Hubbard Grant B, Prusko Ryan M, Nerad Robert D, McNinch Neil, Asubeng-Poku Jeffrey, Hubert Claire M, Sievers Corey J, Gemma Rick A
Department of General Surgery, Western Reserve Hospital, Cuyahoga Falls, OH, USA.
McNinch Biostats, LLC, Kent, OH, USA.
Am Surg. 2025 Aug;91(8):1336-1340. doi: 10.1177/00031348251337143. Epub 2025 Apr 18.
BackgroundHyperkinetic and hypokinetic biliary dyskinesia commonly present with right upper quadrant pain, mimicking biliary colic or cholecystitis. Only gallbladder hypokinesia is a well-accepted indication for cholecystectomy. While there is less literature on the topic, patients with gallbladder hyperkinesia may also benefit from cholecystectomy.MethodsThis single-center cross-sectional study looked at patients 18 years or older, with EF >80% on HIDA scan who underwent cholecystectomy and at least one postoperative visit from January 1, 2018, to February 28, 2023. The primary outcome was symptomatic resolution or improvement.ResultsIn total, 67 patients were identified, with a median age of 46 years, 75% female sex, and a median 30-day follow-up period. All patients presented with abdominal pain, 64% presented with nausea and vomiting, and 31% presented with chronic diarrhea. Partial symptomatic improvement was noted in 94% of patients, while 85% had complete resolution. There was a statistically significant difference in gallbladder ejection fraction between 2 groups: 94% (IQR 90-98%) for those with complete symptom resolution vs 88% (IQR 83-97%) for those who did not have symptom resolution ( = 0.033). Chronic cholecystitis was demonstrated in 73% of specimens.ConclusionsThis data adds to a body of evidence supporting laparoscopic cholecystectomy for gallbladder hyperkinesia. The study further establishes a higher degree of gallbladder ejection fraction to have an association with complete symptomatic improvement after cholecystectomy. A patient's presenting symptoms do not appear to have an association with complete symptom resolution.
背景
运动亢进性和运动减退性胆道运动障碍通常表现为右上腹疼痛,类似于胆绞痛或胆囊炎。只有胆囊运动减退是胆囊切除术公认的指征。虽然关于这个主题的文献较少,但胆囊运动亢进的患者也可能从胆囊切除术中获益。
方法
这项单中心横断面研究观察了2018年1月1日至2023年2月28日期间接受胆囊切除术且术后至少有一次随访的18岁及以上、HIDA扫描显示EF>80%的患者。主要结局是症状缓解或改善。
结果
总共确定了67例患者,中位年龄为46岁,75%为女性,中位随访期为30天。所有患者均有腹痛,64%有恶心和呕吐,31%有慢性腹泻。94%的患者症状部分改善,85%的患者症状完全缓解。两组之间的胆囊射血分数有统计学显著差异:症状完全缓解者为94%(IQR 90 - 98%),未缓解者为88%(IQR 83 - 97%)(P = 0.033)。73%的标本显示为慢性胆囊炎。
结论
这些数据增加了支持对胆囊运动亢进进行腹腔镜胆囊切除术的证据。该研究进一步证实,较高程度的胆囊射血分数与胆囊切除术后症状完全改善相关。患者的症状表现似乎与症状完全缓解无关。