（74.8%）GB 阳性和 51 例（25.2%）GB 阴性患者。GB 阳性组的手术时间（107 分钟 vs. 154 分钟，p<0.001）、出血量（8 毫升 vs. 25 毫升，p<0.001）、cDS（0.8 分 vs. 2.2 分，p<0.001）和安全视野评分（4.0 分 vs. 3.1 分，p<0.001）均显著优于 GB 阴性组。cDS≤2 者 174 例（86.1%），≥3 者 28 例（13.9%）。多变量分析显示，DIC-CT 结果和碱性磷酸酶值是预测术中困难的独立因素。
DIC-CT 结果有助于预测 LC 中的 cDS。
